Auscultation reveals diminished respiratory murmur, and in addi tion very frequently the numerous sibilant and sonorous, mostly expira tory ronchi just mentioned are heard over the entire lung. Percussion yields a loud hollow note and marked emphysema of the lungs, the bor der of which may extend to the eighth rib on the right side anteriorly. The pulse is small and unusually' accelerated. The temperature, on the other hand, is normal in pure bronchial asthma. During sleep, the dyspncea abates. Cough is frequently absent in the beginning; but, on the other hand, sets in towards the close of the attack when the ronchi become somewhat more loosened, bringing to light in older children a tough, purely mucus expectoration which contains Charcot-Leyden crystals, Curschmann's spirals, and many eosinophile cells. The attack lasts for several hours, but may also continue for days and exhaust the patient very much. Towards the close of the attack the dysplima rapidly subsides, emphysema and ronchi disappear. After weeks and months recurrences of the attacks frequently take place. The evil generally lasts for years-.
As already mentioned above, asthmatic bronchitis in children is much more frequently met with than pure bronchial asthma. There are indi viduals in whom every new attack of bronchitis (often febrile) immedi ately assumes; an asthmatic character, i.e., it begins with sonorous ronchi, moderate emphysema, and increased expiration. These asthmatic symptoms then gradually disappear with the resolution of the dry ca tarrh, and the usual remaining bronchitis gets well in a few days or weeks. These children suffer from this kind of bronchitis once or twice a year; and also in the intervals of freedom they are often somewhat short of breath and frequently have chronic nasal catarrh and adenoids.
The diagnosis is based on the acute pulmonary- emphysema and the expiratory dyspncea. A number of types of asthma originating from a nervous, hysterical, uremic, dy-speptic (asthma dyspepticurn), basis are thereby eliminated froin the beginning, as well as a number of diseases which predominantly cause inspiratory- dyspncea, such as spasm of the glottis, paralysis of the recurrent laryngeal nerves, stenosis of the tra chea, foreign bodies. Enlarged bronchial glands may also produce
attacks of dyspncea. Cardiac asthma causes no pubnonary emphysema; inspiration and expiration being equally dyspnceic. If the bronchial asthma is accompanied by catarrhal laryngitis, the clinical picture will show similarity with genuine laryngeal croup in which, however, inspiration is predominantly interfered with, the stenosis is more marked and develops gradually, and pulmonary emphysema and sibilant rfiles are absent. The disease in very young infants is more apt to simulate capillary bronchitis. Dyspnma on inspiration and expiration, marked inspiratory recessions, fever, moist, fine mucous ettles from the beginning, speak in favor of capillary- bronchitis.
The prognosis in individual cases is good. The predisposition to bronchial asthma may, however, remain during the whole lifetime and lead to the development of true emphysema. Frequently, on the other hand, towards puberty there may be an abatement and disappearance of the attacks.
Prophylaxis con.sists in the removal of adenoid vegetations, careful treatment of nasal and bronchial catarrhs, and eczema, strengthening and hardening of the system, much outdoor exercise, prolonged sojourn in the country or mountains, removal from large cities, curtailing of animal food, avoidance of overfeeding, abundant supply of vegetables and fruit. Prolonged milk diet and arsenical treatment are at times of utility.
The treatment has for its first object the relief of the attack, for which chloral hy:drate (frequently 0.25-0.5 Gm. (3-7 gr.) in enema) seems to be the most suitable. Also, codeine, or morphine, in older children is useful. For the relief of the dry catarrh, potassium iodide or sodium iodide (1.0-5.0 Gm. (15-75 gr.) succ. tiquirit 3.0-5.0: 100.0 (45-75 gr. to 3i oz.) 5 Gm. (75 gr.) 5 times daily-, not to be repeated) is of value. In eases which terminate tardily, ammon. bromat. 1.0-5.0 Gm.: 100 c.c. (15-75 gr. to 3i. oz.) may be tried, with warm vapors, and the further treatment of ordinary bronchitis. In frequently recurring asthma, systematic gymnastics of the lungs is often useful. In hay- asthma, Pollantin sometimes gives good results.