Chronic Fibrous Pneumonia. Pulmonary Sclerosis. 313 



fibrous septa and pockets of pus some of which communicate 

 with each other and some with the bronchia. Even where sup- 

 puration has not ensued, the affected parts of the lung, with the 

 lung tissue compressed and atrophied, have assumed a grayish 

 hue. In cases that have followed pleurisy the lower portions of 

 the lung are especially affected, but the whole affected lobe may 

 have a dense fibrous envelope (the condensed false membrane), 

 from which septa pass into the lung circumscribing the lobules 

 and determining parenchymatous softening and absorption. In 

 such cases the bronchia are usually unaffected. 



The fibrous structure may become as hard as cartilage and 

 grates under the knife when cut. This sclerosis may appear at 

 any point, and no matter what may have been the point from 

 which the disease started. 



The right heart is usually dilated by the blood pressure caused 

 by the obstruction to circulation through the lungs, and the tri- 

 cuspid valves become insufiicient. 



Symptoms. These are very varied and not always diagnostic. 

 In case of a fibrinous or broncho-pneumonia or a pleurisy, 

 it may be suspected when the fever subsides without clearing up 

 of the lung, when, on the contrary, hurried breathing and cough 

 continue unabated, and are easily roused or greatly aggravated 

 by even moderate exertion. Perspiration is easily induced and 

 the patient is unfit for work. The chest remains expanded and 

 the nostrils dilated. Most characteristic of all, the consolidated 

 parts of the lungs do not become more resonant to percussion, 

 nor does the respiratory murmur return in them. 



For a time the appetite and spirits may be good, yet the 

 patient loses flesh, and both pulse and respiration are easily 

 accelerated, and accompanied by a muco-purulent discharge. 

 I^ater appetite fails, breathing is made with double lift in expira- 

 tion, cough becomes paroxysmal, and emaciation advances 

 rapidly. 



If it supervenes on broncho-pneumonia, the sibilant and 

 mucous rdles are prominent in the affected parts, a cavernous 

 blowing may be present, the painful cough occurs in fits, and 

 the muco-purulent discharge is often foetid. New attacks of 

 bronchitis are liable to occur at intervals each leaving the subject 

 worse than before, and under these conditions the cough becomes 



