The period of childhood is directly subject to croupous pneumonia; more so than adult life. The formerly accepted view that younger children are not attacked by it is absolutely erroneous. Exceptionally, it has been observed congenitally (in pneumonia in the mother). Al though the disease rarely occurs before the third or sixth mouth of life, it becomes quite frequent during the second year, and reaches its maxi mum from the second to the fifth year. Boys are more frequently at tacked than girls, robust children just as well as debilitated ones.. Al though not very frequent, individual predisposition is undeniable, and may lead to three or four attacks in a child during the course of one or more years.
The pathological anatomy is exactly the same as in the adult and will, therefore, be but slightly- dwelt upon. The disease generally affects an entire lobe or at least the greater part of one. In the first stage (engorgement) and intense hypertemia of the lung tissue is present. The, alveolar epithelia are turbid and swollen, and a serous exudation begins to take place into the alveoli. In the second stage (red hepatization) the affected portion of the lung is large, bloodless, heavy, and tough (like liver). On section it is found to be dark red and coarsely granular. The prominent granules correspond to the contents of the alveoli and consist of a conglomeration of red and white blood corpuscles, detached alveolar epithelium, pneurnococei in enormous numbers, the ivhole agglutinated by a network of fibrin. In children the granules measure only 0.07-0.11 num in diameter (Darnaschino). In the bronchioles, fibrinous coaguluni is frequently found. In the third stage (gray hepa tization) the lung is still more expanded (costal impressions) and anminic from compression of the vessels. The red blood corpu.scles have disap peared and in their stead more and more wbite ones, rapidly undergoing fatty degeneration, appear. In the fourth stage (resolution) the lung becomes soft, more and more yellow, the exudate purulent in charac ter, and the granulation diminishes. The contents of the alveoli disap pear by absorption, less by expectoration, and again become filled with air. The pleura is almost always also involved in the shape of a fibrin ous, and later often a serous or purulent, plemitis.
General Clinical Picture.—In older children, from about the seventh or eighth year on, the beginning of a croupous pneumonia is, as in adults, sudden, with chill, and pain in the side. In younger children,
to whom the following description has particular reference, pneumonia sets in suddenly, though a chill seldom occurs; but in its stead, slight chilliness and pallor. Very frequently the disease commences with -vio lent V() ing, sometimes but more rarely, with convulsions, On careful inquiry, symptoms generally accepted prodromal are mentioned.
Lassitude. discomfort, and a slight cough, have preceded the onset for several days. If pneumonia occurs during an attack of grippe, it usually develops only after a febrile bronchitis of several days' duration. When ever the disease occurs secondarily in the course of measles and diph theria, the onset is often not very striking.
With the beginning of a pneumonia, the patients become very ill and request to be put to bed. high fever manifests itself by spark ling eyes, reddened cheeks. burning skin, and a tense and very frequent pulse. Respiration is accelerated, but is not, or only slightly, dyspnceic; expiration is often somewhat interrupted and moaning, from the very becinning, but not always extraordinarily so. Immediately after the beginning of the illness, older children complain of pain in the side. Those of from three to seven years of age mostly refer the pain to the upper abdominal region; still younger children do not manifest any kind of local pain, or cry when picked up. The cough is slight or absent in the beginning, there is no expectoration, and physical signs are absent in the lungs.
The symptoms of a pneumonia in young children during the first and second clay, therefore, are apt to lead the inexperienced one to think rather of some general febrile disease. In the meanwhile the tempera ture rises to 39° C. (102° F.) and 40.5° C. (105° F.) with restlessness, sleeplessness, thirst, and loss of appetite. In pneumonia involving the upper lobe, the first signs of consolidation (a tympanitic note, dulness, bronchophony and bronchial breathing) are found on careful examina tion in the region of a lobe, very often only in the fourth or fifth day or even later. These lead to a proper diagnosis.
Frequently also, only the appearance of a herpes labialis (see Fig. 82) on the third or fourth day induces an examination of the lungs. About this time, too, the external symptoms which point to a croupous pneumonia become more apparent. The respira tion is markedly accelerated, wi t h dyspncea and dilatation of the nostrils.