Ulcerative excavations, described by Dr. Gairdner as "bronchial ab scesses," sometimes occur. These are found in the centre of collapsed lob ules, and consist of little collections of pus the size of a hemp-seed or larger. They communicate with the terminal tubes, and may be formed of dilatations of these tubes or of ulcerative destruction of the walls of ad joining air-cells. In the former case they are lined by a fine villous mem brane ; in the latter they are minute cavities in the V lung substance, and their purulent contents lie in immediate contact with the lung tissue. According to Dr. Gairdner, these purulent collections are the direct result of pus accumulated primarily in the extreme bronchial tubes of the collapsed lobules. The general appearance of these abscesses is that of softening tubercles, for which, indeed, they have been often mis taken.
In the majority of cases bronchitis is limited to the larger tubes, but even then the purulent secretion may be drawn inwards into the fine bron chi ; and these are often found filled with viscid, yellow matter, even when their lining membrane is not inflamed. In young infants, who cannot cough at will, this retention is very liable to occur, and, as is elsewhere ex plained, is one of the causes which render collapse of the lung so common a lesion in the beginning of life.
Besides the anatomical characters which have been described, spots of catarrhal pneumonia are very common. The appearances resulting from this form of disease and the mode of its production are described elsewhere (see catarrhal pneumonia).
In chronic bronchitis the mucous membrane often appears to be little affected, although sometimes it is smooth and polished. The smaller tubes are considerably dilated ; their transverse fibres are hypertrophied ; and the sub-mucous connective tissue is generally thickened. Considerable emphysema is usually met with, and collapse is an almost invariable feature of this form of the disease.
Symptoms.—When the inflammation is confined to the larger bronchi, the symptoms are not severe unless the patient be a very young or weakly subject. In a new-born child or a feeble, wasted infant a slight degree of bronchial catarrh may be accompanied by very serious symptoms, and even lead to death from the occurrence of pulmonary collapse. This form of the disease is described elsewhere (see Collapse of the Lung).
In stronger infants and older children the occurrence of catarrh of the larger bronchi is indicated by coryza and cough. The child sneezes and
coughs at intervals. He complains of no pain, and if the cough is hard at the first it soon becomes loose, and ceases after a few days. In these mild cases the general symptoms are slight or wanting. There is no fever ; the child is lively and cheerful, and his appetite is little impaired. The tongue is usually furred, and there is some costiveness ; but an aperient powder soon remedies this inconvenience, and the child is quickly well. In such cases the only physical sign to be detected about the chest is the presence of a little sonoro-sibilant rhonchus or an occasional large bubble in the inter-scapular region.
Although these cases are mild in themselves and easily cured, they may yet, by neglect, be so prolonged as to cause considerable interference with nutrition. If care be not taken to protect the patient from the ordinary causes of chill, he may pass through a succession of little colds, so that his cough continues for several weeks, and may be accompanied by a certain amount of catarrh of the stomach. Consequently, the child looks pale and gets flabby and languid. In such a state his condition may not only be considered an anxious one by his parents, who begin to entertain fears of consumption, but the resisting power of the child against changes of tem perature being really lowered, he is very apt to alarm the practitioner by suddenly developing all the symptoms of acute bronchopneumonia.
If the catarrh assume a severe form, it often begins with fever and soreness behind the sternum. The temperature rises to 100° or 101'; the tongue is thickly furred ; the pulse and respiration are both hurried, al though their relation to one another is little altered ; and the bowels are confined. The nares act with respiration. The cough is at first hard and frequent and increases the pain in the chest. The skin is moist, the face flushed, and the child, if an infant, constantly requires to be in his nurse's arms. He is very thirsty, and on this account takes his bottle with eager ness. A certain amount of gastrointestinal catarrh often accompanies the bronchitis. The child may vomit, and his bowels are often relaxed. Usu ally, after a day or two the temperature subsides, the cough becomes looser, and the soreness of the chest abates. Under proper treatment, the child. is usually well at the end of the week.