Bronchitis, the name given to inflammation of the mucous membrane of the bronchial tubes (see Respiratory System: Pathology). Two main varieties are described, specific and non-specific bronchitis. The bronchitis which occurs in infectious or specific disorders, as diphtheria, influenza, measles, pneumonia, etc., due to the micro-organisms observed in these diseases, is known as specific; whereas that which results from extension from above, or from chemical or mechanical irritation, is known as non-specific. It is convenient to describe it, however, under the chemical divisions of acute and chronic bronchitis.
Acute bronchitis, like other inflammatory affections of the chest, generally arises as the result of exposure to cold, particularly if accompanied with damp, or of sudden change from a heated to a cool atmosphere. The symptoms vary according to the severity of the attack, and more especially according to the extent to which the inflammatory action spreads in the bronchial tubes. The disease usually manifests itself at first in the form of a catarrh, or common cold; but the accompanying feverishness and general constitutional disturbance proclaim the attack to be something more severe, and symptoms denoting the onset of bronchitis soon present themselves. A short, painful, dry cough, accompanied with rapid and wheezing respiration, a feeling of rawness and pain in the throat and behind the breast bone, and of oppression or tightness throughout the chest, mark the early stages of the disease. In some cases, from the first, symptoms of the form of asthma (q.v.) known as the bronchitic are superadded, and greatly aggravate the patient's suffering.
After a few days expectoration begins to come with the cough, at first scanty and viscid or frothy, but soon becoming copious and of purulent character. In general, after free expectoration has been established the more urgent and painful symptoms abate; and while the cough may persist for a length of time, often extending to three or four weeks, in the majority of instances convalescence advances, and the patient is ultimately restored to health, although there is not unfrequently left a tendency to a recurrence of the disease on exposure to its exciting causes.
When the ear or the stethoscope is applied to the chest of a person suffering from such an attack as that now described, there are heard in the earlier stages snoring or cooing sounds, mixed up with others of wheezing or fine whistling quality, accompanying respiration. These are denominated dry sounds, and they are occasionally so abundant and distinct, as to convey their vibrations to the hand applied to the chest, as well as to be audible to a bystander at some distance. As the disease progresses these sounds become to a large extent replaced by others of crackling or bubbling character, which are termed moist sounds or râles. Both these kinds of abnormal sounds are readily explained by a reference to the pathological condition of the parts. One of the first effects of inflammation upon the bronchial mucous membrane is to cause some degree of swelling, which, together with the presence of a tough secretion closely adhering to it, tends to diminish the calibre of the tubes. The respired air as it passes over this surface gives rise to the dry or sonorous breath sounds, the coarser being generated in the large, and the finer or wheezing sounds in the small divisions of the bronchi.
Before long, however, the discharge from the bronchial mucous membrane becomes more abundant and less glutinous, and accumulates in the tubes till dislodged by coughing. The respired air, as it passes through this fluid, causes the moist râles above described. In most instances both moist and dry sounds are heard abundantly in the same case, since different portions of the bronchial tubes are affected at different times in the course of the disease.
Such are briefly the main characteristics presented by an ordinary attack of acute bronchitis running a favourable course. The case is, however, very different when the inflammation spreads into, or when it primarily affects, the minute ramifications of the bronchial tubes which are in immediate relation to the air-cells of the lungs, giving rise to that form of the disease known as capillary bronchitis or broncho-pneumonia (see Respiratory System: Pathology; and Pneumonia). When this takes place all the symptoms already detailed become greatly intensified, and the patient's life is placed in imminent peril in consequence of the interruption to the entrance of air into the lungs, and thus to the due aeration of the blood. The feverishness and restlessness increase, the cough becomes incessant, the respiration extremely rapid and laboured, the nostrils dilating with each effort, and evidence of impending suffocation appears. The surface of the body is pale or dusky, the lips are livid, while breathing becomes increasingly difficult, and is attended with suffocative paroxysms which render the recumbent posture impossible.
Unless speedy relief is obtained by successful efforts to clear the chest by coughing and expectoration, the patient's strength gives way, somnolence and delirium set in and death ensues. All this may be brought about in the space of a few days, and such cases, particularly among the very young, sometimes prove fatal within forty-eight hours.
Acute bronchitis must at all times be looked upon as a severe and even serious ailment, but there are certain circumstances under which its occurrence is a matter of special anxiety to the physician. It is pre-eminently dangerous at the extremes of life, and mortality statistics show it to be one of the most fatal of the diseases of those periods. This is to be explained not only by the well-recognized fact that all acute diseases tell with great severity on the feeble frames alike of infants and aged people, but more particularly by the tendency which bronchitis undoubtedly has in attacking them to assume the capillary form, and when it does so to prove quickly fatal. The importance, therefore, of early attention to the slightest evidence of bronchitis among the very young or the aged can scarcely be overrated.