When lobular collapse occurs in the course of an attack of mild bron chitis, the presence of the lesion may be inferred by remarking that the symptoms of prostration and deficient oxydation of the blood are exagger ated out of all proportion to the physical signs. If the bronchitis be severe, we may conclude that atelectasis is present if the breathing becomes sud denly shallow and rapid ; if the cough and cry become suppressed ; while the lividity and general distress are still further aggravated, and the in ternal temperature of the body falls below the level of health.
In cases of diffused atelectasis an examination of the chest reveals. dulness, bronchial breathing, and a sub-crepitant rhonchus. The disease may then be mistaken for croupous pneumonia or pleurisy. In a young infant, however, little hesitation is occasioned, for the symptoms induced by atelectasis are very different from those resulting from either of the diseases which have been mentioned. It is principally in cases where the lesion occurs after the end of the first year that any perplexity is ex perienced. At this age the general symptoms are usually less severe and the child's weakness much less pronounced. Still, the history of the illness is very different in collapse from that of a case of inflammation either of the lung or the pleura. Moreover, in pneumonia the high temperature is a distinguishing mark of great value ; and tubular breathing, with a fine, puffy crepitation noticed at the borders of the dull area, are signs which are. not heard in collapse of the lung. From a localised pleurisy the lesion is not always so easily distinguished. Collapse of a mere layer of tissue on the surface of the lung gives rise to only moderate dulness quite unlike the dead, toneless note over even -a thin stratum of fluid. If, however, an entire pulmonary lobe be collapsed, the dulness may be very marked and the resistance notably increased, although perhaps to a less extent than is found in cases of pleurisy ; still, the difference is one only of degree. To add to the resemblance, the breathing in either case may be weak and bronchial without rhonchus or other adventitious sound. If, however, the vocal resonance be cegophonic, the sign is characteristic of pleurisy and is never found over merely collapsed lung-tissue. In most cases the symptoms alone in the two diseases are sufficiently different to warrant a diagnosis. In atelectasis the distress is greater, and the signs of lividity are more noticeable than in the case of pleurisy of equal extent ; for in the latter disease, unless a great accumulation of fluid occur, or the pain be severe, the child, as a rule, appears little inconvenienced by his illness.
When the collapse occupies the apex of the lung, as in the case narrated above, it is often distinguished with difficulty from an ordinary caseous consolidation, especially if any complication be present, as in that case, to raise the temperature of the body above the natural level. Still, one dis tinguishing mark which was present in the case referred to might suggest simple condensation of tissue, viz., the limitation of the dulness to one aspect of the chest. Complete dulness arising from consolidation would be certainly accompanied by a corresponding alteration of the percussion note on and above the clavicle as well as at the supra-spinous fossa.
Prognosis.—Post-natal atelectasis is always a grave lesion, especially in weakly children. Indeed, if the collapse occur in the course of a severe attack of bronchitis, and the patient be a feeble or rickety infant under the age of twelve months, death may be looked upon as inevitable. Even when the preliminary catarrh is less severe, the life of the child is placed in great danger ; and if the collapse be extensive, or the softening of the ribs extreme, treatment must be very prompt and energetic indeed to afford any prospect of success. The occurrence of convulsions greatly increases
the danger of the case ; and marked apathy and torpor, persistent increase of lividity, great shallowness of breathing, and inability to swallow are all symptoms of unfavourable import. On the contrary, if the face become clearer and the breathing deeper, and especially if the child begin to suck his fingers, to take his bottle readily, or to show any interest in what passes around him, we may have hopes of his recovery.
Treatment.—Re-inflation of the collapsed air-cells in cases of atelec tasis can only be effected by measures which increase the vigour of the in spiratory movement. To attain this object we must make use of energetic stimulation .both internally and externally. The child should be placed as quickly as possible in a hot mustard-bath of the strength of one ounce of mustard, to each gallon of hot water. In this bath he should be al lowed to remain until the arms of the person supporting him begin to prick and tingle uncomfortably. After being removed and dried, the chest should be wrapped loosely in cotton wool, and the child be laid quietly in his cot with head and shoulders raised. The temperature of the room should be between and 75°. If any signs are observed of accumulation of phlegm in the tubes, an emetic is useful ; and a quarter or half a grain of sulphate of copper (according to the age of the child) may be given in a teaspoonful of water every ten minutes until vomiting is produced. The emetic is also valuable in forcing the child to take a deep breath. Mechanical means of increasing the depth of the inspirations form an important part of the treatment. The infant should not be al lowed to sleep too long at onetime. Drowsiness is one of the commonest symptoms of this lesion ; but a careful eye should be kept upon the pa tient during his sleep, and if signs of increasing liviclity are noticed, he must be taken up and put into a mustard-bath, or made to cry by frictions to the soles of his feet or by the application of a strong stimulating lini ment to the chest-wall. The linimentum ammoniaa of the British Phar macopceia, diluted, if necessary, with an equal quantity of olive-oil, is very useful for this purpose.
If the child can suck, he should take white wine whey with cream from a bottle. In many cases, however, on account of his inability to draw up the fluid through the tube, it is necessary to feed him with the syringe. In addition, or as a variety, the child may be fed with milk and barley water with Mellin's food, and five or ten drops of pale brandy must be given at regular intervals. In the case of a weakly infant, when the symp toms of prostration are great, the stimulant will be required every half hour until the child revives. Older children may take milk, strong beef tea, and the brandy-and-egg mixture.
The above measures must be put in force directly any signs are dis covered indicating the occurrence of collapse. The earlier special treat ment is begun, the more likely is it to be successful. It is of the utmost importance that the child be not allowed to sleep himself to death, as he will probably do if left alone. He must be roused at intervals and made to inspire ; and our efforts must be continued perseveringly until signs are noted of returning vigour or of improved aeration of the blood. Even then he must be carefully watched that he may not relapse, and stimu lation must be continued until all danger has passed.
Drugs are not of much value in this lesion. Opium is to be carefully avoided. Diffusible stimulants may, however, be given if thought advis able. The best of these is quinine dissolved in sal volatile in the propor tion of one grain to the drachm. Three or four drops of this solution may be given occasionally in a spoonful of the food.