132 DISEASES OF THE PARENCHYMA OF THE LUNG. 



disease, catarrhal pneumonia, upon which we shall enlarge more fully in 

 Chapter X. Compression of the lung of slighter grade presents an in- 

 creased density and consistence, and a condensed condition of the paren- 

 chyma, which, however, is not entirely void of air. In the more intense 

 forms of compression the air has left the vesicles and bronchi, but the 

 pressure has not sufficed to overcome the blood-vessels and expel the 

 blood. The condensed lung is red, full of blood, moist, resembling a 

 piece of muscle, hence we call it carnified. In the highest grade of all, 

 the vessels also are compressed, the lung appears bloodless, dry, gray, 

 leaden, often converted into a gray, leathery, tough mass. 



SYMPTOMS AND COURSE. The symptoms of congenital atelectasis 

 are essentially those of insufficient breathing and incomplete decarbon- 

 ization of the blood, and have often been described. The child breathes 

 softly and very quickly, is remarkably drowsy, does not cry as it 

 should, but merely whines and whimpers, and cannot suck freely. 

 Finally it grows pale, cool, and even cold, the nose becomes peaked, 

 the lips livid or lead-color, and it usually perishes in the first few days 

 of life; more rarely, not until the third and fourth week, with the 

 symptoms of general paralysis, and much less commonly with convul- 

 sions. It is but seldom that we can succeed in demonstrating by per- 

 cussion that solidified lung lies in contact with the thoracic wall, as the 

 points of atelectasis rarely are very large. When collapse of the lung 

 accompanies capillary bronchitis of little children, it cannot, in many 

 cases, be diagnosticated with certainty. We have seen, in treating of 

 the latter disease, that children may exhibit all the symptoms of insuf- 

 ficient breathing and carbonic-acid poisoning from closure of many of 

 the little bronchial tubes, and without collapse of the air-vesicles. If, then, 

 these symptoms should appear in the course of a capillary bronchitis, 

 we are only warranted in diagnosticating an acquired atelectasis, if we 

 find deadened resonance over a wide extent of the chest. Generally 

 speaking, the collapsed spots are not of sufficient magnitude to make 

 the percussion-sound dull. It most frequently arises in measles, in con- 

 sequence of very extensive collapse of both lower lobes of the lungs, 

 and presents a symmetrical dulness on each side of the spinal column. 



It is difficult to discriminate between the symptoms of compression 

 and those of the diseases which produce compression. The symptoms 

 of imperfect respiration, where the pulmonary vessels also are com- 

 pressed, are accompanied by derangement of the circulation similar to 

 that which we have described as attending emphysema; distention, 

 dilatation, hypertrophy of the right heart, subsequent distention of the 

 veins of the greater circulation, cyanosis, venous engorgement of the 

 brain, liver, and kidneys. In like manner the left heart, which is sup- 

 plied by the uncompressed capillaries alone, receives too little blood. 





