Report on the progress of practical medicine, in ... midwifery and the diseases of women and children : during the years 1844-5 / by C. West.

  • West, Charles, 1816-1898.
Date:
1845
Catalogue details

Licence: Public Domain Mark

Credit: Report on the progress of practical medicine, in ... midwifery and the diseases of women and children : during the years 1844-5 / by C. West. Source: Wellcome Collection.

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    along1 the posterior border of the lungs, and generally accompanies catarrhal inflammation of the pulmonary vesicles. 3. In either of these forms of the foetal state, insufflation reproduces more or less completely the natural con¬ dition of the lobules. 4 Though occasionally met with unassociated with in¬ flammation, yet in by far the majority of cases this condition becomes deve¬ loped under the influence of catarrh and catarrhal pneumonia. 5. When unattended with catarrh and involving only isolated lobules, this condition cannot be detected till after death, but in the new-born infant it usually affects the lobar form, is attended by the physical signs of deficient respiration, and associated with the absence of all signs of constitutional reaction. 6. It is essentially different from hepatization, is produced by causes which interfere with the free performance of respiration, and is to be treated by remedies the reverse of antiphlogistic. 7- Lobular pneumonia has, strictly speaking, no existence, since the action of inflammation is never confined to a single lobule, as is the case with the foetal state of the lung. Partial pneumonia would there¬ fore be a fitter term. 8. Insufflation does not modify the patches of true hepatization, while the bronchi leading to such liepatized nodules are exempt from catarrh ; two characters which distinguish partial pneumonia from the lobular engorgements of catarrhal pneumonia. .9. True partial pneumonia is by no means common in children, though when hepatization does occur in children under 5 years of age, it almost always affects the partial form. The statements, therefore, that have been made with reference to the rarity of lobar pneumonia in infancy are correct; but almost all that has been said about the extreme frequency of lobular pneumonia at that age must be taken as referring to the foetal state of the lung. 10. Catarrhal pneumonia consists in the extension of the catarrhal inflammation from the bronchi to the pulmo¬ nary vesicles. This inflammation may affect healthy lobules, or those in the foetal state. In the latter case it gives rise to appearances which have led to the supposition that these lobules were the seat of a parenchymatous inflam¬ mation. 11. Capillary bronchitis and generalized lobular pneumonia are but two forms of catarrhal pneumonia, which differ according as in the one the catarrhal element or as in the other the lobular congestion predominates. 12. These facts explain why depletion was seldom appropriate in the treat¬ ment of what was called lobular pneumonia. [Simple as the process was by which these results were obtained, no one had previously employed insufflation as a means of ascertaining the real nature of lobular pneumonia and carnifica- tion of the lung in children. The writer of this Report has repeated the experiments of MM. Bailly and Legendre on many occasions, and can fully substantiate the correctness of their statements. An assertion has been made by M. Boucliut, that even true hepatization may be removed by insufflation;* in this, however, he is decidedly wrong. The liepatized portion may some¬ times be made to assume a brighter colour, but not to resume the texture of healthy lung, as is the case with lung in the foetal state.] Dr. Posner, f in some remarks on the treatment of pneumonia in childhood, observes that the strictly antiphlogistic treatment suitable to the inflammatory affections of the adult, are no longer appropriate in early life. He applies these observations especially to pneumonia, in the course of which an adynamic stage comes on, requiring the discontinuance of other remedies, and the use of wine and stimu¬ lants, for the employment of which he lays down clear and sensible directions. Hooping-cough. Dr. LerschJ confirms the statements of some previous writers with reference to the existence of small ulcerations about the root of the tongue in hooping-cough. He does not know whether their formation is preceded by the appearance of vesicles in that situation, for he has always seen them having the character of small ulcerations from one to three lines broad, * Op. cit. p. 317. + Journal fur Kinderkr. Miirz 1844. j Allg. Med. central Zeitung, Sept. 18, 1844.