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Bronchitis Bronchial

cough, catarrh, bronchi, chronic, dust, mucous and lungs

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BRONCHITIS (BRONCHIAL CATARRH).—Inflammation of the mu cous membrane of the bronchi and their branches. The disease may occur as an acute or as a chronic affection ; it may implicate one side or both ; it may affect either only the larger or only the finer ramifications of the trachea ; or it may involve the entire " bronchial tree " (see Fig. 52).

The most frequent causes of bronchial catarrh are colds (caused by sudden cooling of the heated body, by drenching, or by the breathing of cold, damp air), and the inhalation of dust, smoke, or gas. Noxious gases arc especially dangerous. The fumes of nitric and sulphuric acids, the vapours of bromine and chlorine, and the dust of vegetable detritus are all injurious. Mineral and metallic dusts, including those which, owing to their sharp points and rough surfaces, greatly irritate the mucous membrane, and in part even directly injure it, are even more to be avoided. Certain trades, such as the stone-cutter's, carpenter's, miller's, baker's, paperhanger's, turner's, and file-cutter's, are dangerous because of the contact with dust. Experience also shows that children, the aged, and persons affected with scrofula or with diseases of the heart or lungs, are much more liable to be .attacked than thoroughly healthy persons in the prime of life.

Acute bronchitis occasionally sets in with a sudden rise of the tempera ture of the body, even with a violent chill. In many cases, however, it is entirely free from fever. If the affection is very severe, the general condi tion is also impaired. The most essential symptoms are cough and expec toration. The patients continually have the sensation of tickling in the throat and of soreness behind the upper part of the breast-bone, sometimes along the entire breast-bone ; they are tormented by an annoying irritation to cough, without, however, being able to expectorate much, at least not in the beginning. A so-called dry cough is present. The accumulation of viscid mucus in the bronchi causes, upon the passage of the respired air, the occurrence of humming sounds in the chest, which are often noted by the patient, and even some distance from him. So long as the cough is painful, and the sputum can be expectorated only with difficulty, the sleep of the patient is impaired. Solely as a result of the exertions to cough, and the consequent rush of blood to the head, there arise headache, a sensation of vertigo, nausea, and even vomiting. After a few days the sputum, which at

the onset was viscid, mucous, and thread-like, usually becomes more fluid, mucopurulent, and sometimes altogether purulent. This causes the cough to become easier—more moist ; the catarrh is looser. Pains in the chest, which generally are present only in the more severe cases of bronchial catarrh, are not caused by the affected mucous membrane of the bronchi ; they are due to over-exertion of the diaphragm and of the muscles situated between the ribs, in consequence of violent paroxysms of cough.

If the catarrh becomes localised in the finer branches of the bronchi, it is followed almost regularly by fever, and the respiratory disturbances may be marked. In children and old persons the affection may implicate the lungs (bronchopneumonia), where it will form scattered areas of inflamma tion, thereby endangering life, especially in small children. The milder forms of an acute bronchial catarrh generally take a favourable course, and disappear in a week or two ; even the most severe cases usually terminate in cure if carefully treated.

Chronic Bronchitis either develops as a chronic condition from the beginning, or it results from recurring, especially neglected, acute attacks. Its most frequent cause is the continued inhalation of dust, particularly in industrial concerns where much dust is present. Affections of the heart, of the blood-vessels, and of the lungs, may lead to congestions in the blood vessels of the lungs, and thereby to chronic catarrh of the bronchi. The most essential symptoms are also in this case cough and expectoration. The cough is obstinate, particularly in the morning, evening, and night, and may cause nausea and even vomiting. Some patients have little or no sputum ; in others there are expectorated small quantities of viscid, mucous sputum. Many patients bring up profuse masses of a thin, watery mucous or mucopurulent matter. Slight traces of blood may be found in the ex pectorated matter, without pulmonary tuberculosis being present. If the chronic catarrh spreads to the finer ramifications of the bronchi, respiration will become impaired.

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