(FIBROID INDURATION)
=Definition.=—A chronic, inflammatory disease of the lungs,
characterized by an overgrowth of fibrous or connective tissue.
=Etiology.=—With few exceptions chronic affections of the lungs cause
more or less fibroid overgrowth. This is especially frequent after
bronchial pneumonia and pulmonary tuberculosis. It is also excited by
abscesses, hydatids, syphilis, emphysema, sarcoma and old fibrinous
pleurisy. It may also be caused by compression, by aneurism or
neoplasms. It may arise as a primary affection, due to the inhalation
of irritating dusts (stone dust, coal dust and metal dust). There will
be found deeply seated osseous lesions of the upper and middle dorsal
region and corresponding ribs, and frequently of the cervical vertebræ.
=Pathologically=, as it involves limited or extensive areas, it is
recognized as =local= or =diffuse=. It is a unilateral affection. The
involved portion is shrunken and on section it is found to be tough,
firm, of a greenish color and containing an overgrowth of fibrous
tissue. If it affects the left side the heart may be displaced. The
unaffected lung is usually enlarged (compensatory emphysema). There is
hypertrophy of the right ventricle of the heart.
=Symptoms.=—There is a chronic cough, which varies greatly in its
severity; moderate dyspnea, and a variable expectoration. There is
no fever and the general health of the patient may be preserved for
a number of years. The expectoration is generally copious, muco- or
sero-purulent, rarely fetid. There is retraction of the affected
side, displacement of the apex beat and lateral curvature of the
spinal column. The unaffected side is enlarged. The intercostal spaces
disappear, the ribs sometimes even overlapping. The tactile fremitus
is generally increased, but if the pleural membrane is thickened the
fremitus may be decreased. There is generally impairment of resonance.
A tympanitic or amphoric note may be heard over a dilated bronchus.
On the sound side the percussion note is generally hyperresonant. The
breathing sounds may be feeble. They may be bronchial or cavernous, but
rather amphoric. Late in the disease cardiac murmurs are not uncommon.
=Diagnosis.=—This is never difficult. It is mainly to be distinguished
from =fibroid phthisis=. In the latter both lungs are involved
and there is fever and bacilli are found in the sputum. An X-ray
examination should be made.
=Prognosis.=—The disease is exceedingly chronic and may last for many
years. Death may result from gradual failure of the right heart,
hemorrhage or from intercurrent attacks of acute pneumonia involving
the other lung.
=Treatment.=—Little can be done for this condition. Intercurrent
bronchitis may be somewhat relieved by the treatment for chronic
bronchitis. The patient should dwell in a mild climate. Hygienic
surroundings and nutritious food are indicated. Something can be done
by attempting to correct the condition of the ribs and vertebræ, but
this measure, from the nature of the disease, is generally palliative
at best.