Considering that 30% of all deaths in England and
Wales are in infants under the age of two years, and
that in infancy the lungs are perhaps more frequently
the seat of organic disease than are any other
organs in the body, the importance of the subject, of
this thesis can hardly be over-estimated.
It is a subject upon which an immense amount of
work has been done, yet the type of tine disease
known as primary broncho-pneumonia has no recognised
classification, some authors regarding it as a lobar
pneumonia, most placing it with secondary bronchopneumonia,
while only a few consider it as an individual disease.
Again, though most writers refer to the possibility
of fibrosis being a sequel of broncho-pneumonia, there has been but little histological work
done upon the subject.
In this paper my object is
Firstly, to emphasise the differences between
the various forms of pneumonia, and bring forward
the reasons why primary broncho-pneumonia should be
considered as an individual disease, and
Secondly, to show that fibrosis is a very frequent
occurrence in broncho -pneumonia, and that by
thickening the alveolar and bronchiole walls even
to a slight extent, the lung tissue is so devita-
Used that a relapse or an exacerbation of the
disease proves rapidly fatal.
In order to gain information regarding the frequency of the various types of pneumonia in childhood,
the clinical course of each, and the varying
mortality, I have taken a series of 169 consecutive
cases of pneumonia admitted to the East London
Hospital for Children during a period of six months.
Hospital statistics vary very much from the different
classes of patients attending at different
hospitals, from the inclusion or exclusion of infectious
diseases, the prevalence of an epidemic,.etc.
Thus it is necessary to mention that these cases
were taken from a hospital where children from
birth to the age of fourteen years are admitted, so
that the age distribution is fair; where the patient
is taken from the poorest slum class, so that the
vitality is low and the mortality high, and where
a limited number of cases of diphtheria, pertussis,
and measles are treated in an infectious block.
The cases of pneumonia were divided into three
groups, lobar pneumonia, primary broncho-pneumonia,
and secondary bronohc-pneumonia. This classification
was made after viewing each case as a
whole; history, physical signs, symptoms and
course all being taken into account, and in the
fatal cases, the pathological appearances as well.
The main points in the differential diagnosis will
be brought out in the clinical comparison of the
diseases, but it may be wise to say that the
diagnosis of primary broncho-pneumonia was made
when a previously healthy child was attacked by
a sudden severe pneumonic fever, with the physical
signs of patchy consolidation.