Bronchorrhcea, so-called, designates but an exaggerated flow of the bron chial secretions. These may be more or less watery, mucoid, or muco-purulent. As much as six pints have been expec torated in one day by a single patient.
On physical examination but little may be found in the "dry" form. Other wise the findings will depend upon the extent and duration of the disease and the presence or absence of its consequences upon the remainder of the respiratory apparatus. In uncomplicated cases in spection gives 110 result. On palpation a strong fremitus may be felt from the vibration of mucus within the air-tubes. The bubbling and rattling of this mate rial may be audible at a distance. On percussion there is no change unless the pulmonary structure is already involved or bronchiectases have formed. On aus cultation loud bubbling and mucous or sibilant and sonorous rules are heard, which shift their position or may be en tirely dissipated by cough. Sometimes the breath-sounds over one portion of the lung may be feeble for a time from partial obstruction by mucus to the en trance of air. The diagnosis presents no difficulties if careful examination of the chest and of the sputum be made.
Etiology.—The chronic form is pro duced by the same causes as those men tioned under acute bronchitis acting for a longer time or frequently repeated. Insanitary surroundings, debility, and possibly inherited vulnerability are strong predisposing factors. Gout would seem also to be to some extent a pre disposing cause. Antral disease and enlargement of the tracheo-broncbial glands are contributing conditions be cause of their causing interference with the return-flow of blood and lymph from the bronchial tree.
Chronic bronchitis is very apt to be found in the two extremes of age. In children it may be associated with ad enoid vegetations and enlarged lymphat ics and hypertrophied tonsils. Among older persons the more common causes of chronic bronchitis, aside from lym phatic and scrofulous tendencies, are the gouty diathesis, insufficient action of the heart, emphysema, and asthma.
Six cases of bronchitis and broncho pneumonia caused, respectively, by chlorine-gas, sulphurous-acid gas, for maldehyde, kerosene-smoke, and smoke containing some unknown acid fumes.
In the first three cases the irritants had only caused bronchitis, while in the last three broncho-pnenmonia developed. The writer concludes that the above forms of bronchitis are much more painful in the beginning than the or dinary kind. They are likely to have loud, rough, wheezing rules, and, in the case of certain chemicals, fine, moist ones as well. This form of bronchitis may easily go on to a broncho-pneu monia. Hall (Phila. Med. Jour., Dec. 20, 1002).
Pathology.—The appearance of the bronchi differs much in accordance with the duration and severity of the disease. In the mildest forms the mucous mem brane is of a dull-red or slate color, thickened, and corrugated longitudi nally. In more severe or long-standing cases atrophy of the mucous membrane is present in places; and this atrophy may extend to the deeper layers of the tubes. Consequent upon this atrophy there is dilatation of varying degrees (see BRONCIIIECTASIS). When all of the coats are involved, infiltration and fibrosis of the surrounding connective tissue takes place, giving rise to one variety of fibroid disease of the lung. in elderly people the cartilaginous rings frequently undergo calcification, render ing the tubes rigid. Ulceration may oc cur, but is rare unless bronchiectasis has occurred or there is tuberculous or syph ilitic infection. Other organs are in volved secondarily, such as the right side of the heart (hypertrophy or dilata tion) or the pulmonary structure (em physema, fibroid disease).
Histologically sections of the bron chi show marked proliferation of the epithelial layer, or, in long-standing cases, great denudation thereof. New formation of connective tissue within the tissue proper of the bronchi and in the peribronchial connective tissue is seen to an extent corresponding to the duration of the disease. Commensurate with the fibroid change in the walls there is atrophy of the proper cellular ele ments.