During the febrile period, the general condition is often very much affected by headache, malaise, thirst, disturbance of the appetite, and sleep. In younger children, diarrhma often sets in.
Simple bronchitis terminates in recovery in from two to six weeks on an average. However, during the early years, the occurrence of bronchiolitis, bronchopneumonia, and also other complication.s (otitis, gastro-intestinal disturbances), are frequent and dangerous.
Chronic bronchial catarrh develops gradually or follows protracted acute or relapsing catarrhs. A peculiar form of chronic tracheal and bronchial catarrh often occurs in nurslings and is often seen even during the early months (Henoch). Associated with a frequent, initiating cough, an inspiratory and expiratory stridor is heard at a distance (rat tling in the chest), which temporarily- disappears after an attack of cough ing. Auscultation reveals coarse or sibilant rales, especially between the shoulder blades. Fever is absent. The general condition is undis turbed, and infants often look pale and shrivelled. I. also, can vouch for the frequency of this very obstinate form of catarrh which is also often found in pasty looldng infants.
Membranous or plastic (fibrinous) bronchitis is a disease the chief characteristic c,f which is tubular, white or yellowish white exuda lion on the mucous membrane of the trachea or of the bronchial tree. Leaving out of consideration the frequent diphtherial bronchitis, bron chial croup (see diphtheria) in its limited sense, one not infrequently finds in croupous pneumonia, a membranous coagultun formation in the finer bronchi emanating from the alveoli. Besides these two diseases which we do not consider here, membranous bronchitis rarely appears, and is in children especially seldom met with, probably only from about the fourth year on.
An acute and chronic form are distinguished. The acute form seems to be dependent on bacteria; pneutnococci (Jaccoud, Marfan), pneumobacillus of Friedlaender (Magniaux), streptococei (Claisse), are held responsible. The patients suffer from fever, irritating cough, dys pncea, and cyanosis. After expectoration of conglomerated dendritic
coagulum, great relief often occurs which frequently, however, is only temporary. Relapses may occur after days and weeks, and terminate either in recovery or in death from asphyxia and exhaustion.
The chronic, relapsing form produces attacks similar to the acute, which recur from time to time for years anti years. The expectorated matter does not consist of fibrin but mostly of mucus, and is so-to-speak sterile and often contains eosinophile cells, Charcot-Leyden crystals, and Curschmanns spirals. Accordingly, the disease may be regarded as a possible neurosis of secretion in favor of which are the occurrence, not uncommonly, of asthmatic conditions during the intervals of freedom.
The diagnosis is to be made by the tubular, dendritic, branched, casts. Marked inspiratory recessions, impeded expiration, cyanosis in the absence of bronchiolitis, and normal percussion note, with reduced thoracic movements, must lead one to think of this rare affection.
The prognosis in the acute cases is mostly fatal; but in the chronic form life is less endangered, though lasting recovery is seldom to be e xpec ted.
The treatment requires trial of sweat-cures, inhalations of alkaline waters, and especially potassium iodide. Lastly, where the membranes are loosened an entetic is to be considered.
The diagnosis of bronchitis depends on the presence of non-metallic coarse and medium or sibilant rales, with normal percussion note, ab sence of bronchial breathing, and bronchophony. Involvement of the trachea often produces, on coughing, a burning pain behind the sternum, which cannot be physically diagnosed (without a reflection). Coarse rates or wheezing equally perceptible over both lungs may be located in the trachea or in the neighborhood of the bifurcation. Frequently a cough with negative auscultatory findings is diagnosed as tracheal catarrh where merely a pharyngo-rhinitis is in question. Coarse rffles originating during crying, and accumulation of mucus in the nasopharyn geal space, may readily- pose as bronchitic signs to the inexperienced.