Ulceration, ampullar dilatation of the bronchi, pneumonia, pleurisy, gangrene, and metastatic purulent deposits in other regions are the main complications of this stage of bronchitis. Abscess of the brain may thus become the cause of death.
Etiology and Pathology.—It is prob able that in all cases retention of the secretion, with bacterial activity, is the cause of the fcetor. Leyden and Jaffe found small rod forms, to which they gave the name "leptothrix pulmonalis." They also noticed in the putrid sputum spirilla and infusoria. Lum niczer describes a short, somewhat curved bacillus, which he found in great numbers in the plugs of pus and detritus expectorated, which give the sputum its characteristic foul odor. More recently IIitzig isolated two species of bacillus, the one presenting the characteristics of the eoli bacillus—short, thick rods— did not liquefy in gelatin; was found pathogenic for guinea-pigs and rabbits. The second did not liquefy in gelatin and was pathogenic for mice and guinea pigs. This question may still be said to be sub judice.
Besides the causative factors acting in the case of chronic bronchitis, re peated exposure to dust, especially that originating from dyed woolens or cotton fabrics, is prone to lead to the fcetid form: a mere complication of those already described.
Treatment —The agents recommended in chronic bronchitis are also valuable here, especially the balsams, terpine, tur pentine, or terebene. Five to 10 min ims of the latter in capsules, taken after meals, are very effective in most cases. The preparations of tar, already mentioned, are also valuable. In cases in which the foetid expectoration only occurs at intervals, sandal yields gratify ing results. Narcotics should be avoided. Hyposulphite of soda has been highly extolled; it promptly changes the char acter of the expectorated material and thus eliminates the fcetor.
Naphthalin is an excellent remedy in foetid bronchitis. Following mixture may be given:— 13 Naphthalin, 1 drachm.
Absolute alcohol, Syr. of wild cherry, of each, fluidounees.
Fl. ext. of squill, 4 fluidrachms.
Tinct. of aconite, S drops. Teaspoonful every three hours.
The following capsules may be also taken with the above :— 13 Iodoform, Calcium phosphate, of each, 24 grains.
Powd. ipecac, Ext. of hyoscyamus, of each, 6 grains.
Powd. opium, 4 grains.
Oil of anise, 10 drops.
Divide into twenty-four capsules. One every three hours. Pirnot (St. Louis Med. Era, Sept., 1000).
Intratracheal injections have been rec ommended, the agents used—menthol, camphor, etc.—being dissolved in oil or albolene. A Pravaz syringe with a long curved tip, which may readily be in troduced into the larynx, is used. Fif teen to 30 minims are well borne, and if properly applied excite comparatively no cough. Nitrate-of-silver solutions of varying strengths have also been em ployed, but one exceeding 10 grains to the ounce is apt to excite laryngeal spasm. Still, much stronger solutions have been employed with impunity.
Fibrinous, or Plastic, Bronchitis.
In this variety the secretion from the mucous membrane tends to form co herent casts of the bronchial tree.
Symptoms. — Fibrinous, or plastic, bronchitis is characterized by the occur rence of paroxysms of cough and dysp ncea, which immediately cease on the expectoration of the casts. The par oxysms are usually preceded and fol lowed by a sort of catarrh. Themop tysis may be absent or it may be very serious. It usually ceases at once with the ejection of the casts. As a general thing, but little pain is present, except that caused by coughing. In acute cases the temperature may rise to 104° F.; in chronic cases it is seldom above nor mal. Sometimes the onset of an attack is marked by one or more rigors: sug gestive of pneumonia. As a rule, each attack consists of a number of short par oxysms. It may subside after a few days never to recur again, or may last continuously for ten, fifteen, or twenty years. (West.) Auscultation and percussion reveal signs similar to those witnessed in chronic catarrhal bronchitis, but they occupy a limited area like those of ob structed bronchioles; from time to time, intense paroxysmal cough occurs, accom panied with dyspncea and cyanosis, end ing in the expectoration of the pathog nomonic sputa.