File:Principles and practice of physical diagnosis (1911) (14764581562).jpg

Identifier: principlespracti1911daco (find matches)
Title: Principles and practice of physical diagnosis
Year: 1911 (1910s)
Authors: Da Costa, John C., jr., 1871-
Subjects: Diagnosis Diagnosis
Publisher: Philadelphia and London : W.B. Saunders Company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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Fig. 100.—Radiograph of chronic interstitial pneumonia (cf. Fig. 70). Note denseshadows of fibrosis through the right lung. (Plate by Dr. W. F. Manges.) history of pneumonia, pleurisy, syphilis, or local damage to thelung, to account for the initial cirrhotic changes. In a doubtfulcase the #-ray generally affords a certain means of diagnosis (Fig.100). The differentiation of pure pulmonary cirrhosis from so-calledfibroid phthisis, which is not always possible when positive bac-teriologic findings and a clear history are wanting, is referred tounder the latter affection. (See p. 223.) 206 PHYSICAL DIAGNOSIS ACUTE PNEUMONIC PHTHISIS (Phthisis Florida; Galloping Con-sumption) Clinical Pathology.—This acute type of pulmonary tuberculosis,popularly known as galloping consumption, consists of a rapidlyspreading caseous pneumonia or bronchopneumonia, which is com-monly secondary to a primary apical focus of infection (Fig. 101). Diffuse infiltrationand softening Infarct
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CavityFig. 101.—Acute pneumonic phthisis (Jefferson Hospital Laboratories). The vesicles and bronchioles are the seat of intense inflammatorychanges, and are filled with an inflammatory exudate which,owing to its tuberculous character, does not readily undergosoftening and expulsion, but becomes caseated; the vesicular andbronchiolar walls in the affected areas are infiltrated and thick-ened, and their blood-supply is obliterated. With the spread of theinfection from its original site to adjacent vesicles and bronchioles, DISEASES OF THE BRONCHOPULMONARY SYSTEM 207 there is rapid implication of the entire lobule, whence the processspreads to adjacent lobules, either by coalescence of their lesions orby direct extension. The size of these patches of tuberculous con-solidation varies greatly in the individual case, according to thevirulence of the infection and the resistance of the subject. In theso-called pneumonic type of the disease there is a diffuse, apparentlyuniform consolidat

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