The physical signs in these cases are of trifling amount. They consist merely in more or less large bubbling at each base, with dry rhonchus and occasional bubbling riles at various parts of the lungs.
When the inflammation penetrates into the smaller tubes (capillary bronchitis) the symptoms become alarming. The features look pinched, and the expression is one of extreme distress. The face is pale, with much lividity about the eyelids and mouth. The child is restless. His dysp nom is great, and his respiratory movements are laboured as well as hur ried ; but if the disease is uncomplicated with collapse or lobular pneumo nia, there is little disturbance of the normal proportion between the pulse and respiration. Often the child is subject to suffocative spasms if laid down, and has to be supported partially upright in his nurse's arms, or raised in his cot by pillows. At each inspiration considerable recession is noticed of the soft parts of the chest ; and if the ribs are yielding from rickets, the retraction of the bases of the chest may be extreme. The tem perature at first is raised to 101° or 102°, but when aeration of the blood is greatly interfered with the mercury usually sinks to 99°.
The pulse rises to 140 or 150, or even higher, and is small and often hard. The cough is hacking and hoarse, and occurs in stiffing paroxysms, greatly increasing the difficulty of breathing and intensifying the lividity of the face. The skin is moist and beads of sweat are often seen stand ing upon the brows. The tongue is moist and thickly furred. Appetite is completely lost and the child is very thirsty. Still, on account of the dyspncea an infant is quite unable to draw fluid from a bottle. The mouth is required as an air-passage, ancIthe needs of respiration preclude its being used for any other purpose. Vomiting sometimes follows a par oxysm of cough, and much whitish or yellowish phlegm is thrown up with the contents of the stomach. In this state the child rarely speaks or cries. Crying interferes with respiration, and he has no breath to spare.
On examination of the chest percussion discovers no dulness. With. the stethoscope the breath sounds are found to be more or less completely covered by a copious sub-crepitant rhonchus which is heard over both lungs.
In an uncomplicated case the breathing is nowhere bronchial or blowing, and the resonance of the voice is unaltered. These cases are, however, so often complicated with atelectasis or bronchopneumonia that the physical signs connected with these forms of disease are often to be detected at the posterior bases.
Unless an amelioration in the symptoms occurs suddenly, the distress becomes more and more marked. The fits of dyspncea are more frequent and alarming. The child, as long as his strength will allow, tosses in his bed, throwing his arms about restlessly. In an infant or rickety child the symptoms pass on to those which have been described as characteristic of atelectasis or of catarrhal pneumonia. In older children, in whom these complications are less likely to occur, the face assumes a leaden hue ; the fingers and nails grow purple; the breathing is more hurried, and the pulse gets excessively rapid and small. As the weakness and asphyxia become more marked the cough ceases ; the restlessness diminishes ; the child be comes drowsy and intensely apathetic, and soon dies comatose or con vulsed. The temperature often sinks to a normal level when the symptoms of asphyxia become more pronounced, but often rises again before death to 102° or 103°.
If the case terminate favourably, the eyes grow brighter and the livid ity begins to clear ; the cough is looser and less paroxysmal ; the pulse slackens ; the breathing is less laboured ; and the child takes more notice, seeming to be less absorbed in his own uneasy sensations.
The chronic form of bronchitis is not rare at the age of five or six years and upwards. It usually occurs in children of scrofulous tendencies who have been subject to repeated attacks of bronchial catarrh, and suffer in consequence from some permanent emphysema of the lungs. SuCh children are very sensitive to chills, and are apt to be troubled in the changeable seasons of the year with a distressing cough and shortness of breath. Measles and pertussis in strumous subjects are often followed by the same pulmonary susceptibility, so that during the colder months the patients wheeze and cough, and present all the symptoms of chronic bron chitis such as result from the same conditions in elderly persons.