Broncho-Pneumonia.

Synonyms.—Capillary Bronchitis; Lobular Pneumonia; Catarrhal Pneumonia.

Definition.—An inflammation of the terminal bronchi, air-vesicles, and interstitial tissue of a few or many of the lobules.

Etiology.—This is peculiarly a disease of early childhood and old people, though enfeebled vitality and prolonged sickness of any kind predisposes to broncho-pneumonia. In children it is especially apt to follow the infectious diseases that affect the bronchi and are attended by a cough, such as measles, whooping-cough, influenza, diphtheria, and scarlet fever.

Tubercular patients, especially where the lungs are involved, are. frequent subjects of this form of pneumonia. Typhoid fever, small-pox, and diseases of like character, are not infrequently complicated with this disease.

The inhalation of particles of food or broken-down material from the throat, as from diphtheria or tonsillitis, may give rise to inflammation, and is known as inhalation or deglutition pneumonia.

The disease is seen most frequently in the winter and early spring- months, when the weather is marked by sudden changes.

Pathology.—The pathological changes are essentially those of bronchitis and of pneumonia in about eighty per cent of the cases, both lungs being involved.

The pleural cavities usually contain their normal amount of fluid, though their surfaces, pulmonary and parietal, may exhibit inflammatory patches—fibrinous pleurisy.

In most cases, the lung crepitates on handling, and will float when placed in water, though the small, mahogany-colored nodules found distributed throughout the lung, when excised, sink in water. The nodules are found in greater numbers in the posterior part of the lower lobes. These nodules vary in size from a pinhead to a pea, and, when pressed, a small amount of blood exudes. These nodules may be so numerous as to resemble a hepatized lung; where these indurated patches are few in number, the intervening lung tissue may be normal, though usually it is congested or edematous.

Surrounding the nodules, emphysematous lung-tissue is not infrequently seen, with occasional collapsed areas—atelectasis.

The bronchi, small and medium-sized, are the seat of catarrhal inflammation, the walls of which are swollen and infiltrated with round cells. The exudate within the bronchi consists of leukocytes and micro-organisms.

Northrup speaks of a mechanical dilatation of the smaller bronchi, which occurs most frequently in the lower lobes.

Symptoms.—Primary Form.—Though a much rarer form than the secondary, broncho-pneumonia sometimes begins as an acute primary affection, the symptoms being those of acute bronchitis. The usual prodromal symptoms, malaise, with loss of appetite, precede the initial chill, which is followed by febrile reaction. The temperature is usually between 100° and 103°. though in exceptional cases it may reach 104° or 105°.

A hard, dry cough, with a sense of constriction in the chest, accompanied by a sharp pain, is a characteristic feature. The respiration is rapid, and in children may reach 60, 70, or even 80 per minute. Dyspnea is quite marked. The pulse varies from 120 to 140 per minute. Expectoration attends the cough after the first twenty-four hours, at first a glairy mucus, frequently tinged with blood, which later becomes mucopurulent in character.

Secondary Form.—This is the form usually seen, and comes on more gradually, the earlier symptoms being those of the preceding bronchitis. Not infrequently, the pneumonia complication is not suspected during life.

The first symptom to call attention to the true nature of the disease is the sudden increase in the respiration, quickened pulse, and cyanotic appearance. The expectoration is muco-purulent in character. The cough is hard and harassing, and is accompanied by pain and constriction of the chest.

Physical Signs.—In the primary form, the sibilant and mucous rales are the most prominent signs, the subcrepitant appearing as the disease progresses and the areas of the vesicular changes increase. In the secondary form, the subcrepitant fine, moist rales are usually present.

Palpation usually reveals local areas of vocal fremitus.

Percussion reveals areas of dullness, where much consolidation exists, but where deep-seated and confined to small spots, is negative.

Complications.—Cerebral complication is not a very rare occurrence, the child becoming restless, the face is flushed, and the head is rolled from side to side; delirium may ensue, while a convulsion is not unusual.

Pleurisy may occur, and tuberculosis is not uncommon. Gangrene and abscess of the lung is a more rare sequela.

Diagnosis.—The diagnosis is readily made as a general rule. The persistent bronchitis with sudden rise of temperature, the dyspnea, hurried respiration, and the rapid pulse, together with the physical signs, are sufficient to determine the character of the disease.

Prognosis.—The prognosis is favorable except in feeble, delicate babies, and in very old people.

Treatment.—The treatment is similar to that of bronchitis or lobar pneumonia. The specific remedies being given for specific conditions.

Aconite.—Where there is fever, with small, frequent pulse, there is no better remedy than aconite. This may be combined with any one of a half-dozen remedies that are frequently called for.

Rhus Tox.—Where there is restlessness and the child is unable to sleep, the pulse quick and sharp, rhus goes nicely with the sedative aconite. Where the smaller tubes are choked up, and oppression is a marked feature, lobelia is the remedy par excellence.

Ipecac.—We sometimes meet a case where there is marked irritation. The cough is hacking and persistent; the tongue is red and pointed; the pulse is quick and hard; the child is cross and peevish. Here ipecac alone, or combined with the sedative, is sure to give good results.

Tartar Emetic.—Where the cough is loose, and the bronchioles are choked with mucus, there are few, if any, remedies that can take the place of tartar emetic. It was a most effective remedy with my father, who used it for over forty years with the best results. Take about one-tenth of a grain of the crude drug to a half a glass of water; teaspoonful every hour. If nausea or vomiting follow, add more water.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.