Etiology. — Although syphilis and tuberculosis have been considered as etiological factors, it is probable that these diathetic affections were probably, in the cases reported, but concomitant disorders—manifestations originating in local and general depravity. indeed, in many cases no diathesis, inherited or acquired, could he discerned. There seems, however, to be a familial tend ency to the affection, several members of individual family having suffered from it as a result of bronchial catarrh. This sufficiently indicates how obscure is our knowledge of the causes of this affection. Plastic bronchitis occurs fre quently after pneumonia. In some cases it is associated with grave skin affections. There seemed in one case, also, to be a relation between the formation-casts and the catamenia. (Wrest.) Analysis of all the cases recorded in the literature show that they can be grouped in nine classes as follows: 1. Chronic bronchitis with expectoration of branching casts of the bronchial tree.
2. Acute bronchitis with expectoration of branching casts of the bronchial tree.
3. Cases in which branching casts were not expectorated, but were found in the bronchi at autopsy. 4. Casts ex pectorated, but not showing branching. 3. Branching casts expectorated asso ciated with organic heart disease. 6. Branching casts expectorated in pul monary tuberculosis. 7. Small east. often associated with asthma. S. Casts m the bronchi asso ciated with pulmonary aMeina following thoracentesis. Cases incompletely re ported.
The most important form is the first. and the results that it occurs in either sex. increases to middle age, and then declines, and in several eases the patients were to dusty atmos pheres. Occasionally some infectious disease precedes the attack. or there may be some chemical irritant, or a family history of tuberculosis. Nearly all the patients had suffered from chronic bronchitis for some time. The symptoms consist of an exacerbation of chronic catarrh. The disease is par oxysmal and may last for many years. The symptoms are dyspncea, cough, oc casionally slight fever, and very occa sionally hmmoptysis. The physical signs are not characteristic, there may be all types of rides, and the patient may emaciate considerably. The subjective symptoms are usually oppression and tightness until the cast is expectorated. A curious feature is that in many cases there has been an associated affection of the skin. Of those casts examined the majority were composed of mucin.
The bronchial mucous membrane usually does not show any characteristic change. In the acute form the symptoms arc somewhat similar, but there is usually a history of an acute infectious disease. Bettman (Amer. Jour. Med. Sciences, Feb., 1902).
Pathology.—The casts may be found rolled up in the form of balls in the sputum. On mixing the sputum with water the casts are unrolled and may be spread out with needles. In some cases they are associated with Cursch mann's spirals and Charcot-Leyden crystals. Bronchial casts are occasion ally seen in croupous pneumonia, in diphtheria, and in lmuoptysis, but these casts are to be explained other wise than as examples of fibrinous bron chitis. Eppinger has observed that in croupous exudation there seems to be a central condensed mass of exudate, which serves as a nucleus upon which are deposited successive layers of trans lucent fibrin. The mucous membrane is not infiltrated, as it is in a croupous exudation. Eppinger advanced the idea that on account of a chronic congestive catarrh of the bronchi the permeability of the walls of the vessels of the sub mucous connective tissue is increased and allows the fibrinogenous substance of the blood to escape. This transuda tion, moreover, is favored by the attenu ated epithelial covering of the tubes: a condition that is the direct result of the catarrhal inflammation present in nearly all these cases. The exact cause of this cast-formation has not been definitely determined. That the casts are com posed of mucus, and not of fibrin, has been definitely proved by Graudy. In a case in which the casts were expelled in great numbers Stirling found that the majority measured from 3 to 4 inches, some as much as 6 inches. They had evidently been deposited in successive layers and in concentric lamina?, which could be separated when dry. They consisted of coagulated albumin soluble in alkalies. They showed fibrillary mate rial, in the meshes of which were numer ous leucocytes and fat-globules, some htemocytes, and epithelial cells. Octa hedral crystals, said to be similar to those found in bronchitis asthma, have been observed by others, but the spirals seen by Curschmann were not found by Stir ling.
Case in which the autopsy showed that the pseuclomembranes extended from the posterior nasal outlets clear down to the third divisions of the bronchi. The only bacteriological ele ment found was the staphylococcus. J. Clover (Anna. des Mal. de ]'Oreille, du Larynx, etc., No. 5, '90).