Bronchitis, or inflammation of the lining membrane of the bronchial tubes, is a disease of very common occurrence in Great Britain and in the United States, and one of the greatest importance, for, though in most cases completely recovered from, it may, if carelessly treated, lead to premature and miserable old age, or even in some cases to speedy death. Moreover, besides occurring independently, it is an extremely common complication in other diseases—e.g. in fevers, and in affections of the heart or kidney. It is usually caused by exposure to cold; but persons whose occupations expose them to the constant inhalation of irritating dust (masons, needle-grinders, and many others), often suffer from a form of bronchitis which is extremely apt to lead to disease of the lungs. The first symptoms of acute bronchitis are generally those which distinguish a common cold—viz. shivering, headache, and sense of weariness, with occasional cough; but the cough continues, and recurs in paroxysms; there is a feeling of oppression on the chest and pain behind the breastbone on coughing, and the person wheezes when he breathes. He also breathes more rapidly, six or ten respirations in the minute more than he did when in health, his pulse is quicker, and his temperature a little above normal; and the ear applied to his chest, after these symptoms have continued for two or three days, will hear a rattling, as if air was bubbling through thickish fluid, which indeed is the case; he is breathing through an extraordinary amount of mucus secreted by the inflamed lining membrane of the tubes. During his paroxysms of cough, this mucus is spit up. If the inflammation extend no further than the larger bronchial tubes, it is termed tubular bronchitis, and is seldom a fatal disease in the first attack. When the minute ramifications of the bronchial tubes are chiefly or alone affected, either from the first or by downward extension of the inflammation, the danger to life is very great; this form is called capillary bronchitis, and is most often seen in children, though happily less frequently than tubular bronchitis. In such a case, the cough and associated pain may be less severe, but all the other symptoms—feverishness, distress, prostration, &c.—are much more intense than in the milder form. The breathing may be so embarrassed that the patient can no longer lie down, but requires to sit or stand up, and use all his muscles of respiration. Though he coughs, he spits very little, till about the third day, when he expectorates large quantities of yellow fluid. At last, prostration becomes so complete that he ceases to spit, and dies suffocated by the accumulated mucus, from the fifth to the seventh day.
A patient who has once had acute bronchitis is very apt to suffer from it again, and after one or many attacks the disease may become chronic. Chronic bronchitis leads to important structural changes in the lungs, especially Emphysema (q.v.), to consequent embarrassment of the respiration and circulation, with secondary changes in other organs, and is generally fatal, though, it may be, not for many years. The patient is always liable to severer attacks, much resembling acute bronchitis, and often induced by very slight causes.
The treatment of bronchitis must vary with the patient's constitution; but in most cases, counter-irritation, applied through the medium of mustard or hot turpentine fomentations, will be found very useful. These remedies act more rapidly than a blister, and may be frequently repeated. It is of the greatest importance that the patient should remain in a warm, equable, and moist atmosphere. In the early stages, before free expectoration is established, ipecacuanha is generally the most useful remedy; but it should be remembered that patients suffering from bronchitis are very easily depressed, especially after the first few days, and then stimulating expectorants, such as ammonia, squills, balsams, should be added. In very acute cases, after a brisk purge, an emetic is often very useful to remove accumulations of mucus. In some cases of bronchitis, the persistence of the disease depends upon some constitutional weakness (gout, syphilis, &c.); and no treatment will effect a cure unless it include remedies for the particular condition which may be present.
In chronic bronchitis, avoidance of the causes which lead to 'catching cold' is of the utmost importance. Residence during the winter in a mild, equable climate, or confinement to a well-warmed house, is sometimes the only measure that will be of much service. The exacerbations must be treated on the same principles as acute bronchitis. In the bronchitis of old persons, chloric ether will be found very useful, and may be combined with sedatives, as henbane; but opium must be given with great caution, or not at all, as it tends to diminish the expectoration of mucus from inflamed tubes. The paregoric elixir (compound tincture of camphor) is an old and popular remedy in bronchitis, but enough has been said to impress on the reader the danger of tampering with bronchitis. In every case where it is possible, a skilled medical man should be employed, to determine, by the stethoscope, not only the disease but its exact situation and cause; and as it is but too likely to recur at some future period, or symptoms caused by it to appear, a skilled opinion has a permanent value to the patient. See CATARRH.