A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck.
- Date:
- 1887
Licence: Public Domain Mark
Credit: A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
168/1022 (page 136)
![1. Catarrh of the Larger Bronchi.—This is the common form of simple bron- chitis after taking cold, after irritation on the bronchial mucous membrane, etc. Many cases of secondary bronchitis also remain confined to the larger bronchi. The symptoms are moderate, although the irritation from coughing may some- times be quite severe. Auscultation gives the coarser humming sounds [rhon- chi], or, as has been said, in many cases nothing at all abnormal, so that we can recognize the disease only from the subjective thoracic symptoms, the cough, and the expectoration. With good care uncomplicated bronchitis runs its course in a few days, or at most in a few weeks, and goes on to complete recovery ; but with a lack of care on the patient’s part, or where the irritation has been severe, the disease may of course continue for a long time, and finally run into a chronic bronchitis. 2. Catarrh of the Finer Bronchi—Capillary Bronchitis.—A simple primary bronchial catarrh rarely extends to the finer bronchi in adults. The secondary bronchitis, however, which develops in other severe diseases (vide supra), often extends into the ultimate divisions of the bronchi, and finally leads to the forma- tion of nodules of lobular pneumonia—“ catarrhal pneumonia ” (vide infra). We recognize the implication of the finer bronchi by hearing the high, shrill, whist- ling rhonchi [sibilant rhonchi], or the abundant small, moist rales. Respiratory symptoms may be quite marked in extensive catarrh of the finer bronchi. Res- spiration is evidently accelerated and expiration is usually prolonged. There is often quite a severe cough. The expectoration is muco-purulent and usually not very abundant. Capillary bronchitis in children is of great practical importance. Every bron- chitis in young children has, as experience tells us, a tendency to attack the smaller bronchi. Extensive bronchitis is seen especially in weak children who are rachitic or predisposed to tuberculosis. Children have an especial predisposi- tion to be attacked with bronchitis at the time of the first dentition, but it is also seen at an even earlier age. The parents’ attention is usually called to the disease by the appearance of a cough, which is excited especially by the child’s crying. Small children never expectorate, for they swallow the secretion which is coughed up into the pharynx. The rapidity of respiration is very striking, it being increased to sixty or eighty, or even more, in a minute. The respiration is also labored, but it is usually super- ficial, and in severe cases interrupted. We often see a retraction of the lower lat- eral portions of the thorax on inspiration as a result of the imperfect entrance of air into the smaller bronchi. Tllfe expiration is often noisy and groaning in chil- dren. We hear extensive small, moist rales over the lungs. In severe cases the child becomes restless, anxious, often markedly cyanotic, and finally apathetic and stupid. In such cases, however, we have no longer to deal with simple bronchitis, but catarrhal pneumonia has already developed. The disease almost always runs its course with fever, the temperature rising to 104° (40° C.) and over. The pulse is increased to 120 or 140 or more per minute. The duration of the disease is seldom less than two or three weeks, and it often lasts much longer. Death may ensue, especially in ill-nourished children, partly as a result of general weakness, and also directly from the imperfect respiration. In such cases we find at the autopsy not only diffuse bronchitis, but also almost always lobular pneumonia. In many cases a gradual recovery finally takes place in spite of the most severe symptoms. The secondary bronchitis in children in measles, whooping-cough, diphtheria, etc., has the same tendency to involve the finer bronchi and to lead to lobular pneumonia. In conclusion, we must mention that acute bronchitis in old people also readily](https://iiif.wellcomecollection.org/image/b21981565_0168.jp2/full/800%2C/0/default.jpg)
