CATARRHAL PKE&MONIA. 



197 



have already stated, while speaking of whooping-cough, that the cessa- 

 tion of the protracted coughing-spells and the occurrence, in their stead, 

 of short, harsh, painful " hacks," are very serious symptoms ; but, in 

 the catarrh of measles, and in a genuine capillary bronchitis, attentive 

 observers will rarely miss the modification of the cough just mentioned. 

 A fact established by Ziemssen is of great diagnostic value, namely, 

 that the temperature of the body always becomes elevated upon the 

 supervention of a catarrhal pneumonia upon a catarrhal bronchitis. 

 While the temperature of the body, according to Ziemssen, seldom 

 reaches the height of 102.2 F. in simple capillary bronchitis, upon the 

 development of a catarrhal pneumonia, it often mounts, in a few hours, 

 to 105 F. and sometimes still higher. At the same time the pulse 

 becomes more frequent, the face redder, and the child evinces great 

 terror and restlessness, or, in severe cases, soon falls into a state of 

 apathy and somnolence. Upon examining the chest of a child suf- 

 fering from measles, whooping-cough, or genuine bronchial catarrh, 

 whose cough has begun to grow painful, or whose fever has suddenly 

 grown worse, or in whom intense fever has arisen where none has pre- 

 viously existed, we must not expect for the first day or two to discover 

 the characteristic physical signs of catarrhal pneumonia. When the 

 pneumonic spots are surrounded by healthy parenchyma, and are of no 

 very great magnitude, neither auscultation nor percussion furnishes any 

 diagnostic data throughout the whole course of the disease. On the 

 other hand, if the complaint have developed from an extensive atelec- 

 tasis in a few days, an adept in percussion will find a dulness, which is 

 almost always symmetrical, ascending posteriorly upon both sides of 

 the spinal column in a narrow stripe, which is characteristic of it, and 

 which does not extend toward the lateral regions of the thorax until a 

 late period. As the collapsed portion of the lung at first presents but 

 a thin layer, void of air, we must percuss with feeble, short stroke, in 

 order to recognize the dulness. The pectoral fremitus and the respi- 

 ratory sounds are not as yet altered. At most, the rhonchi and rdles 

 of the capillary bronchitis, in the vicinity of the collapsed region, are 

 somewhat less loud and less distinctly audible than in other parts of 

 the lung. Should the collapse extend, and should the collapsed part 

 become more voluminous and dense, the dulness becomes more distinct, 

 extends more outwardly, the pectoral fremitus becomes stronger. The 

 breathing is bronchial, any rdles which may be heard have a ringing char- 

 acter ; in brief, the signs of auscultation and percussion are now iden- 

 tical with those of a croupous pneumonia at the stage of hepatization. 

 If not called to see the sick child until this period, it may be difficult and 

 even impossible to decide whether we have to do with a croupous pneu- 

 monia or with an extensive catarrhal inflammation of collapsed lung. 



