The respiration, which may be increased to 100 per minute, is super ficial and at times irregular. The severe dyspnoca and the great inspira tory retraction of the diaphragmatic attachment and of the sternal notch with contemporaneous hoarseness may at the first glance simulate stenosis of the larynx. These recessions are especially marked in an existing rachitis of the thorax. The dyspncea renders prolonged crying impossible, and also the holding of the breath which young infants usually do during auscultation. The nursling is frequently compelled to release the nipple. Very significant is the change in the ratio of respiration to that of the pulse, from the not:Dial 1:3-4 to 1:2.5 or even 1: 2. In bronchopneumonia expiration is moaning and cut short espe cially while crying, although not so marked as in croupous pneumonia. The cough is frequent and harassing, in bronchopneumonia often painful.
The cireolatory organs are seriously involved. The pulse is very frequent, in severe illness of younger infants as high as 200, although this alone is not necessarily serious. Of far greater importance than tbe frequency of the pulse is the degree of arterial distention. From stasis in the pulmonary: circulation the heart becomes over distended with blood, and, if of longer duration, dilated, which in whooping-cough may often be demonstrated clinically. Not uncommonly, fatty degeneration of the heart is found on section, rarely purulent pericarditis. Manifes tations of stasis in the circulation (cyanosis, (edema of eyelids, hands, and feet) occur much earlier and more frequently in bronchopneumonia than in croupous pneumonia. Cases of sudden death are met with at times which are, how:ever, less often clue to cardiac failure than to rapid suffocation.
Organs of the onset is more acute, vomiting often occurs. In nurslings, especially those who are rachitic. a trouble some meteorism is frequently present. During the first two years, diarrhom and intestinal catarrh are frequent accompaniments of broncho pneumonia and are often responsible for a fatal termination. Occasion ally, in protracted cases, enlargement of the liver and spleen occurs. The kidneys usually remain intact.
The temperature in acute bronchiolitis and bronchopneumonia is high in the beginning, and in favorable cases gradually returns to the normal. A gradual rise is frequently: observed in cases slowly develop ing from a simple bronchitis. As a general rule, the temperature is not as high in bronchiolitis as in bronchopneumonia, so that a temperature remaining at 39.5° C. (103° F.) for any length of time often indicates a
bronchopneumonia (Wyss). The temperature is, however, not typical in character. In bronchopneumonia it is mostly remittent, also inter mittent, and shows great variations and sudden remissions, frequently increasing from 40° to 40.5° C. (104° to 105° F.) (see Fig. 7S). In cases of fresh involvement high elevations of temperature often occur. Accord ing to Comby, the pseudolobar form produees a regular temperature like the disseminated form. In weak and emaciated infants, the fever may often be entirely absent in bronchiolitis, as well as ix: bronchopneu tnonia (cachectic form). The temperature in chronic eases is also no criterion regarding the gravity of the case, and especially in fatal eases often shows a decline towards the end.
Special Forms of the infrequently bronchiolitis rap idly terminates fatally in front 1-3 days, especially in young infants. There are cases of bronchiolitis with dangerous dyspmea which show accentuated or absence of vesicular breathing without any fine Hies. 011 section the large bronchi are found free, but, on the other hand, the finer bronchi are occluded with larger or smaller areas of atelectasis alongside (TIenoeh). In young infants, occasionally after an attack of coryza or false croup, there 0C11111.8 a sudden threatening bronehiolitis (mith few riles) which rapidly terminates favorably in two to four days. Ihmoch properly regards them to be of asthmatic origin. Perhaps, the acute bronchitis with congestion, described by Cadet de Gassicourt, also belongs to this class. Attacks of bronehiolitis in a circumscribed spot are occasionally found in chronic bronchitis and in pulmonary tuberculosis.
t+everal forms of bronchopneumonia are distinguished clinically: 1. A disseminated form in which small scattered areas are present without leading to extensive consolidation.
2. A psendolobar form in which confluence of smaller areas, or even from the beginning a large portion or even the entire lobe, is involved. The mucus rates may be entirely absent so that the physical signs may correspond with those of a croupous pneumonia.
3. A cachectic form—frequent in feeble, rachitic children, suffering from gastro-intestinal diseases and progressing without, or almost without any fever. The frequent occurrence of bronchopneumonia in children suffering from gastro-intestinal diseases is regarded by some as a specific infection of the part through blood and lymph channels. The proof of this connection has never been submitted (Fischl, Spiegelberg).