THE University of WESTERN LANCET AND HOSPITAL REPORTER. EDITED BY L. M. LAWSON, M. D. PROFESSOR OF PHYSIOLOGY AND PATHOLOGY IN THE MEDICAL COLLEGE OF OHIO; FORMERLY OF GENERAL AND PATHOLOGICAL ANATOMY AND PHYSIOLOGY IN TRANSYLVANIA UNIVERSITY. AND GEORGE MENDENHALL, M. D. PROFESSOR OF OBSTETRICS AND DISEASES OF WOMEN AND CHILDREN, IN THE MIAMI MEDICAL COLLEGE, ETC, ETC. ART. I.-Lectures on the Pathology, Diagnosis, and Treat- ment of Diseases of the Chest; delivered in the Commercial Hospital and Medical College of Ohio. By L. M. Law- LECTURE XIV.-Chronic Bronchitis. Definition: Symptoms; Pathology; Causes; Duration; Prognosis; Diagnosis. Definition.-Chronic Bronchitis is a low grade of inflam- mation, of long continuance, occupying more or less exten- sively the mucous membrane of the bronchial tubes. It may exist as a primary affection, or as a result of the acute variety; and when arising from some other and distinct disease (such as general fever) it is called secondary bronchitis; or specific, when it proceeds from the Syphilitic or Scrofulous diathesis. The distinctions between the acute and chronic forms of bronchial inflammation, relate more to time than degree; for the stage of resolution in the acute form, and the permanent condition of the chronic variety, are essentially the same. In other words, the chronic form is merely a prolongation of the second, or (according to the views previously given) the third stage of the acute disease. In addition to this, it must be re- marked, that mere duration is not infallible evidence of chro- nicity, for the disease may continue for weeks or months and still manifest a grade of action above the legitimate chronic excitement. When, however, the stage of resolution of the acute disease does not terminate within a few weeks, but be- comes indefinitely prolonged; or when an idiopathic bronchitis, of a low grade, continues for weeks or months, the disease is properly termed chronic. Chronic bronchitis is particularly remarkable for the number, extent, and importance of its complications, or secondary lesions. Thus the morbid action is manifested, not only in the bronchial tubes, but it may also extend to the air cells and substance of the lungs, thereby inducing disease and even closure of the vesicles, emphysema, and, secondarily, affections of the heart, together with serious derangments of the functions of hæmatosis, innervation, circulation, secretion and nutrition. Symptoms. The symptoms of chronic bronchitis are extremely variable, depending largely on the intensity of morbid action. The lowest grade of excitement that receives the name of bronchitis, is an apyrexial disease, characterized by occasional cough and expectoration, manifesting a tendency, under favorable circumstances, to almost entire cessation, but readily reproduced and increased on exposure to a variable or cold atmosphere. In persons thus affected, but little disease may be manifested during warm weather; but when the cold and variable season of winter sets in, all of the symptoms are liable to great aggravation, the cough becoming more constant and distressing. These annual remissions and exacerbations may continue for years in succession, the former becoming less complete, and the latter more protracted and intenseuntil finally the disease becomes fully developed, and the most serious lesions are produced. In a case of medium intensity from the beginning, there is some degree of febrile excitement, with evening exacerbations; together with more or less mucous, muco-purulent, or albuminous sputa. The cough is generally paroxysmal, and varies greatly in intensity; tightness and soreness of the chest are often complained of, together with wandering pains and embarrassed respiration. The degree to which respiration is impeded, varies greatly in different examples, and is produced by different lesions. Where the nervous element predominates, causing undue contraction of the parts, it becomes simply asthmatic, and occurs in paroxysms; but it may depend on permanent lesions, such as obstruction or dilatation of the bronchi, collapse of the air-cells, and emphysema; and it is then more fixed and uniform, though still manifesting appreciable exacerbations and remissions. As the disease advances, various constitutional symptoms become manifest; the patient emaciates, hectic and night sweats are established, the sputa become copious, often purulent, and occasionally tinged with blood. When this train of symptoms become established, the patient is generally (at least by his friends, if not physician) believed to labor under tubercular phthisis; and the cure of such cases by irregular and too often designing practitioners, at once produces the impression that the extraordinary skill of the doctor has enabled him to cure consumption. The sputa in chronic bronchitis become important as indicative of particular kinds and degrees of lesion. It will be remembered that a transparent and tenacious mucus is characteristic of the acute form; and that when the disease reaches the stage of resolution, the secretion becomes opaque, white or yellowish, and much less tenacious. Now this latter substance which characterizes the stage of resolution in acute bronchitis, is the ordinary sputum of the chronic variety. It does not, however, always present the simple form just mentioned, but the color, general appearance and actual composition, exhibit different modifications, according to the special characters of each case. Dr. Stokes enumerates five varieties: First-Transparent mucous secretion. Second-Opaque mucous or albuminous secretion. 2. Moulded to the form of the tubes. This arrangement, it seems to me, is objectionable in several important particulars. In the first place, the transparent tenacious secretions is a sign of the acute disease, as previonsly stated; and when it occurs in the course of the chronic variety, it indicates merely a return or increase of the excitement. It is not, therefore, a characteristic sign of that long continued and low grade of action which exist in the chronic disease. The second division, which is styled by Dr. Stokes the "opaque mucous, or albuminous secretion," embraces the common white or yellowish sputa properly belonging to the disease; but there is an error in denominating it a mucous or albuminous secretion. These two properties-mucus and albumen-are by no means similar, although they may occur conjointly. The common opaque mucus contains a large proportion of mucin, with a mere trace of albumen; and the albumen as the chief constituent, is present only when the secretion becomes purulent. It is an error, therefore, to make |
