Synonyms.—Tracheo-Bronchitis; Cold on the Chest.
Definition.—An inflammation of the mucous membrane of the bronchial tubes, varying greatly in intensity; hence it has received different classification. Thus, in the milder forms, it is termed subacute or cold on the chest; in the more severe types, acute or sthenic bronchitis, while in elderly people and those of feeble vitality it is termed asthenic bronchitis. The inflammation also involves the mucous membrane of the trachea; hence the more proper name, tracheo-bronchitis, and where the disease is actively acute, the nares, pharynx, and larynx share in the inflammatory process.
Formerly the extension of the inflammation to the bronchioles. was termed capillary bronchitis; but as this is attended with an involvement of the air-cells, giving us pneumonia as well, it is now classed as broncho-pneumonia. Should the inflammation stop short of the lungs, capillary bronchitis would be a proper term. The disease is both acute and chronic.
Etiology.—Among the predisposing causes are: Age, children, and elderly people being very susceptible; debility, resulting from malnutrition; defective drainage, poor ventilation, overcrowding, insufficient food and clothing, or other diseases; occupations, certain trades, whereby irritant particles are inhaled, such as steel, brass, wood, coal, and tobacco working, etc.; also the fumes of sulphurous acid, chlorine, and bromine. Sedentary habits also render one more susceptible than a more exposed life. Children shielded from every draft of air by overanxious mothers,. and who wear an excess of woolens whereby the system is weakened, are very susceptible to inflammatory conditions of the chest.
The exciting cause is usually atmospheric changes; sudden changes in the weather, which so frequently occur in the spring and fall, whereby the patient catches cold, are fruitful sources. Also getting the feet wet, or sudden chilling after exertion, may insure the disease. There is also an epidemic condition different from influenza, that prevails during some seasons.
Bronchitis is also a common attendant on some diseases, as typhoid fever, whooping-cough, measles, and other exanthematous affections. The disease may be acute or chronic.
Pathology.—The mucous membrane of the trachea and bronchi is congested and swollen, at first dry, but soon covered with mucus, which at first is clear, glairy and viscid, but soon becomes opaque, and finally muco-purulent. There is swelling of the mucous glands, and some of the smaller bronchial tubes are dilated; in the more severe cases the smaller tubes are choked with mucus. The ciliated epithelium desquamates and the sub-mucosa becomes infiltrated with leukocytes.
Symptoms.—Simple catarrhal bronchitis, or cold on the chest, begins as a common cold; there is languor, with frequent chilly sensations, which are alternated with flashes of heat. There is increased secretion from the nose; the throat is dry and rough, which causes the patient to make frequent attempts to clear it. The voice is hoarse, and a short hacking cough soon develops. The skin is dry, the urine scanty, and there is constipation.
As the cough develops, there is a sense of constriction of the chest, with a dull pain in the median line. The first twenty-four or forty-eight hours the cough is tight, and there is but little expectoration, the mucus being clear and viscid; but within another twenty-four hours the cough is not so dry and hard, the mucus becomes more profuse, changes color, becoming yellow, and is raised more easily. There is now an abatement of all the symptoms, and the patient is convalescent by the sixth or eighth day. In the more acute forms the chill is quite marked, followed by an active grade of fever.
The skin is hot, dry, and constricted, the urine is scanty and high-colored, and there is constipation. The throat is dry, red, and somewhat swollen, the voice hoarse and rough. A hard, dry bronchial cough follows reaction, which is attended by a dull pain in the chest. The respiration is humid, and there is a sense of oppression in the chest. The tongue is coated, and there is more or less headache.
The fever may be quite active, although remittent in character. On auscultation the dry, sibilant rhonchus is heard, followed within forty-eight hours by a mucous rhonchus, which becomes more marked as secretion increases. At first the mucus is viscid and tenacious and sometimes streaked with blood, but soon changes, becoming opaque and finally mucopurulent. With free expectoration, the sufferings of the patient are relieved; he sleeps well, the cough being more severe in the early morning, owing to accumulation during the night.
When occurring in young children and in elderly people, the prostration is much greater, the cough harassing, greatly distressing the patient. The respiration is more labored, and there is more or less dyspnea. The expectoration in the old is more watery in character. The cough is persistent, occurring in paroxysms. In children the inflammation is more apt to extend to the smaller tubes, and the oppression of the chest is consequently great. The respiration is embarrassed. Auscultation gives mucous rhonchus, the smaller tubes being choked with mucus.
Diagnosis.—The diagnosis is easily made. The coryza, dry-ness of throat, the dry bronchial cough, and sibilant respiration, call our attention to the chest. Auscultation gives us the dry rhonchus the first twenty-four hours, followed by the mucous rhonchus. Percussion gives resonance, showing conclusively that the lungs are not involved.
Prognosis.—The prognosis is generally favorable, though where it occurs in delicate children there is a marked tendency in the inflammation to extend to the lung, giving rise to broncho-pneumonia. In old and feeble patients whose vitality has become exhausted, the prognosis will be guarded.
Treatment.—The treatment for bronchitis by the use of specific remedies is very satisfactory; the disease is shortened, the distress mitigated, and the patient rendered comfortable without the use of opiates. Our first object is to control the fever, thereby arresting the inflammatory process; just in proportion as we are able to modify the symptomatic fever, do we modify the cough, and early establish secretion.
Veratrum.—In acute inflammation of the respiratory apparatus, there is usually excessive power in the heart's action as evidenced by the full, bounding pulse, and veratrum in full doses succeeds, not only in reducing the force and frequency of the pulse and lowering the temperature, but also modifies the cough. Veratrum, 20-60 drops; water, 4 ounces; aconite where the pulse is small and frequent, either in child or adult, calls for this agent. Aconite, 5 drops; water, 4 ounces. Teaspoonful every hour:
Bryonia.—This is one of our best cough remedies, and is called for where there is pain in the chest, sharp in character, a vibratile pulse being additional evidence for its use, ten drops added to the sedative mixture, or it may be given on alternate hours.
Lobelia.—Where there is dyspnea and a sense of oppression in the chest and the pulse is full and oppressed, this remedy will be especially useful. In children, where the smaller tubes are choked with mucus, there is no better agent; ten or fifteen drops being added to the aconite mixture.
Eupatorium.—This will be useful in those cases where the temperature is high, yet the skin is inclined to be moist, and the pulse is full and respiration difficult; add ten to twenty drops to the half glass of water.
Sanguinaria.—Where there is a constant tickling in the throat, this agent will be of use. Put one-fourth grain of the nitrate of sanguinaria in mortar, and rub it down with four ounces of boiling water; add enough syrup to render palatable, and give teaspoonful every hour.
Ipecac.—Where there is irritation of any mucous membrane, ipecac will be found beneficial. Where there is extension to the lung tissue and the cough is hacking in character, add ten drops to the usual amount of water, and give every hour.
Local Applications.—The only local application needed will be the flannel cloth spread with lard or vaselin and thoroughly dusted with the compound emetic powder. Where this produces too much counter irritation, rub throat and chest with stillingia liniment. The antiseptics are not usually called for in this disease, although there may be an occasional call for them. Good nursing is, of course, necessary. The patient must be kept quiet in bed, and a fluid but nourishing diet administered. The patient should not be dismissed until the cough is thoroughly subdued: if this course were carried out, there would be fewer cases of chronic bronchitis.
The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.