Studies of Pneumonia in Childhood

S OF CASES ILLUSTRATED. Case 1. (Plate I, Fig. 1, and Plate III, Fig. 11.) Acute disseminated broncho-pneumonia following measles. Male, aged 3 years and 7 months. Breast-fed for 1 year. Scarlet fever at 1 year. Pneumonia at 2 years. Fatal illness started with measles 3 weeks before admission. Admitted moribund and died almost at once. Post-mortem, development and nutrition fairly good. Much thin muco-pus in upper respiratory passages. Scanty fibrinous pleural exudate on both sides. Lungs voluminous, and extensively and almost equally affected with small patches of pneumonia showing as tiny yellow spots round bronchi and bronchioles. Little tendency to confluence. Lung substance very moist, large amounts of frothy fluid exuding on pressure. Mediastinal glands swollen and of a deep red colour. Heart grossly dilated in all chambers and muscle pale and flabby. Moderate degree of toxic change in solid abdominal organs. Case II. (Plate I, Fig. 2, and Plate IV, Fig. 14 and 15.) Acute disseminated bronchopneumonia with confluence in parts, of 12 days' duration. Female, aged 1 year. Fourth child. One died at 3 months. Two basement rooms; gas burning all day. Breast-fed for 3 weeks. Thereafter on condensed milk. First tooth at 9 months. Chicken-pox at 7 months, with middle ear inflammation. At 9 months, in hospital for 2 weeks with sharp respiratory illness. Continued to cough. Readmitted 4 days before death. Had been acutely ill for 8 days, with severe cough and noisy breathing. Big pale flabby child. Four teeth. Temp. 102. Pulse 160. Respirations 52. Dyspnceic and cyanosed. Lower chest drawn in on inspiration. Generalized bronchitis, with doubtful consolidation on both sides. Severe suffocative symptoms before death. Post-mortem, both pleural sacs partially obliterated by loose organised adhesions. Both lungs widely involved. Broncho-pneumonia mostly discrete, but in right lung (Fig. 2) confluence in middle lobe, postero-medial part of upper lobe, and postero-inferior portion of lower. Microscopic evidence of chronic process in two areas in right lung, one in upper lobe near root and other in middle lobe (this chronic interstitial process, as well as organized pleural adhesions regarded as legacy of respiratory illness 3 months before death). Mediastinal glands large and inflamed. Heart dilated on right side. Early acute peritonitis in upper abdomen. Marked toxic changes in spleen, liver and kidneys. No evidence of rickets or lymphoid hyperplasia. B. Pfeiffer grown in pure culture from heart blood and in mixed culture from lung substance. Case III. (Chart A, Plate I, Fig. 3 and 4.) Acute broncho-pneumonia, with widespread confluence, of 4 weeks' duration. Male, aged 1 year. Father unemployed. Three other children. Bad home. Artificially fed from birth on boiled cow's milk. Severe digestive disturbance at 2 months. Hernia operation at 4 months. At 10 months, in hospital for 3 weeks with dyspepsia. Subsequent progress unsatisfactory. Readmitted 31 weeks before death, having been acutely ill for 3 days. Symptoms at outset mainly gastro-intestinal, but illness obviously respiratory. General state of nutrition poor. Acute bronchitis passed into typical broncho-pneumonia. Mouth and nasopharynx became septic and double otitis developed. Went steadily downhill. For temperature, etc., see chart. Post-mortem, body extremely emaciated. Bilateral fibrinous pleural exudate. Very extensive broncho-pneumonia in both lungs (Figs. 3 and 4), especially right (Fig. 3). Posterior part of each base solid, and throughout rest of lungs large pneumonic patches of irregular shape and size, with intervening crepitant areas. Yellow mottling characteristic of confluent bronchopneumonia prominent in solid areas. Smaller bronchi dilated. Mediastinal glands enlarged and red, and mediastinal tissues edematous. No gross dilatation of heart. Very slight t,zxic changes in liver and kidneys. Spleen small. 121 122 ARCHIVES OF DISEASE IN CHILDHOOD Case IV. (Plate II, Fig. 5 and 6; Plate III, Fig. 12; Plate IV, Fig. 13 and 17.) Acute broncho-pneumonia, with confluence at bases, of 8 days' duration. Female, aged 7 months. Illegitimate child, adopted by deaf and dumb woman. Fed on cow's milk and oatflour. No previous illness. Admitted to hospital with 4 days' history of fever, cough and heavy breathing. Temp. 105. Pulse 176. Respirations 56. Indifferently nourished. Flushed and distressed, with indrawing of lower chest. Crepitations most numerous at bases. Cyanosis a conspicuous feature. Steam, oxygen and bleeding of no avail. Died 4 days after admission. Post-mortem, much muco-pus in large air passages. Pleural surfaces sticky but without definite exudate. Numerous subpleural petechial hwmorrhages over pneumonic patches. Extensive pneumonia in lower lobes of both lungs (Fig. 5 and 6). Large areas in each lung relatively free from pneumonia, but no dubiety as to broncho-pneumonic nature of consolidation. Presence of air in connective tissue framework of lung (interstitial emphysema) a conspicuous feature at autopsy (shown very well in large sections). Heart muscle pale and soft, and chambers greatly dilated. Relatively slight toxic changes in organs.