Page:EB1911 - Volume 04.djvu/658

 After a few days expectoration begins to come with the cough, at first scanty and viscid or frothy, but soon becoming copious and of purulent character. In general, after free expectoration has been established the more urgent and painful symptoms abate; and while the cough may persist for a length of time, often extending to three or four weeks, in the majority of instances convalescence advances, and the patient is ultimately restored to health, although there is not unfrequently left a tendency to a recurrence of the disease on exposure to its exciting causes.

When the ear or the stethoscope is applied to the chest of a person suffering from such an attack as that now described, there are heard in the earlier stages snoring or cooing sounds, mixed up with others of wheezing or fine whistling quality, accompanying respiration. These are denominated dry sounds, and they are occasionally so abundant and distinct, as to convey their vibrations to the hand applied to the chest, as well as to be audible to a bystander at some distance. As the disease progresses these sounds become to a large extent replaced by others of crackling or bubbling character, which are termed moist sounds or râles. Both these kinds of abnormal sounds are readily explained by a reference to the pathological condition of the parts. One of the first effects of inflammation upon the bronchial mucous membrane is to cause some degree of swelling, which, together with the presence of a tough secretion closely adhering to it, tends to diminish the calibre of the tubes. The respired air as it passes over this surface gives rise to the dry or sonorous breath sounds, the coarser being generated in the large, and the finer or wheezing sounds in the small divisions of the bronchi. Before long, however, the discharge from the bronchial mucous membrane becomes more abundant and less glutinous, and accumulates in the tubes till dislodged by coughing. The respired air, as it passes through this fluid, causes the moist râles above described. In most instances both moist and dry sounds are heard abundantly in the same case, since different portions of the bronchial tubes are affected at different times in the course of the disease.

Such are briefly the main characteristics presented by an ordinary attack of acute bronchitis running a favourable course. The case is, however, very different when the inflammation spreads into, or when it primarily affects, the minute ramifications of the bronchial tubes which are in immediate relation to the air-cells of the lungs, giving rise to that form of the disease known as capillary bronchitis or broncho-pneumonia (see : Pathology; and ). When this takes place all the symptoms already detailed become greatly intensified, and the patient’s life is placed in imminent peril in consequence of the interruption to the entrance of air into the lungs, and thus to the due aeration of the blood. The feverishness and restlessness increase, the cough becomes incessant, the respiration extremely rapid and laboured, the nostrils dilating with each effort, and evidence of impending suffocation appears. The surface of the body is pale or dusky, the lips are livid, while breathing becomes increasingly difficult, and is attended with suffocative paroxysms which render the recumbent posture impossible. Unless speedy relief is obtained by successful efforts to clear the chest by coughing and expectoration, the patient’s strength gives way, somnolence and delirium set in and death ensues. All this may be brought about in the space of a few days, and such cases, particularly among the very young, sometimes prove fatal within forty-eight hours.

Acute bronchitis must at all times be looked upon as a severe and even serious ailment, but there are certain circumstances under which its occurrence is a matter of special anxiety to the physician. It is pre-eminently dangerous at the extremes of life, and mortality statistics show it to be one of the most fatal of the diseases of those periods. This is to be explained not only by the well-recognized fact that all acute diseases tell with great severity on the feeble frames alike of infants and aged people, but more particularly by the tendency which bronchitis undoubtedly has in attacking them to assume the capillary form, and when it does so to prove quickly fatal. The importance, therefore, of early attention to the slightest evidence of bronchitis among the very young or the aged can scarcely be overrated.

Bronchitis is also apt to be very severe when it occurs in persons who are addicted to intemperance. Again, in those who suffer from any disease affecting directly or indirectly the respiratory functions, such as consumption or heart disease, the supervention of an attack of acute bronchitis is an alarming complication, increasing, as it necessarily does, the embarrassment of breathing. The same remark is applicable to those numerous instances of its occurrence in children who are or have been suffering from such diseases as have always associated with them a certain degree of bronchial irritation, such as measles and whooping-cough.

One other source of danger of a special character in bronchitis remains to be mentioned, viz. collapse of the lung. Occasionally a branch of a bronchial tube becomes plugged up with secretion, so that the area of the lung to which this branch conducts ceases to be inflated on inspiration. The small quantity of air imprisoned in the portion of lung gradually escapes, but no fresh air enters, and the part collapses and becomes of solid consistence. Increased difficulty of breathing is the result, and where a large portion of lung is affected by the plugging up of a large bronchus, a fatal result may rapidly follow, the danger being specially great in the case of children. Fortunately, the obstruction may sometimes be removed by vigorous coughing, and relief is then obtained.

With respect to the treatment of acute bronchitis, in those mild cases which are more of the nature of a simple catarrh, little else will be found necessary than confinement in a warm room, or in bed, for a few days, and the use of light diet, together with warm diluent drinks. Additional measures are however called for when the disease is more markedly developed. Medicines to allay fever and promote perspiration are highly serviceable in the earlier stages. Later, with the view of soothing the pain of the cough, and favouring expectoration, mixtures of tolu, with the addition of some opiate, such as the ordinary paregorics, may be advantageously employed. The use of opium, however, in any form should not be resorted to in the case of young children without medical advice, since its action on them is much more potent and less under control than it is in adults. Not a few of the so-called “soothing mixtures” have been found to contain opium in quantity sufficient to prove dangerous when administered to children, and caution is necessary in using them.

From the outset of the attack the employment of fomentations, or especially a turpentine stupe, gives great relief, and occasionally in the non-specific form this treatment, combined with a good dose of calomel and salts, may render the attack abortive. Some relief is always obtained by inhalations, and theoretically, an acute specific bronchitis should be successfully treated by inhalation of antiseptic and soothing remedies. In practice, however, it is found that the strength cannot be sufficiently strong to destroy the bacteria in the bronchial tubes. However, much relief is obtained from the use of steam atomizers filled with an aqueous solution of compound tincture of benzoin, creosote or guaiacol. A still more practicable means of introducing volatile antiseptic oils is the globe nebulizer, which throws oleaginous solutions in the form of a fine fog, that can be deeply inhaled. Menthol, eucalyptol and white pine extract are some of the remedies that may be tried dissolved in benzoinol, to which cocaine or opium may be added if the cough is troublesome.

When the bronchitis is of the capillary form, the great object is to maintain the patient’s strength, and to endeavour to secure the expulsion of the morbid secretion from the fine bronchi. In addition to the remedies already alluded to, stimulants are called for from the first; and should the cough be ineffectual in relieving the bronchial tubes, the administration of an emetic dose of sulphate of zinc may produce a good effect.

During the whole course of any attack of bronchitis attention must be paid to the due nourishment of the patient; and during the subsequent convalescence, which, particularly in elderly persons, is apt to be slow, tonics and stimulants may have to be prescribed.