CONSUMPTION OF THE LUNGS. 2^1 



Df the lung, as well as of bronchiectatic cavities. The pneumonia 

 which follows immediately upon a haemoptysis or a pneumorrhagia, 

 and which, in my opinion, is caused by effusion and coagulation of the 

 blood within the bronchi and air-vesicles, is of a very similar character. 

 The greater the area of dulness which develops after an attack of 

 haemoptysis, and the longer it lasts, the more pronounced the pleuritic 

 symptoms, the more intense and persistent the fever, so much the more 

 reason is there to fear that the retained blood and the inflamed paren- 

 chyma have undergone cheesy metamorphosis, involving serious disor- 

 ganization of the lung. As we have already explained, however, sub- 

 sequent liquefaction and absorption of the caseous mass are still possible, 

 as are also its incapsulation and induration of the affected lung through 

 profuse proliferation of the connective tissue, followed by contraction. 

 The invasion of a considerable number of air-cells by an acute 

 catarrh is sometimes attended by such serious symptoms, especially 

 violent fever and a rapid decline of the strength and nutritive condi- 

 tion, that the diagnosis is sometimes difficult. It is excusable ih such 

 cases if for a while, and until reliable data can be obtained, the phy- 

 sician ascribe the catarrh a'nd intense fever to infection, or to acute 

 tuberculosis of the lung. The case soon clears up, however. The 

 sputa begin to assume the characteristic admixture of blood peculiar 

 to pneumonia, pleuritic pains, of varying severity and extent, are felt, 

 the percussion-sound becomes hollow and tympanitic in the upper part 

 of the chest, and, if the points of solidification, originally lobular, coa- 

 lesce into one voluminous mass, the percussion-sound is dull. At the 

 same time the rales, which at first were indefinite, become ringing, 

 and the respiratory murmur becomes bronchial. It is possible that an 

 acute catarrhal infiltration may undergo complete resolution ; far more 

 generally, however, the infiltrated tissue suffers caseous metamorphosis, 

 and soon disintegrates. Most cases of galloping consumption, where 

 wide-spread destruction takes place in a lung within a few weeks, the 

 patient quickly wasting away and sinking under violent fever, arise 

 from the extension into the vesicles of an acute catarrh, involving a 

 considerable portion of the lung, and which may be called an acute 

 phthisis, resulting from acute or subacute catarrhal pneumonia. When 

 an entire lobe of a lung is involved in a process of this kind, subse- 

 quent absorption or incapsulation of the caseous deposit, with indura- 

 tion and wasting of the affected part, rarely occurs. Such a termination 

 is much more frequent where the disease is less extended. We may 

 often trace back a depression of the supra and infra-clavicular region, 

 with sinking of the summit of the lung, to an attack of acute catarrhal 

 pneumonia, which has become chronic, and resulted in induration and 

 contraction. We not unfrequently have the opportunity of observing 

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