242 DISEASES OF THE PARENCHYMA OF THE LUNG 



patients who have survived such attacks again and again, at varying 

 intervals, the area of dulness and depression of the thoracic wall ex 

 tending itself on each occasion, and who are finally carried off by a 

 tuberculosis, or a less fortunate repetition of the pneumonia. 



In contrast to the form of disease hitherto described, the implica- 

 tion of the air-cells in the bronchial catarrh may be unattended by any 

 violent symptoms, and may even be entirely latent. Upon dissection, 

 we often find the apex of the lung to be the seat of cicatricial con- 

 tractions, of incapsulated caseous deposits, and callous indurations, 

 resulting from a pneumonia which has totally escaped observation. 

 And we find many persons whose supra and infra-clavicular regions are 

 sunken in, and the summit of whose lungs is in a state of abnormal 

 depression, without any clew as to the date of the pneumonia by which 

 the apex of the lung has become solidified and wasted. Still, when- 

 ever the inflammatory process is at all extensive, even chronic catarrhal 

 pneumonia is almost always accompanied by fever. True, for a while, 

 this insidious fever is generally unobserved, or else misunderstood by 

 the patient, and sometimes, too, by the physician, as the more obvious 

 subjective febrile symptoms, the shivering, sense of heat, thirst, and 

 the like, are slight, and are thrown into the background by the wasting, 

 and the pernicious influence of the fever upon the appetite, the diges- 

 tion, the haematosis, and general nutrition. When a patient with 

 chronic bronchial catarrh, which has no ill effect upon his general 

 health and activity, begins to lose appetite, to grow pale and thin, and 

 to perceive a marked decline in his strength, there is reason to suspect 

 that the pulmonary vesicles have become involved in the catarrh, and 

 it is our imperative duty to ascertain the existence of fever, and of 

 solidification of the lung, by careful measurement of the temperature, 

 and by repeated physical examination of the chest. The chronic form 

 of catarrhal pneumonia shows a decided tendency, under favoring cir- 

 cumstances, to end in induration and shrinking, as well as to relapse 

 under pernicious irritation. This is the reason why so many persons, 

 in spite of the callosities and bronchiectatic cavities in the summit of 

 their lungs, feel tolerably well during the summer months, and gain in 

 strength and weight, while in winter, especially if obliged to work, 

 and to expose themselves to cold, they grow feverish, thin, and pale, 

 and suffer further induration of their lungs. Such alternations often 

 go on for a number of years. Patients of this class furnish a large 

 contingent to the hospitals, where (unless they present some physical 

 signs of especial rarity) they are apt to be unwelcome guests, " chronic 

 pulmonary tuberculosis," as it is called, being generally regarded as a 

 somewhat uninteresting disease. The striking manner in which this 

 form, which is by far the most common form of phthisis, yields to 



