142 DISEASES OF THE RESPIRATORY ORGANS 



Pathological Anatomy.— In a lung affected with catarrhal pneumonia, 

 we always find all the characteristics of bronchitis, and as the disease ad- 

 vances, the group of alveoli that belong to the affected bronchia are 

 rapidly filled with the catarrhal deposit, preventing the air from penetrat- 

 ing into them. Soon we see an intense hypersemia of the walls of the 

 alveoli and the exudation of a thin, non-coagulating fluid, and numerous 

 white blood corpuscles, which soon become pus corpuscles, and the com- 

 mencement of a fatty degeneration and detachment of the alveolar cells. 

 The alveoli and the small bronchia become entirely filled with pus corpus- 

 cles and a certain number of blood corpuscles and broken-down epithelial 

 cells, and the inflamed portion of the lung can easily be distinguished 

 from its healthy surroundings, forming firm, tough, roundish or lobulatcd 

 lumps, which vary in size and number, projecting slightly above the sur- 

 face of the lung, and on making a cross-section of the diseased portions, in 

 the earlier stages of the disease, they are seen to be dark bluish-red and 

 later on become gray, while the surrounding tissue that is not diseased is 

 normal or, what is more frequent, is slightly congested with blood. The 

 detached centres, which show plainly in the early part of the disease, soon 

 become confluent, so that finally we find large sections of the lung in- 

 volved. In rare cases we find fibrinous (croupous) centres in connection 

 with the catarrhal pneumonic centres and extended vesicular emphysema 

 in the neighborhood of the affected centres, and at the borders of the lungs 

 it is often seen. We may also have subpleural and interstitial emphy- 

 sema and sero-fibrinous or pussy pleuritis about the broncho-pneumonic 

 centres. 



Clinical Symptoms. — It is very difficult to make a sharp distinction 

 between capillary bronchitis and lobular pneumonia on account of the 

 close relation between these two diseases. If the disease has affected the 

 alveoli, there is a marked acceleration of the respirations, in some cases as 

 high as 60 per minute, and also inflation of the cheeks with each expira- 

 tion; the cough is short, frequent, and apparently very painful, the pulse 

 running from 150 to 170, temperature rises quickly and remains high. 

 On making a physical examination by percussion, there are a number of 

 dull centres though the lungs; in some instances the whole of the lung 

 gives dull sounds on auscultation. According to the stage of the disease, 

 we hear rales of various characters, strong vesicular breathing, snoring, fine 

 or loud bruits, and where there is extended infiltration, we hear bronchial 

 respiration and certain spots where there is no respiratory murmur at all. 



The temperature often goes up to 40° or 41°; this high temperature 

 usually commences early in the disease or it often makes a rise when the 

 disease has become converted into catarrhal pneumonia. If this compli- 

 cation does not occur, the temperature will not make any marked change, 

 but will follow a regular course, which is to rise quickly at the onset 



