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Fibroid Induration of the Lung

tissue, pneumonia, disease, children, tubes, bronchi and catarrhal

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induration of the lung (cirrhosis of the lung, interstitial pneumonia) is not very in children, and is often mistaken for phthisis. The complaint gives rise to a chronic derangement of health which is subject to marked variations according to the season of the year. In colcl and changeable weather the patient suffers greatly from attacks of bronchitis and catarrhal pneumonia. Consequently, at these times he is apt to be feverish and grow pale and thin, even if his life be not put in actual peril. In warmer and more settled weather he usually greatly improves and gains considerably both in flesh and strength. Cases of very chronic "consump tion," in which the patient is constantly ill and failing during the winter, but revives and regains flesh during the summer months, are often exam ples of this form of pulmonary disease. Cirrhosis of the lung rarely at tacks infants. It is usually found in children of five years old and up wards.

induration is always a secondary complaint, and usually owes its origin to an attack of inflammation of the lung. Both croupous and catarrhal pneumonia tend to promote a multiplication of the connective tissue elements ; but in children the fibroid increase is commonly clue to the lobular form, especially to the subacute variety which is apt to follow attacks of measles and whooping-cough. Catarrhal pneumonia is always accompanied by dilatation of the bronchi, and this condition of the air-tubes favours the catarrhal process. It hinders the escape of secre tion and so maintains a state of continual irritation of the air-tubes and their terminal alveoli. As a result, the persistence of the pulmonary in flammation tends to promote a fibroid thickening of the walls of the bronchi and air-cells ; the dilatation of the tubes becomes a permanent lesion, and this, again, helps in its turn to perpetuate the irritation.

Croupous pneumonia is less often than the preceding a cause of cirrho sis ; but sometimes, if the disease is protracted, thickening and indura tion may occur in the walls of the alveoli, and the indurating process may continue after the original disease is at an end. Weber has reported the cases of three children in whom the disease had this origin, for he had himself treated the patients for the primary attack of pneumonia.

Sometimes, although rarely in young subjects; inflammation of the pleura may lead to the fibroid overgrowth. It is in cases where the lung has been subjected to long-continued compression that this consequence is most likely to occur. The thickening in this form is limited at first to the superficial interlobular septa ; but the process may afterwards pene trate more deeply and be accompanied by dilatation of the bronchi.

Induration of the two lungs as a consequence of the inhalation of grit in the course of industrial labour is not found in children. Young persons under twelve years of age are not exposed to this source of disease ; and even in adults whose employment obliges them-to breathe continually an air filled with irritating particles, disease of the lung thus induced is in variably chronic, and only becomes developed after an exposure extend ing over many years.

Morbid examination of a lung, the seat of fibroid indura tion, a great development is noticed of fibro-nucleated tissue in the Walls of the alveoli, the interlobular connective tissue, and the bronchial tubes. As this increases it involves all the connective tissue of the lung. The or gan becomes excessively dense and shrunken. Its substance is firm and tough, and a section shows a smooth or faintly granular surface, iron-gray or grayish-red in colour, intersected in all directions by white fibrous bands. Dotted over it are white rings of various sizes, which are the di vided walls of thickened and dilated tubes.

The fibroid material is not spread evenly over the parenchyma, but often surrounds islets of more healthy tissue, which are thus separated, from one another by the dense fibrous bands. Sometimes in the neigh bourhood of the fibroid parts the uninvaded tissue may be emphysematous. Small cavities containing cheesy matter or thick purulent fluid are seen here and there in the dense tissue. Some of these are dilatations of the bronchi ; others are the result of ulceration which has spread from the enlarged tubes. Sometimes, as in the case of a child five years old who was under my care in the East London Children's Hospital, large expanded channels are found radiating from the root of the lung and ending abruptly, like the fingers of a glove, at the surface of the organ immediately under neath the pleura.

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