CHRONIC AND INTERSTITIAL PNELTMONIA Etiology and infrequently, the symptonis of consolidation in bronchopneumonia last for 3-6 months or even longer. This chronic pneumonia is seen particularly after measles, influenza, and whooping-cough; less frequently after croupous pneumonia (IIen och). In the latter event, atypical forms are probably mostly responsi ble, and not a pneurnococcus pneumonia. It consists of coagulation of the exudate in the alveoli, which are filled with cellular material that has undergone fatty degeneration, a thickening of the walls of the alveoli, and a cellular infiltration of the interstitial connective tissue. If absorp tion does not take place, the small celled infiltration becomes organized, and spreads, resulting in an inlerstitial pneumonia.
Otherwise, interstitial pneumonia, except a dragging pneumonia, gen erally develops secondarily, especially- in pleurisy with thickening, and also follows bronchitis. The same is true in connection with all kinds of affections of the lungs (tuberculosis, etc.),, and in stasis of the pulmonary circulation. Jacobi believes that acute and chronic interstitial pneu monia often occur primarily-, with relative frequency, and that it is not rare especially in children. The alveoli are filled with newly formed connective tissue, which later also extends into the inter-alveolar spaces and extensively, infiltrates thc respective portions of the lung, which subsequently become tough, grit on section, and present a bluish white appearance—induration. Later, it frequently- leads to considerable shrinkage of the affected part, to formation of bronclaieetasis, and to the isolation of bronchi; also to pleuritic thickening. Poor circumstances and unsanitary dwellings are favorable to the production of chronic and interstitial pneumonia. In croupous pneumonia free blood-letting (Llinnec) and rapid reduction of temperature (Marchand) are held responsi ble.
a pneumonia or some other of the above mentioned diseases there are signs of consolidation in a portion of a lung (dulness, diminished breathing, bronchial breathing, fine rales,
etc.). The scat is usually in one of the upper lobes, more frequently on the right side (Jacobi). There is usually fever in the beginning, often remittent, less frequently intermittent in character; later, the tempera ture is normal in favorable cases. Older children sometimes expectorate sputum streaked with blood. llyspmea, emaciation, tendency to perspiration, and sometimes diarrhcea, are present.
With the occurrence of contraction of the lung supra- and infra clavicular depressions, abnormally- loud cardial pulsations, accentuation of pulmonic second sound, bronchiectases, adhesions, ete., are found. Jacobi mentions the absence of cough as being characteristic.
Resolution and recovery are still possible even after a year's dura tion, as long as contraction has not taken place, and tuberculosis is not present. Even the frequent termination in pulmonary- contraction may be accompanied by a fair state of health, provided a small portion of the lung only is involved. Frequently, the subsequent phthisis, cachexia, or the results of the bronchiectasis, cause death.
The diagnosis often presents great difficulties, especially from pul monary tuberculosis (examination of the ;sputum); also from pleuritic thickening and empy-eina (conapare with diagnosis of these diseases).
The treatment should be directed towards strengthening the consti tution by ft nutritious diet and tonics (quinine). Woolen underwear and protection against colds are important. As remedies, the syrup of the iodide of iron and codliver oil arc to bc considered. Jacobi recommends arsenic and phosphorus. Later, a stay in the country, or at the sea shore, and in the South during the winter, is to be urged. Pulmonary gymnastics are often useful after the fever has subsided.