Acute Catarrhal Bronchitis.
Synonyms:—Acute bronchitis; bronchial catarrh.
Definition:—An acute inflammatory disorder, involving the mucous membranes lining the bronchial tubes and ex-: tending also in most cases to the mucous membrane of the trachea.
Etiology:—A common cause for this disease is exposure to cold, moist atmosphere. In the lake region of North America above forty-two degrees latitude, the disease is very prevalent, because of the abrupt changes of temperature, and the persistent moist atmosphere. It is most common in the spring and fall, but because of the sudden changes above referred to, which occur in this region in mid-summer, it is not uncommon at that season. It seldom occurs in the tropics and sub-tropics or where the atmosphere is persistently dry. All ages and conditions of life are subject to it, but it occurs more readily in those who are of feeble constitution or who are debilitated and in the aged and children.
The disease is also caused by the inhalation of various forms of dust and irritating vapors. It may follow as a result of acute coryza, influenza and all of the exanthe-matous diseases and of protracted fevers. In childhood it is often an accompaniment of measles and of whooping cough. The condition known as cold in the chest, accompanied with an acute severe cough, is one form of catarrhal bronchitis. Bronchitis also follows acute spasmodic laryngitis, especially when that disease is induced by the inhalation of dry, dusty, furnace heated air% Robust individuals who live a strenuous life in the open air and are inured to the effects of cold are not likely to be attacked.
The mucous membrane of the bronchial tubes is especially sensitive to cold, congestion of the capillary circulation occurs readily on direct exposure. It is equally susceptible to the influence of heat and these facts may be proven by the direct application of heat or cold. It is also proven by the fact that this disease may occur suddenly .upon exposure to extreme cold and may sometimes be completely aborted within a few hours by the persistent application of moist heat as intense as can be borne to the throat and upper portion of the chest.
The disease can not be attributed as yet to a microorganism. Those which are found present are characteristic of pathologic conditions, which follow the primary inflammation. These are the various pyogenic staphylococci. If diphtheria has pre-existed, the Klebs-Loeffler bacillus will be found present; frequently the pneumococcus is present.
Symptomatology:—The onset of this disease is usually abrupt and presents the symptoms of an acute cold of a severe form, localized in the chest. At first there is chilliness with flashes of heat, general indisposition, malaise, slight sore throat, hoarseness and a harsh, dry, hacking, persistent cough. There is soreness and aching throughout the general muscular system, and often extreme soreness with a sensation of rawness beneath the sternum, accompanied with a hot, burning sensation which is constantly increased by the coughing, with a sense of constriction and some oppression of breathing.
The cough, at first, is usually persistent, often occurring in incessantly repeated little short hacks. Later, as secretion increases, the cough changes in character, becoming moist and occurring in severe paroxysms.
While the temperature usually does not run above 102° F. for the first two or three days, in the severer cases it sometimes reaches 103.5° F. or 104° F. The pulse is not greatly accelerated and the respiration may not be more rapid than normal, unless there be an involvement of the bronchioles or of the lobules of the lung structure, in the latter stages of the disease. During the early stage of this disease there is but little secretion, but after perhaps three days, secretion becomes free, the discomfort, constriction and oppression in the chest become relieved, the soreness disappears and the cough which is now paroxysmal is not by any means as distressing as the primary persistent hacking cough. The cough may be increased upon lying down, or during the later stages of convalescence. It may occur when rising in the morning. At first the secretion is purely mucous in character, afterward becoming viscid or tough and tenacious and yellowish in color. In the later stages of a severe case it becomes distinctly light green in color, or of a greenish yellow hue and mucopurulent or purulent in character. As the expectoration becomes free the symptoms abate and often there is actual increase in the amount of the cough. The author has frequently noticed that the cough, which was distressing but restricted during the stage of dryness of the mucous membranes, was greatly increased as the patient improved, but devoid of harshness and irritating or distressing properties. At this time there is abatement of the constitutional symptoms; the temperature falls nearly to normal; the pulse becomes slower and full, and the respiration is regular and nearly or quite normal.
The disease under favorable circumstances may run its entire course and terminate within five days, it is more likely, however, to continue from ten to twelve or fourteen days if not modified by treatment.
Physical Signs:—Percussion at first is normal, but as secretion becomes free the normal resonance in the infra-scapular spaces becomes diminished. Upon auscultation the respiratory murmur is feeble, sometimes disappearing entirely in local areas, at other times the respiratory murmur is harsh and distinctly audible. Over the .entire chest sibilant and sonorous rales are distinctly heard. In the latter stage, as secretion becomes free, there are both large and small moist rales and ronchi, which may appear in one locality, to disappear shortly and reappear in another locality or to temporarily disappear entirely after a severe paroxysm of coughing.
Diagnosis:—The localization of the phenomena in the region of the large bronchial tubes with the physical signs just described will facilitate an immediate and unmistakable diagnosis.
It is not difficult to differentiate between these symptoms and those of pneumonia or of pleurisy with effusion, but it is somewhat difficult to diagnose early bronchial invasion in a case of whooping cough or to determine the involvement of the lung structure in broncho-pneumonia. The areas of consolidation determined by dulness on percussion, determine the presence of the latter named condition.
Prognosis:—In adult life and in previously healthy individuals, the prognosis is in every way favorable. The mortality is greatly increased in childhood and in old age. In cases caused by inhalation of dust and irritating vapors, the irritation having been prolonged over a length of time, the mortality is higher. The inclination for this disorder to involve the lung structure to a severe extent increases the severity of the disease and the resultant mortaWty. Those cases which occur as the sequelae of infectious diseases are especially severe and difficult of cure.
Treatment:—The author feels that he is justified in stating that there is no severe acute inflammatory disease more amenable to treatment or more readily influenced by correct remedial measures, than acute bronchitis. If the treatment be begun early the disease will respond promptly and satisfactorily. For the general symptoms, appearing at the time of the invasion, which usually resemble those of an acute cold, the plan advised in the treatment of an acute coryza, may be carried out thoroughly in every detail, with the addition of the application of pungent moist heat to the chest, persistently, if necessary for twenty-four or thirty-six hours, until the primary capillary congestion has been entirely overcome, and until the distressing phenomena have all abated. This includes the inhalation of steam in a proper atmosphere as advised for spasmodic laryngitis. If the skin be dry and hot, with the developing fever, the secretions deficient, with dry bronchial cough, both aconite and bryonia are distinctly indicated. If congestive phenomena with persistent chilliness be present belladonna is given to excellent advantage, for the first day or two. For many years the author adopted a uniform course which was almost a routine practice with him, especially in children. In two ounces of water in one glass he would drop about five minims of the tincture of aconite, and eight minims of the tincture of belladonna, the quantity of each remedy varying a little with the age of the child. Into the same quantity of water in another glass, he would drop ten minims of bryonia and five minims of ipecac. These twoo mixtures were given alternately, in half teaspoonful doses; to children under six years of age, every half hour. Ale advantage of giving the smaller dose more frequently has been demonstrated in many cases. The result of this treatment during the first two days of the attack is some-times phenomenal, the remedies directly antagonize the Progress and development of those pathologic processes, which are immediately and essentially involved in the development of the disease. Both aconite and bryonia restrain the temperature, antagonize the throwing out of exudates, encourage and promote their absorption when thrown out, prevent the breaking down of tissue, and the formation of pus. Belladonna antagonizes the determination of blood, or primary congestion, and facilitates an equalization of the circulation, quickly overcoming the tendency to chilliness; while ipecac has a positively reliable influence in soothing the irritability of the mucous membranes. The dosage of belladonna must not be sufficient to produce its characteristic physiological effect in retarding the secretion, and thus antagonizing this influence upon the part of the ipecac.
In those cases induced suddenly by the inhalation of dry, hot, dusty atmosphere, or other irritating vapors, usually accompanied with a hoarse, dry, barking or hacking cough, it is sometimes of great service to give preliminarily a full dose of one-half dram of the syrup of ipecac, or ten minims of this syrup may be given every two hours, until slight nausea occurs. This treatment is more applicable in older children, and in adults, than in infants. If the cough is persistently dry and harsh, a syrup may be improvised by combining ten minims of specific lobelia and ten minims of specific sanguinaria with two drams of dilute acetic acid, in three ounces syrup of tolu, or syrup of wild cherry, which is given in teaspoonful doses, every two hours. A most valuable stimulating expectorant which is well given in conjunction with bryonia, during the latter stages of the disease, is the ammonium chlorid, it need not be given in large doses—from two to four grains in syrup every two hours will be as efficacious as the larger dose.
The author has obtained excellent results where the dry irritating cough was unusually persistent, and where the secretions were dry, the mucous membranes of the mouth and tongue dry and red, by the use of turpentine in from two to five minim doses, dropped on a square of loaf sugar. This should be very slowly dissolved on the tongue, the patient breathing, in long, steady inhalations, through the mouth and the saliva slowly swallowed. Turpentine is also specifically indicated in those cases of bronchitis which are characterized by an immense outpour of mucus, in which as one author states it, the patient is nearly drowned in his own secretions. It may be given as just advised or in the form of an emulsion.
Other available remedies which should be studied with reference to their specific application to the varying phases of bronchitis are apomorphine, asclepias, dulcamara, hyoscyamus, phosphorus, jaborandi, sticta and thuja. Quinin is to be given in bronchitis only as a restorative. It can be given in capsules in conjunction with powdered ipecac, to very good advantage, except during a period of excessive bronchial secretion. It should be given only after the temperature has abated and secretions are all free, the tongue moist and cleaning, and the appetite returning. The author has found no place for the continuous use of opium in the treatment of this disease. Combined with ipecac and powdered capsicum he has given one or two small doses of one-fourth of a grain of the powdered extract of opium, to temporarily allay a most incessant, irritating cough, until permanent action could be obtained from other specific remedies. In protracted cases of bronchitis, the treatment should be adjusted to the conditions in hand, with reference to the specific influence of each remedy; this is fully considered under the treatment of chronic bronchitis.
Summary:—If the disease is seen early, endeavor to abort it by restoring all excretion and by the application of heat to the chest.
Let the air of the room be very moist and the moisture persistently renewed. Use hot applications from the first, as long as the soreness continues, study every indication with great care in order to determine the exact specific remedy demanded.
Keep in mind constantly in the adjustment of the remedies, the underlying pathological factors and the necessity of correcting them.