In chronic bronchitis the mucous membrane is brown or grayish red, often thickened from proliferation of interstitial connective tissue. Fibrinous peribronchitis, dilatation of the bronchi, swelling of the bronchial glands, are frequent findings, and more rarely, emphysema.
Symptoms.—Catarrh of the trachea scarcely- ever occurs isolated, usually being founcl in connection with catarrh of the larynx or of the bronchi. It is customary to distinguish bronchitis without fever, and bronchitis with fever, although they cannot be sharply defined, and many transitions exist. In the following short description, only simple bronchitis will be considered. Disease of the finer bronchi (capillary bronchitis) is described in the following chapter.
Acute bronchitis generally develops rapidly after an analogous af fection of the air-passage above, or simultaneously with it, and mani fests itself by cough and fever of a varying degree. In some individuals, especially during the first years, a descending bronchitis regularly sets in after each attack of coryza.
The cough in acute bronchitis is at first frequent, dry, and irritating, it is also present at night, and is at times paroxysmal (frequently so in grippe); later it is loose and less frequent, and no longer disturbs the night's rest. It is often accompanied by pain in the chest anteriorly.
Expectoration is usually absent in children under ,CVCD tO ten years in all bronchial and pulmonary affections. It is seen only in younger children after vomiting or in experienced coughers; for instance, if pre ceded by a protracted siege of whooping-cough. Infants swallow the expectoration as soon as it is thrown against the roof of the pharynx by the cough.
On careful examination the respective movements of swalloming may be seen after severe fits of coughing. Prolonged coughing in the morning on awakening is usually the sign of free secretion. If the spu tum of an infant be desired, it, can be easily obtained with a sterile eotton swab, passed through the opened mouth during an attack of coughing. It is also readily obtained by siphoning the empty stomach. The expec toration, as in the adult, is at first glassy ancl tough, later mostly tnuco purulent. Seldom and only in older children "dry catarrh" is met with.
Where the expectoration is offensive, it is spoken of aS ft-etid bronchitis; frequently complications of bronchiectasis, foreign bodies, or gangrene of the lungs, are present. At times the temperature reaches as high as 40° C. (104° F.), but usually declines after a few days. The elevation and duration of the temperature do not depend so much on the bron chitis alone, as, often in a great measure, on the accompanying general infection (for instance influenza, grippe). Long-continued or repeated elevations of temperature mostly depend on the bronchiolitis that sets in, or on complications (otitis, etc.).
The respiration often remains unchanged in a febrile bronchitis, and is increased and labored only when there is much accumulation of mucous or when emphysema is present. When fever is present, it is often difficult to decide to what extent the increased respiration is due to the elevation of temperature or to the bronchitis. Marked dyspncea or cyanosis, increased inspiratory recessions, usually- point to the pres ence of a capillary bronchitis. Only in nursling:5 are inspiratory- reces sions seen, even when the catarrh is limited to the coarser bronchi merely, and they- stand out more prominently during crying or coughing.
The circulatory- organs usually present nothing remarkable except a moderate acceleration of the pulse which is correspondingly increased by the height of the fever. In the course of whooping-cough demon strable dilatation of the right heart frequently develops.
Physical examination often gives cognizance of whizzing ronchi palpation of the thorax, which may also be heard at a distance. Pain on lifting up under the arms frequently proceeds from a florid rachitis, and only exceptionally from a dry pleurisy. At first auscultation is negative as long as the catarrh is dry, and limited to the trachea and the very large bronchi. Soon scattered purring and nbizzing ronchi appear, later moist, coarse, and medium rAles. The vesicular breathing is often accen tuated, expiration prolonged. Percussion shows normal conditions except in bronchial asthma and in emphysema.