The mucous membrane which lines the air passages, from the Adam’s apple (larynx) and windpipe (trachea) to the finest bronchial tubes, is liable to be inflamed in any part. When a cold descends from the head down the windpipe to the bronchial tubes, then it becomes bronchitis, and this is the usual way in which bronchitis is set up. It may be set up, however, directly, without there being at first a cold in the head. One attack predisposes to others, and a chronic condition of congestion of the mucous membrane may be set up. This is chronic bronchitis. The symptoms of acute bronchitis are tightness across the chest, frequent short cough, at first dry, then resulting in expectoration of scanty, frothy or viscid mucus, at first clear, then yellow and frothy, becoming thick and white. The phlegm may be streaked with blood. Sometimes bronchitis is accompanied with much fever; sometimes there is little. According to the extent of it, and the bronchial tubes affected, the difficulty of breathing will vary. If the smaller tubes are attacked, the shortness of breath will be intense. This is the form most to be dreaded in children. It is a frequent complication of measles and whooping cough. As the disease improves, the breathing becomes easier and the phlegm thicker.
Diagnosis.-Bronchitis must be distinguished from inflammation of the lungs (pneumonia), from pleurisy, and from asthma. Bronchitis, pneumonia, and pleurisy are all characterised by cough following a chill. In bronchitis there is usually more distress of the breathing, and less pain and fever than in the other two. In the early stages of bronchitis on putting the ear to the chest there is wheezing heard almost all over, and afterwards a loose rattling sound; in pneumonia there is over the inflamed part a dry tubular sawing sound-as if some one were blowing across the end of a pipe, with very fine crackling (crepitation), like the sound made by rubbing a few hairs between thumb and finger close to the ear; in pleurisy there is a creaking, rubbing sound. On tapping the chest there is no loss of resonance in bronchitis; in the other two there is dulness. In bronchitis there is at first no expectoration, then yellowish mucus is brought up, and finally thick whitish mucus. In pleurisy there is no expectoration; in pneumonia there is at first rusty and afterwards clear transparent expectoration. Asthma is distinguished from bronchitis by the suddenness and transient nature of the attacks.
Many coughs are due to irritation affecting the wind-pipe, and not extending so far as the bronchial tubes. These are often called bronchitis, but on listening to the chest there are no abnormal sounds, and the irritation is usually referred to the throat-pit.
Chronic bronchitis is not to be easily mistaken for anything else, and the persistent loose cough with copious yellowish expectoration, and the history of repeated acute attacks, make it clear enough.
General Treatment.-Care must be taken to protect the patient from chills and draughts; at the same time, the apartment must be well supplied with fresh air. Light, easily digestible nourishment must be given frequently. If the breathing is laboured, the air of the room may be softened by keeping a kettle on the fire. Kettles are made on purpose, with long spouts, which may be made to come close up to the patient’s bed if necessary. Poultices are not, as a rule, of much value in bronchitis, but an occasional linseed poultice is often useful. In chronic bronchitis, which usually recurs in those subject to it every winter, wearing woollen clothing and avoiding exposure to chills are necessary precautions. Elderly people who are subject to severe attacks of bronchitis would do well to keep indoors altogether in the winter; or else to spend the winter abroad in some warm climate.
Medicines.-(Every hour, or less, according to urgency of symptoms.)
Skin hot and dry; pulse hard, frequent; quick breathing; short, dry, frequent cough, excited by tickling in throat or chest; thirst; restless tossing about.
Antimonium tart. 6.-
Much rattling of phlegm; patient inclined to slumber with eyes half open; cries from being touched, but will be carried about. Face bluish, pale, and puffy.
Severe headache aggravated by coughing; oppression of chest and constriction as if bound, with rattling in the chest; dry fatiguing cough, worse at night; child cries when coughing.
Cough dry or with viscid mucus, sometimes tinged with blood; mouth dry; stitches in chest hinder breathing.
Respiration continuing oppressive; dry cough, excited by tickling in throat or chest, aggravated by talking or laughing, or going into open air.
When accompanied by excessive perspiration, which does not relieve. Tongue coated thick yellow. Patient cannot endure either hot or cold air.
Mucus rattling in chest, almost suffocating patient on coughing in fits; shortness of breath, perspiration on forehead. Sec also under COUGH.