Page:The American Cyclopædia (1879) Volume III.djvu/316

 810 BRONCHITIS chronic. By German and French writers, in- flammation here, as in other mucous mem- branes, is called catarrh. The term bronchial catarrh means neither more nor less than inflam- mation of the bronchial mucous membrane, or bronchitis. Acute or subacute bronchitis is the affection popularly known as a cold in the chest. It is generally preceded by an inflam- mation of the mucous membrane lining the nostrils (coryza), and not infrequently by in- flammation of the pharynx (pharyngitis) and of the larynx (laryngitis). In a certain pro- portion of cases, however, the inflammation attacks the bronchial membrane without affect- ing the parts situated above. The extension of inflammation from the mucous membrane above the bronchial tubes to the latter may often be prevented by an opiate at bedtime, followed by a hot, stimulating drink to excite free perspiration. The Russian or Turkish bath, also, seems sometimes under these cir- cumstances to prevent the supervention of bronchitis. In acute bronchitis the inflamma- tion, limited to the larger tubes, gives rise at first to a dry cough, which is especially excited by breathing cold air, and by taking a deep inspiration. The cough is usually loud and sonorous. There is a sense of soreness and of constriction on coughing, felt beneath the ster- num or breast bone. The expectoration at first is small, viscid, and not infrequently streaked with blood. There is little or no em- barrassment in breathing ; the patient does not suffer from a sense of the want of air, and the respirations are little if at all increased in fre- quency. There is only slight fever, as denoted by the pulse and the thermometer in the arm- pit. The lassitude and debility are often not sufficient to lead the patient to take to the bed. Chilly sensations followed by flashes of heat occur, and the appetite is more or less impaired. In from two to four days the expectoration be- comes more or less abundant ; and it now con- sists of solid masses (sputa) of a yellowish or greenish color. The acts of expectoration are easier. The cough is said to be loos.e. The substernal soreness and constriction diminish ; and the fever, together with other evidences of constitutional disturbance, gradually disap- pears. The duration of the affection is from six to twelve days. The symptoms are essen- tially similar in acute and subacute bronchitis, except that in the latter they are less marked. Subacute bronchitis occasions so little local and general disturbance as rarely to lead persons to remain within doors. In acute bronchitis it is prudent, if not necessary, for patients to keep within doors ; and confinement to the bed for a few days is sometimes judicious. A saline purgative is often serviceable. Moderate counter-irritation to the chest, as by the ap- plication of mustard, is useful. Anodynes to allay cough, and remedies promoting gentle perspiration, afford relief, and hasten the pro- gress toward recovery. The Russian bath, if available, may be resorted to with advantage ; and the inhalation of warm vapor promotes expectoration and affords relief. After infancy an ordinary bronchitis is never of itself danger- ous. If it prove a serious affection, it is in consequence of its occurrence in connection with other and graver diseases, or in persons enfeebled by age or other causes. In such cases, the danger connected with the bronchitis relates chiefly to the inability to expel the mucus from the bronchial tubes by coughing. If the efforts for expectoration are ineffectual from any cause, the inflammatory products may accumulate within the tubes sufficiently to ob- struct the free passage of air to the air cells, and consequently to destroy life by interference with the function of respiration. In early in- fancy it is sometimes a grave affection in con- sequence of a greater liability to obstruction of the bronchial tubes, and the occurrence of collapse of pulmonary lobules as a result of this obstruction. These effects are more liable to occur in infants, on account of their feebleness, and the want of voluntary efforts to expecto- rate. Bronchitis, excepting where it is second- ary to some other pulmonary disease, belongs in the class of affections called symmetrical ; that is, the bronchial tubes in each side of the chest are equally affected. It is, in other words, a bilateral disease. As implied in the popular name, "a cold," it is generally attrib- uted to exposure to atmospherical changes in temperature. In certain cases it seems clearly to be thus produced. A continued current of air upon a portion of the body is especially apt to produce it. From its frequent occurrence, however, when it cannot be traced to exposure to cold, and from the fact that a considerable number of persons are often affected simultane- ously, the disease not prevailing sufficiently to be called an epidemic, it may be reasonably inferred that the causation involves the presence in the atmosphere of some morbific agency not yet ascertained. Owing to a peculiar susceptibility of the mucous membrane of the air passages, constituting a curious idiosyncrasy, some per- sons are affected by bronchitis, often associated with asthma, during the summer season; the cause being evidently vegetable emanations in the atmosphere, as these persons escape an at- tack on going to sea or to places where there is little or no vegetation. As thus produced, the affection is known as hay bronchitis, hay asthma, and hay fever. The emanations are however by no means derived exclusively from hay. The powder of ipecacuanha, emanations from feathers, &c., give rise to bronchitis, usu- ally accompanied with asthma; in some persons, irritating gases or vapors when inhaled are traumatic causes. It is an important fact that the liability to " take cold " is as a rule less in proportion as the habits involve out-of-door life. In medical practice, ordinary bronchitis is to be discriminated from other inflammatory affections giving rise to cough and expecto- ration, with fever and other symptoms deno- ting constitutional disturbance. "With refer-