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Acute Phthisis

usually, child, time, lung, found and accompanied

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Acute phthisis, or " galloping consumption," is not uncommon in early life. The term is sometimes used to include cases of acute pulmonary tuberculosis. It is, however, more properly restricted to cases of rapid catarrhal pneumonia where, as a result of an acute inflammatory process, the air-cells become stuffed with epithelial elements which undergo rapid caseation, and the solidified tissue quickly breaks down into cavities. The consolidation is at first lobular and is generally diffused over the lungs. Softening takes place pretty equally in all parts at the same time, so that the lung becomes destroyed by sinuous and burrowing cavities separated by reddened and oedematous tissue ; much purulent matter is formed, and the lining membrane of the air-passages is excessively red. In this form miliary tubercle may occur as a complication, but its appearance is com-. paratively rare, for the disease is essentially pneumonic in its nature.

Acute phthisis generally occurs in a child who has been reduced in health by previous illness or bad hygienic conditions, and is sometimes seen to attack one already the subject of a chronic consolidation which had given rise to but few symptoms: The age of patients so affected is usually five or six years and upwards.

Symptoms.—The general features of the illness are those of an acute attack of pneumonia combined with very great severity of the general symptoms. At first the child usually complains of a pain in the side. This may come on quite suddenly during some slight muscular exercise. Thus, in a little girl under my care, the child first complained while she was helping her mother to make a bed. The pain may subside after a time, or be complained of occasionally all through the illness. Cough comes on at the same time with the pain, and the child is noticed to be very feverish at night. In older children the cough is usually accompanied by expectora tion. The sputum is at first whitish and aerated, but as the lungs begin to break down it becomes yellow or greenish and nummulated, and is found to contain large quantities of yellow elastic tissue. The number of

bacilli found in the sputum is not, however, always very great. In some cases under my care these organisms were found in much less quantities than in cases of phthisis which ran a more chronic course.

Dyspinna is always an early symptom ; the appetite is very poor, thirst is great, the tongue is furred, the bowels are relaxed or confined, and the child wastes with extreme rapidity. In some cases swelling of the abdomen is noticed, and the liver may be found to be enlarged from fatty infiltration.

The fever is often very high. It is not uncommon to find that the tem perature rises to 104° or 105° at night, sinking to 100° or 101° in the morning. It soon begins to be accompanied by copious sweats, and the night-clothes may be drenched by the profuseness of the secretion.

Examination of the chest discovers principally the signs of broncho pneunioni.h. Dulness is noticed, usually beginning•at the upper part of the lung. At the onset this may be limited to one side of the chest, but the opposite lung becomes very quickly affected. That first attacked, how ever, generally maintains its precedence and keeps in advance of its fellow throughout the course of the disease. The diminution of resonance in volves more and more of the area of the lung, and is accompanied by bronchial or blowing breathing which may be more or less covered by a copious; coarse, subcrepitant rhonchus. This rale is usually heard over the whole extent of both inspiration and' expiration, and is very large and metallic in quality. In spots here and there cavernous respiration may be heard after a time ; and the rhonchus in such places is larger and more ringing than elsewhere. If a cavity of some size form, the breath-sounds may be amphoric. Vocal resonance is usually stronger than natural, and may be bronchophonic in places.

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