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 tho very yoir.ig or the aged can scarcely
bo overrated.Bronchitis is also apt to be very severe when it occurs in persons who are addicted to intemperance. Again, in those who suffer from any disease affecting directly or indirectly the respiratory functions, such as consumption or h?art disease, the supervention of an attack of acute bronchitis is an alarming complication, increasing, as it necessarily does, the embarrassment of breathing. The same remark is applicable to those numerous instances of its occurrence in children who are or have been suffering from such diseases as have always associated with them a certain degree of bronchial irritation, such as measles and hooping-cough.
One other source of danger of a special character In bronchitis remains to be mentioned, viz., collapse of the lung. Occasionally a branch of a bronchial tube becomes plugged up with secretion, so that the area of the lung to which this branch conducts ceases to be inflated on inspira tion. The small quantity of air imprisoned in the portion of lung gradually escapes, but no fresh air enters, and the part collapses and becomes of solid consistence. Increased difficulty of breathing is the result, and where a large portion of lung is affected by the plugging up of a large bronchus, a fatal result may rapidly follow, the danger being specially great in the case of children. Fortunately, the obstruction may sometimes be removed by vigorous coughing, and relief is then obtained.
With respect to the treatment of acute bronchitis, in those mild cases which are more of the nature of a simple catarrh, little else will be found necessary than confinement in a warm room, or in bed, for a few days, and the use of light diet, together with warm diluent drinks. Additional measures are, however, called for when the disease is more markedly developed. Medicines to allay fever and promote perspiration, such as the well-known Mindererus spirit, combined with antimonial or ipecacuan wine, are highly serviceable in the earlier stages. Later on, with the view of soothing the pain of the cough, and favouring expectora tion, mixtures containing squill or tolu, with the addition of some opiate, such as the ordinary paregorics, may be advantageously employed. The use of opium, however, in a;iy form should not be resorted to in the case of young children without medical advice, since its action on them is much more potent and less under control than it is in adults. N"ot a few of the so-called " soothing mixtures," have been found to contain opium in quantity sufficient to prove dangerous when administered to children ; and, indeed, it is to be feared that fatal results not unfrequently follow their incautious use in this way.
From the outset of the attack the employment of warm applications to the chest in the form of fomentations or poultices affords great relief. Few remedial measures are of greater value than the frequent inhalation of steam. This is accomplished readily enough in the case of adults by the use of an inhaler or simply by breathing over an open-mouthed vessel containing boiling water. In children in whom this plan cannot be carried out in the same manner, there is in general no difficulty in surrounding them with an atmosphere of steam by placing around them vessels containing hot water, the vapour from which envelopes them. The relief to the cough and breathing, and the aid to expectoration afforded by this simple plan, are often sur prising, and the cases are rare where it cannot be borne.
Should the cough persist for a length of time, and the disease threaten to become chronic, counter-irritant applica tions to the chest in front and behind, in the form of stimulating liniments, or even of blisters, will be rendered necessary.
When the bronchitis is of the capillary form, the great object is to maintain the patient s strength, and to endeavour to secure the expulsion of the morbid secretion from the fine bronchi. In addition to the remedies already alluded to, stimulants are called for from the first ; and should tho cough be ineffectual in relieving the bronchial tubes, the administration of an emetic dose of sulphate of zinc or squill may produce a good effect.
During the whole course of any attack of bronchitis, attention must be paid to the due nourishment of the patient; and during the subsequent convalescence, which, particularly in elderly persons, is apt to be slow, tonics and stimulants may have to be prescribed.
Chronic bronchitis may arise as the result of repeated attacks of the acute form, or it may exist altogether inde pendently. It occurs more frequently among persons advanced in life than among the young, although no age is exempt from it.
The usual history of this form of bronchitis is that of a cough recurring during the colder seasons of the year, and in its earlier stages, departing entirely in summer, so that it is frequently called "winter cough." In many persons subject to it, however, attacks are apt to be excited at any time by very slight causes, such as changes in the weather; and in advanced cases of the disease the cough is seldom altogether absent.
The symptoms and auscultatory signs of chronic bron chitis are on the whole similar to those pertaining to the acute form, except that the febrile disturbance and pain are much less marked. The cough is usually more trouble some in the morning than during the day. There is usually free and copious expectoration, and occasionally this is so abundant as to constitute what is termed bronchorrhcea.
Chronic bronchitis leads to alterations of structure in the affected bronchial tubes, their mucous membrane becoming thickened or even ulcerated, while occasionally permanent dilatation of the bronchi takes place, often accompanied with profuse foetid expectoration. In long standing cases of chronic bronchitis, the nutrition of the lungs becomes impaired, and dilatation of the air-tubes (emphysema) and other complications result, giving rise to more or less con stant breathlessness. Chronic bronchitis is liable in some instances, particularly when accompanied with loss of flesh and strength, to be mistaken for consumption ; but the physician who carefully regards the history of the case and observes the physical signs and symptoms, will in general be able to distinguish the one disease from the other.
Chronic bronchitis may arise secondarily to some other ailment. This is especially the case in Bright s disease of the kidneys, and in heart disease, of both of which maladies it often proves a serious complication.
Chronic bronchitis does not often prove directly fatal, nor is it necessarily inconsistent with long life. Its chief danger lies in the tendency to intercurrent acute attacks, particularly in the aged ; and in this manner it very fre quently causes death.
pends upon the severity of the case, the age of the patient, and the presence or absence of complications. Attention to the general health is a matter of prime importance in all cases of the disease, more particularly among persons whose avocations entail exposure, and tonics with cod-liver oil will be found highly advantageous. The use of a respirator in very cold or damp weather is a valuable means of protection. In those aggravated forms of chronic bronchitis, where the slightest exposure to cold air brings
on fresh attacks, it may become necessary, where circum-