BRONCHITIS.
Definition. — Au inflammation of the mucous membrane of the bronchi, usu ally including the trachea. It occurs as a primary affection or as a feature of many general diseases, especially the exanthemata.
Varieties.—Bronchitis may be sub divided into four distinct forms: the acute, in which the inflammatory process is more or less severe, but of limited duration; the chronic, in which organic changes in the mucous membrane main tain the activity of the final stage of the previous form; the foetid, which differs from the two previous forms by the foetid odor of the sputa; the fibrinous, or plastic, which is characterized by the presence of pseudomembranous casts formed in the bronchi.
Capillary bronchitis, so-called, being in reality a form of catarrhal pneumonia, will be treated under PNEUMONIA.
Acute Bronchitis.
Symptoms.—The course of acute pri mary bronchitis is fairly uniform. After exposure to cold, wet, or, oftentimes, to a close atmosphere, there is a feeling of malaise accompanied by chilly sensa tions or, more rarely, a pronounced chill. Within a short time slight fever devel ops, and coincidentally with this or shortly afterward a. feeling of constric tion or oppression beneath the sternum, which is intensified by deep inspiration.
Cough soon appears, but is at first dry, harassing, and not productive of relief. The temperature is usually elevated by a few degrees, but in children may rap idly rise to 102° or 103° F. In the course of twenty-four hours the cough increases in severity, and by the end of that time is accompanied by the expec toration of a small quantity of glairy mu cus produced only by inordinate effort. Gradually the cough becomes softer, the expectoration increases in amount and becomes opaque and finally yellowish. As expectoration increases the substernal discomfort lessens, the general feeling of illness diminishes, and the tempera ture falls to almost, if not quite, the normal point. After three or four days (sometimes sooner) the only symptoms remaining are frequent cough and a rather copious expectoration of yellow ish-white muco-purulent material occa sionally appearing as distinct clumps.
The cough gradually lessens, the expec toration becomes less profuse, until finally the patient recovers completely after the course of a week or ten days.
In cases running a short course the mucous membrane probably becomes at once normal, although one attack of bronchitis frequently leaves behind it a certain susceptibility.
In children the initial general symp toms are more severe, the temperature elevation is greater, there is no visible expectoration until the fourth or fifth year, and vomiting is more frequent. Catarrhal pneumonia and atelectasis are frequent complications which may cause a fatal termination.
In the aged there is but little general disturbance at the outset, but the disease is apt to assume a subacute or chronic course, or the disease may end fatally in those enfeebled by advanced years or structural disease in other parts.
Physical examination in the early stages may show nothing or merely a few scattered sibilant riles. The respirations are slightly increased in frequency and a little more shallow than in health, ex cept in infants, where the respiratory rate may be greatly increased. In the course of the first twenty-four hours there develop sibilant riles over areas on both sides of the chest, but especially in the spinal gutter. These riles rapidly shift their position and may be either produced or dissipated by the act of coughing. As the swelling of the mu cous membrane increases or mucus is secreted in sufficient amount to mate rially alter the calibre of the larger tubes, sonorous riles appear. The outpouring of mucus in larger amounts causes the appearance of moist, mucous riles in ad dition. In the absence of involvement of the pulmonary parenchyma percussion gives negative results. Palpation fre quently, especially in children, reveals a coarse fremitus, which may be found to disappear after free expectoration or vomiting. The occurrence of complicat ing pneumonia or atelectasis produces the signs peculiar to those conditions.