Acute Pneumonic Phthisis.
Synonyms.—Acute Phthisis; Galloping Consumption.
This variety occurs in persons whose vitality has been reduced by previous illness or who have led an exposed or dissipated life. While it may be primary, by far the larger number is secondary to a pre-existing tubercular focus, as of the lung, pleura, mesentery, or lymph glands. While it may occur at any age, it more frequently selects for its victims children or early adults.
Pathology.—The tuberculous deposits may be confined to one lobe, but more frequently the entire lung will be involved, or small tubercles will be found thickly distributed throughout both lungs. The part affected has the appearance of a hepatized lung, is heavy, and contains but little, if any, air. The exudate in the air-cells may caseate, break down, and form cavities. The pleura is usually covered by a thin exudate, which, breaking down, leaves a purulent material. See Fig 20.
Varieties.—Clinically, two forms are to be recognized, the pneumonic and the broncho-pneumonic.
Pneumonic.—Symptoms.—The disease often begins abruptly. The patient has been in apparent good health, though, when his attention is called to his previous condition, he can generally recall a progressive feeling of malaise and loss of vitality. The attack may be preceded by a cold, though, as a rule, the onset is sudden, as in lobar pneumonia.
Following the initiatory chill, the fever rises quite rapidly, the temperature soon reaching 104° or more. The skin is dry, the urine is Scanty, and there is constipation. The face is flushed, tongue coated, and a harassing cough, with severe pain in the side, is quite characteristic. The expectoration at first is frothy and mucoid in character, but soon changes to the characteristic rusty sputum of pneumonia. The breathing is humid, and where a large portion of the lung is involved, there is marked dyspnea.
The physical signs are those of pneumonia; namely, the crepitant, followed by the subcrepitant rhonchus, with increasing dullness on percussion. The fever may be continued or assume the remittent type. By the eighth or tenth day, when in pneumonia we look for a crisis, the fever becomes irregular, the dyspnea increases, the expectoration loses its rusty tinge, becoming yellow and of a mucopurulent character or of a greenish hue. The expectoration is abundant, and raised with less difficulty.
Night-sweats now appear, and the rapidity with which the patient shows the inroads of the disease is remarkable. The emaciation is rapid, as seen in the hollow cheeks and pinched features. The course of the disease varies from four to eight weeks, though sometimes the disease may last from four to six months, when the symptoms are those of chronic tuberculosis.
Diagnosis.—The diagnosis in the early stage is extremely difficult, unless there is a history of gradual failing health, or tubercular taint. The early symptoms all point to pneumonia, unless there should be hemoptysis, which might arouse suspicion. In the course of a week or ten days, however, the disease assumes a more characteristic form. The irregular fever; the continued dullness on percussion; the thick, greenish, mucopurulent expectoration; the rapid emaciation; the beginning of night-sweats,—are a group of symptoms that can not be overlooked.
Broncho-Pneumonic Form.—This form rarely attacks persons in good health, and the history shows a gradual decline. Chilly sensations, if not a marked chill, ushers in its presence, to be followed by a high fever. About this time hemorrhages may occur, which should arouse suspicion as to the nature of the disease. The fever is quite active, and a hard, irritating, bronchial cough, with pain in chest and lung, early manifests itself.
The expectorated material is at first a tough, viscid, glairy mucus, occasionally streaked with blood. As the smaller bronchioles become choked, the breathing becomes hurried and labored. The exudate fills the air-cells, and dullness is marked over the portion of the lung affected, usually the apex.
The breathing is now difficult, the expectoration is of a muco-purulent character, night-sweats occur, emaciation is rapid, and "galloping consumption" is written upon the hollow cheeks, the pinched face, and the wasted frame. Sometimes, even after these grave symptoms appear, there will be an amelioration of all the symptoms, and the case passes into the chronic form.
In children the disease frequently follows measles, whooping-cough, scarlet fever, diphtheria, and influenza. The child, weakened by the infectious fever, is a fit subject for tuberculosis. The early symptoms are those of capillary bronchitis. The small bronchioles are first choked, and the lung complication soon follows. The child breathes with difficulty, and is disturbed by a hacking cough.
Weakened by previous sickness, the destructive forces rapidly do their work, and in from three to six weeks the little sufferer gives up the contest.