The violent paroxysmal cough ending in retching, and the discharge of a large quantity of offensive purulent mucus is very characteristic ; and this symptom, combined with the sudden change in the physical signs which is noticed at once when the dilated tubes have been relieved of their contents, is a strong argument in favour of fibroid induration.
• Pleurisy, with retraction of the side, presents physical signs very similar to the above. But in this case, although the breathing in the child is not unfrequently hollow, it is rarely cavernous, and is not accompanied by metallic gurgling. Moreover, the cough is not paroxysmal, and expectora tion is scanty or absent. Cirrhosis of the lung may, however, follow upon long-standing pleurisy. It is detected by the gradual supervention of signs of bronchial dilatation with copious purulent sputa.
If on account of extreme dilatation of the bronchi no retraction of the side is present, the characteristic cough, the profuse sputa, the sudden change in the physical signs after expectoration, and the history of repeated failure of health, with rapid improvement under favourable conditions of living, are symptoms of the utmost value.
Ordinary pulmonary phthisis is usually combined with a certain degree of fibroid overgrowth. The distinction between dilated bronchi and cavi ties due to ulcerative destruction of lung is elsewhere considered (see page 514). In any case the strict limitation of the disease to one side of the chest is a strong argument in favour of the fibroid disease, for pulmonary phthisis in the third stage is never confined to one lung. It must be re membered that cavities resulting from ulceration of lung may be combined with dilated bronchi (fibroid phthisis). In such a case the apex of the opposite lung is probably also the seat of disease. The diagnosis will then rest upon the history of the illness and the evidence of marked contraction.
Prognosis.—Although fibroid induration of the lung usually tends to increase, the immediate prospects of the child are not unfavourable so long as the disease is limited in extent and remains uncomplicated. The danger of these cases arises from the secondary disturbances, which are a common and unfortunate consequence of this condition of the lung. A catarrh causes great increase of bronchial secretion, and often leads to retention. and decomposition of purulent matter in the dilated tubes. The irritation thus induced may be sufficient by itself to set up a catarrhal pneumonia. Fortunately in these attacks the type of the intercurrent disease is usually -subacute ; but its course is apt to be protracted, and if the fibroid consoli dation is advanced, or the nutrition of the child impaired, the patient may succumb to the complication.
The continuance of healthy nutrition is very necessary to the favour -able progress of these cases, and any derangement which tends to reduce the strength, such as digestive disturbance, vomiting, or diarrhoea, is dis tinctly injurious. The progress is more favourable when the disease is seated at the upper part of the lung than when it occupies the base. In the first case, on account of the downward direction of the air-tithes, retention of secretion is less liable to occur ; in the second case the force of gravity helps to favour accumulation in the tubes.
In the later stage of the illness, when amyloid disease of organs has occurred, the prognosis is serious ; but even at this period, if the patient be living in a climate which allows him to pass much of his time in the open air without risk of chill, nutrition may be carried on fairly well. CEderua with or without amyloid change is an unfavourable sign, as it indicates a a very unsatisfactory state of the blood.
the treatment of this chronic disease we can do nothing to remedy the mischief in the lung so far as it is already completed. Wherever the fibroid change has advanced, the tissue affected is injured beyond hope of repair, and no treatment can cause absorption of the mor bid material in the lung. Still, we can do much by careful attention to the conditions of life of the child to prevent further spread of the disease. Our efforts must be directed to the removal of irritation in the lung, so.as to arrest the tendency to active change, and to the promotion of lung, nutrition. The chief cause of the extension of the indurating process is the presence of bronchial secretion in the tubes. We must therefore do all in our power to avert the risk of chill ; and if a catarrh attack the lung, it must be treated without delay. The child must be dressed from head to foot in flannel or woollen underclothing, and should- never leave the house in cold or damp weather without suitable covering to his neck and chest. This precaution is the more necessary as confinement to hot rooms is to be deprecated ; and if the child be properly protected from cold, regular exer cise should be insisted upon. If practicable, it is desirable that the child should pass the winter in a dry and bracing, but equable climate, where he is not liable to suffer from constant changes of temperature. His diet should be nutritious, consisting of meat, eggs, milk, etc., avoiding excess of farinaceous food ; and if he be weakly, half a glass of port wine, or of the St. Raphael tannin wine, diluted with an equal quantity of water, may be given him with his dinner. Iron and cod-liver oil are always indicated in these cases.