disease cough acute chronic bronchial tubes chest sounds particularly symptoms
BRONCHITIS, inflammation of the mucous membrane of the bronchial tubes. Well known as one of the most common diseases of the climate of Great Britain, bronchitis exists in either an acute or a chronic form.
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. The disease usually manifests itself at first in the form of a catarrh, or common cold ; but the accompanying feverishness and general constitutional disturbance proclaim the attack to be something more severe, and symptoms denoting the onset of bronchitis soon present themselves. A short, painful, dry cough, accompanied with rapid and wheezing respiration, a feeling of rawness and pain in the throat and behind the breast bone, and of oppression or tightness throughout the chest, mark the early stages of the disease. In some cases, from the first, symptoms of the form of asthma known as the bronchitic are superadded, and greatly aggravate the patient's suffering. See ASTHMA.
After a few days expectoration begins to conic 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 seine 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 riles. 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 sonic degree of ow elling, 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 riles 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. 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.
During life, in addition to the auscultatory signs present in ordinary bronchitis, there generally exist in this form of the disease abundant fine moist riles at the bases of both lungs ; and the appearance of these organs after death shows the minute bronchi and many of the air-cells to be filled with matter similar to that which had been expectorated, and which has thus acted as a mechanical hindrance to the entrance of the respired air and caused death by asphyxia.
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 yowl; 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 hart 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 hooping-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 winch 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 plugginab 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 warns 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, such as the well-known Mindererus spirit, combined with antimonial or ipecacuan wine, are highly serviceable in the earlier stages. Later on, with the view of soothing the pain of the cough, and favouring expectora• tion, mixtures containing squill or 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 inure 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, indeed, it is to be feared that fatal results not unfrequently follow their incautious use in this way.
From the outset of the attack the employment of warm applications to the chest in the form of fomentations or poultices affords great relief. Few remedial measures are of greater value than the frequent inhalation of steam. This is accomplished readily enough in the case of adults by the use of an inhaler or simply by breathing over an open-mouthed vessel containing boiling water. In children in whom this plan cannot be carried out in the same manner, there is in general no difficulty in surrounding them with an atmosphere of steam by placing around them vessels containing hot water, the vapour from which envelopes them. The relief to the cough and breathing, and the aid to expectoration afforded by this simple plan, are often surprising, and the cases are rare where it cannot be borne.
Should the cough persist for a length of time, and the disease threaten to become chronic, counter-irritant applica tions to the chest in front and behind, in the form of stimulating liniments, or even of blisters, will be rendered necessary.
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 or squill 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.
Chronic bronchitis may arise as the result of repeated attacks of the acute form, or it may exist altogether independently. It occurs more frequently among persons advanced in life than among the young, although no age is exempt from it.
The usual history of this form of bronchitis is that of a cough recurring during the colder seasons of the year, and in its earlier stages, departing entirely in summer, so that it is frequently called "winter cough." In many persons subject to it, however, attacks are apt to be excited at any time by very slight causes, such as changes'in the weather ; and in advanced cases of the disease the cough is seldom altogether absent.
The symptoms and auscultatory signs of chronic bronchitis are on the whole similar to those pertaining to the acute form, except that the febrile disturbance and pain are much less marked. The cough is usually more troublesome in the morning than during the day. There is usually free and copious expectoration, and occasionally this is so abundant as to constitute what is termed bronchorriaea.
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 fetid 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. Chronic bronchitis is liable in some instances, particularly when accompanied with loss of flesh and strength, to be mistaken for consumption ; but the physician who carefully regards the history of the case and observes the physical signs and symptoms, will in general be able to distinguish the one disease from the other.
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.
Chronic bronchitis does not often prove directly fatal, nor is it necessarily inconsistent with long life. Its chief danger lies in the tendency to iutercurrent acute attacks, particularly in the aged; and in this manner it very frequently causes death.
The treatment to be adopted in chronic bronchitis depends upon the severity of the case, the age of the patient, and the presence or absence of complications. Attention to the general health is a matter of prime importance in all cases of the disease, more particularly among persons whose avocations entail exposure, and tonics with cod-liver oil will be found highly advantageous. The use of a respirator in very cold or damp weather is a valuable means of protection. In those aggravated forms of chronic bronchitis, where the slightest exposure to cold air brings on fresh attacks, it may become necessary, where cireumWhen expectoration is attended with difficulty, such remedies as squill in combination with ammonia may prove useful. When, on the other hand, bronchorrhcea exists, astringents are called for. The inhalation of vapour containing iodine or turpentine is often followed with marked benefit in this way. Where breathlessness accompanies the disease, besides the use of ethereal preparations, marked relief is often derived from large doses of iodide of potassium. Counter-irritation to the chest with turpentine, mustard, or croton oil is generally attended with good results. In aged and weak persons stimulants are an indispensable part of the treatment. Acute exacerbations of the disease, which are so apt to arise in the chronic form, must be dealt with on the principles already indicated in treating of acute bronchitis. (J. 0. A.)