Bronchitis

“ By mechanical bronchitis is meant those cases in which the inflammation is caused by the direct action of mechanically irritating substances floating in the inspired air, as fine particles of steel and other metals, particles of stone, charcoal, and various vegetable powders and fungi. Such substances, when inhaled, are liable to impinge on the surface of the bronchial membrane and produce direct irritation and inflammation, both acute and chronic. ”

“ In bronchitis the skin is warm, but moist; in inflammation of the lungs it is hot and dry: in bronchitis the mouth is warmer than usual, but moist; in inflammation of the lungs it is burning hot: in bronchitis the breathing is rather hurried, and attended with wheezing; in inflammation of the lungs it is very short and panting, and is unaccompanied with wheezing, although occasionally a very slight crackling sound might be heard: in bronchitis the cough is long and noisy; in inflammation of the lungs it is short and feeble: in bronchitis the child is cross and fretful ”

“ The temperature is the best guide in such cases; if it is above normal (983/5° F.) the patient should stay indoors. In infants, young children, enfeebled or elderly people, bronchitis may be a serious matter, and may be followed by pneumonia by extension of the inflammation from the small bronchial tubes into the air sacs of the lungs, and infection with the pneumonia germ. The principal signs of severe attacks of bronchitis are rapid breathing, fever, and rapid pulse.
The normal rate of breathing in adults is seventeen a minute, that is, seventeen inbreaths and seventeen outbreaths. ”

“ Simple bronchitis is usually connected with climatic change or exposure, tends to affect a number at once, gives the blowing and mucous râles, without indications of extended lung consolidation or pleural effusion, and after death does not furnish lesions of all ages, recent and remote. ”

“ In bronchitis inflammation affects the lining of the air-tubes, travelling from the larger towards the smaller, and in bad cases extending even to their termination in the minute air-cells. The inflammation leads to the pouring out of a secretion, which by degrees becomes thick like matter, or even very tenacious, almost as tough as though it were a thin layer of skin. ”

“ It is universally conceded that bronchitis, as well as inflammation of all other parts of the mucous membrane lining the air-passages, prevails most in such countries as are characterized by a cold, damp, and variable climate. ”

“ That broken wind is a frequent concomitant or sequel of chronic bronchitis is undeniable, and theoretically nothing is more likely to cause dilatation and rupture of the air cells and consequent impairment of the innervation and contractility of the lung than violent fits of coughing, while the bronchial tubes have thickened and friable walls, or are partially plugged by tenacious mucus. ”

“ Chronic bronchitis leads to alterations of structure in the affected bronchial tubes, their mucous membrane becoming thickened or even ulcerated, while occasionally permanent dilatation of the bronchi takes place, often accompanied with profuse foetid expectoration. In long-standing cases of chronic bronchitis the nutrition of the lungs becomes impaired, and dilatation of the air-tubes (emphysema) and other complications result, giving rise to more or less constant breathlessness. ”

“ In the later stages of the illness areas of impaired note or of actual dullness may be found, particularly over the posterior aspects of the lungs, associated with bronchial breathing and crepitant râles. These may be due to the progression of the purulent bronchitis into hypostatic pneumonia, or into actual bronchopneumonia at the bases; or, on the other hand, they may be due to massive collapse of the lungs secondary to the bronchitis and obstruction of the bronchioles by pus. ”

“ The relation between such lung diseases as bronchitis and pneumonia and the unwholesome condition of the air of our dwellings has not been sufficiently recognized by the medical profession and the public. One of the most common causes of an attack of bronchitis is a Budden exposure of the bronchial mucous membrane to extreme conditions of air. A man who breathes for some hours the hot and dry vitiated air of an unventilated room is prone to be thus affected on passing out into cold, damp night air. ”

“ Acute bronchitis, like other inflammatory affections of the chest, generally arises as the result of exposure to cold, particularly if accompanied with damp, or of sudden change from a heated to a cool atmosphere. The symptoms vary according to the severity of the attack, and more especially according to the extent to which the inflammatory action spreads in the bronchial tubes. ”

“ For the first few years chronic bronchitis is usually found alone, and unaccompanied by disease of the body or lungs. The patient suffers more or less difficulty of breathing, which is affected by changes of the weather, and by variations in the weight of the atmosphere. He coughs frequently, and the expectoration is composed, for the most part, of white frothy and yellowish mucous fluid, occasionally containing blackish particles of carbon, the result of the combustion of the lamp, and also of minute coal-dust. ”

“ This care is essential not only in idiopathic bronchitis, but in those general diseases, such as measles and whooping cough, in which bronchitis is constantly present. As children of bad constitution and those exposed to depressing hygienic conditions, such as over-crowding, bad air, and the like, are most liable to become attacked with this form of pneumonia during the course of a bronchitis, it is especially in such cases that our precautions must be most stringent. ”

“ Chronic bronchitis in the ox is characterized by a persistent disturbance of the respiration, paroxysms of coughing, a white flocculent discharge from the nose, increasing emaciation, pallor of the mucous membranes, a mucous râle over the windpipe and median part of the chest and a cooing sound over other points. If left to itself emaciation becomes extreme, the skin is harsh, inelastic, attached to the ribs and covered by vermin, and death usually ensues from diarrhœa or consumption. ”

“ When the disease is diffused and general, bronchitis is sooner or later almost always encountered, and is then of a congestive rather than an inflammatory type, being often unaccompanied by fever, and in part due to interference with the circulation through the smaller bronchial arteries. ”

“ In the improved breeds the lungs remain larger than the exigencies of the life demand, and large portions remain out of use. In bronchitis the condition is acquired, and is mainly dependent on the blocking of a bronchial tube with tenacious mucus or a desiccated mass. The pathological lesions of bronchitis favor this since one of the earliest changes in the inflamed mucosa is the desquamation of the columnar epithelium. ”

“ Inhaling cold air after sitting in a close atmosphere, will induce an attack of bronchial inflammation, or thickening of the air-tubes, in persons of all classes and conditions. Persons who are liable to frequent attacks of bronchitis, are apt to imagine that their lungs are affected, since it prevents a free use of the voice in singing or speaking audibly. I will repeat that this complaint generally terminates with a loss of tone in the lung substance, caused by the failure of the tubes to supply them with oxygen or air ”

“ This lack of forced respiration is a frequent cause of acute bronchitis running into a chronic form.
In chronic bronchitis it is especially in the lower part of the lungs that stagnation of the secretions takes place, [Pg 169] and they can only be dislodged from the mucous membrane by forced abdominal expiration and the ascent of the diaphragm. This causes a cough which expels the mucus, and forcible abdominal expiration and cough are the only means of drainage of the lower and deep-seated parts of the lungs. ”

“ A dangerous symptom which sometimes arises in the course of the chronic bronchitis accompanying emphysema is profuse bronchial catarrh, which may destroy life by producing apnoea, the surface becoming cold and the pulse feeble and vanishing as the patient seems to be drowning in his own secretion. ”

“ Chronic bronchitis may arise secondarily to some other ailment. This is especially the case in Bright’s disease of the kidneys and in heart disease, of both of which maladies it often proves a serious complication, also in gout and syphilis. The influence of occupation is seen in the frequency in which persons following certain employments suffer from chronic bronchitis. Hirt has shown that the inhalation of vegetable dust is very liable to produce bronchitis through the irritation produced by the dust particles and the growth of organisms carried in with the dust. ”

“ The chief distinguishing symptoms are the abundance and nature of the discharge, the fetor of the breath, and the presence of the mucous râle in the chest. It is one of the conditions known by the horseman’s expression “thick wind.”
Treatment. Like its type (dilatation of the bronchia, bronchiectasis) in man this disease obstinately resists treatment. In our efforts to cure it the same general principles must be followed as in acute bronchitis, with this grand qualification that the general aim must be to stimulate and support. ”

“ It is most usually met with in middle-aged or old people. Cough, shortness of breath and expectoration, are the three most constant symptoms of chronic bronchitis. This disease may occur as a consequence of old age merely, or it may come on as a sequel to an attack of acute bronchitis. Cab-porters, costermongers, bargemen, and others whose occupation exposes them to all kinds of bad weather, are extremely subject to this disease.
Treatment—Removal of the sufferer to a warmer climate for the winter and spring, if possible. ”

“ Chronic or Recurrent Bronchitis.—Bronchitis becomes chronic when the treatment of an acute attack fails to cure the condition. The failure usually is dependent upon the condition of the child. It may be suffering with some disease resulting from poor nourishment or poor sanitary and hygienic surroundings or both. The bronchitis, in other words, is dependent upon some other condition, and will not get wholly better until the cause is cured. These children should lead an active outdoor life when the weather is favorable. Their sleeping-room should be well aired and ventilated. ”

“ Bronchitis is another complaint which calls for change of air. There are persons who contract a cough regularly at the beginning of every winter, which disappears only with the warm spring days. They hawk, and expectorate, and have pains in the breast, and a sore and tickling throat all the cold months. This is bronchitis, chronic bronchitis. Clergymen are very liable to it from neglect of precautions in using the voice. It is quite common among elderly people, and often paves the way for their final illness. In young persons it portends consumption. ”

“ Bronchitis is always developed out of previous catarrh, though there is a wide difference between the duration of the preliminary stage and the occurrence of serious symptoms in different cases; while it may be laid down as a general rule that the severity and danger of an attack are in proportion to the rapidity of its onset. An attack of pneumonia, or inflammation of the lung-substance sets in, as a rule, more suddenly, with fever, a temperature of 103° to 105°, general distress, headache, not unfrequently delirium ”

“ A simple bronchitis, possessing nothing specific in its origin at least, will persist and extend to the lobuli of the lung and excite a catarrho-pneumonia which ends in consumption and death; a simple intestinal catarrh will result in inflammation and caseation of the mesenteric glands—a tabes mesenterica ”

“ Henry James and Coulter got back Monday from their trip to Boulogne. Henry said [Pg 130] it was well worth while and seems to have enjoyed it very much.
Every one is coughing. Bronchitis is rife, and is running a very virulent course. An autopsy on one of the men yesterday showed the bronchia to be filled with pus. This was especially true in the smaller ramifications. They die from an apparent sepsis and are fine examples of a purulent bronchitis. McW., James, Stillman are all coughing and sneezing. Practically all the younger men have been in hospital with bronchitis, or influenza. ”

“ The effects of bronchial narrowing or occlusion produce serious mischief in the lungs proportioned to the degree of obstruction. By the retention of the bronchial secretions the air-supply to the vesicles is interfered with; emphysema with or without asthmatic symptoms or atelectasis may ensue. Further, the results of bronchial narrowing affect the circulation through the lungs, and in combination with atelectasis very intractable local bronchitis may be developed ”

“ In the more mild form of bronchitis the symptoms develop rather gradually and the first noticed may be a coryza or nasal catarrh. As the bronchi become involved there will be a slight rise in the temperature, noticeably increased respiration, and a slight cough. There may be restlessness, anorexia and vomiting, usually caused by swallowing the mucous that is coughed up.
Rales are heard over the entire chest. These appear very early and may remain for some little time after all other symptoms have disappeared. It is very common to hear coarse rales with a very slight cold in the young infant. ”