TRACHEAL AND BRONCHIAL CATARRH (BRONCHITIS) Occurrence and Etiology.—Caturrlad affections of the and of the bronchial tree are found with extraordinary frequency during the entire period of childhood, especially at the ages of six months to three years. Uncleanliness, poor sunless dwellings, lack of care (constant dorsal position in infants), promote its development to a very great extent. Abrupt changes in the weather, with heavy rains and raw winds during the cooler season of the year, produce an increased number of cases at this time. The prolonged stay in closed and heated rooms dur ing the winter,—lowering the Natality more and more,—reinforeed by the inclemency of the spring-weather, cause the majority of cases to develop during this season of the year. The infectious diseases rapidly increase in number during October, reach their maximum during Novem ber and December, and decrease very rapidly again during April (Horn burger). Colds exercise considerable influence. The normal mucous membrane of the trachea and the bronchi destroys the majority of the invading germs, and harbors only a few attenuated pathogenic bacteria (Diirek, Muller). The mucous membrane, weakened from whatever cause, is no longer capable of preventing the increase of the on-rushing bacteria; while in severe infections (measles, influenza), the safeguards of the normal mucous membrane also fail.
The acute catarrhs depend mostly upon infection with very many different kinds of bacteria, particularly with pneumo- and streptococci (A. Friinkel), The contagion so frequently observed is thereby readily explained. I.ike Muller, I also have frequently observed in private practice, that the same infection in different members of the family evidently causes eoryza, angina, bronchitis, or intestinal catarrh (espe cially in infants). according as the case may be. The specific catarrhs in the course of many infectious diseases (measles, whooping-cough, influenza), frequently undergo secondary infection. The contagious do mestic grippe, occurring regularly and often epidemically (luring the cold season of the year, chiefly runs its course with manifestations of bronchitis (epidemic bronchitis). I agree with Filatow and Stooss, that the grippe, which probably depends upon pneumococci titittooss,Luzzato) and which preferably attacks children (infantile grippe) is not identical with pandemic influenza with which it is tnostly classed. This also
explains why the influenza bacillus frequently fails to be found in "influenza." The chronic bronchial catarrhs frequently arise in connection with chronic affections of the nasopharynx, very often in mouth-breathers (adenoids), or accompany diseases of the lungs. In these instances, infection plays a rather unimportant and secondary role. Of much more importance are the anatomical changes in the mucous membrane and the constitutional anomalies, antrinia, rachitis and scrofulosis. While the majority of German authors are unfavorably inclined thereto, much importance is attached by the French to the gouty diathesis, the nemo arthritismus, and especially also to a closer connection between chronic skin affections (eczema, prurigo, scrophulus) and bronchitis, particu larly the asthmatic form, a fact which has been given prominence, with others. both by Heubner and myself.
According to my observations, I regard dentition as blameless in the etiology of the disease in question, and moreover in the whole path ology. The still great popularity of dentition as an etioligical factor with physicians and laymen may be accounted for by the great con venience and comfort which it affords to one or both parties.
Disturbance of the pulmonary circulation, mostly due to mitral lesions, leads to statis bronchitis. The frequent occurrence of bronchial and pulmonary affections with inte.stinal diseases is attributed without sufficient proof to coli infection by Lesage and SevOstre.
Pathological Anatomy.—In acute catarrhal inflammation of the trachea and the bronchi the mucous membrane is swollen, loosened and reddened from the dilatation of the small blood vessels. The mucous secreting goblet-cells are markedly increased, and likevise the deeper lying coils of the mucous glands. The subepithelial layer and often also the subrnucosa are greatly infiltrated by round cells which partly wander to tbe surface of the mucosa. The secretion of the coarser bronchi is more. slimy, that of the finer bronchi more purulent. The bacterial content is very large.