66 DISEASES OF THE TRACHEA AND BRONCHI. 



the tuberculous pulmonary tissue proceeds from this ulceration as soon 

 as the wall of the bronchus has been destroyed, a view which we fully 

 share with him as regards infiltrated tuberculosis (or cheesy pneumonia). 



L ACUTE CATARRH OF THE TRACHEA AND LARGER BRONCHI. 



SYMPTOMS AND COURSE. Acute catarrh of the trachea and greater 

 bronchi is often combined with catarrh of the larynx, nasal mucous 

 membrane, that of the frontal sinus, and of the conjunctiva. More 

 rarely it spreads into the smaller bronchi. The greater its extent, so 

 much the more frequently does it begin with shivering, and, in sensitive 

 persons, perhaps even with a chill. This chilliness, however, is rarely 

 confined to a single rigor, and this is an important point of distinction 

 between the onset of a catarrhal and of an inflammatory fever. It often 

 happens that throughout the whole attack, with every slight alteration 

 of temperature, or upon changing the linen, and especially if the patient 

 be kid in a fresh bed, shivering-fits continue to recur. During the in- 

 tervals the patient experiences a sensation of burning heat, without any 

 indication from the thermometer of an actual increase of temperature. 

 Added to this, there come distressing frontal headache, pulsation of the 

 temporal arteries, soreness of the limbs, sensation of pain in the joints, 

 increased upon pressure, constituting " catarrhal rheumatic fever." 



Should the appetite fail, too, and the tongue become coated, we even 

 hear " gastro-catarrhal-rheumatic fever " spoken of. It is very indicative 

 of catarrhal fever that the intense feeling of weakness does not bear any 

 proportion to the trifling elevation of temperature and frequence of the 

 pulse, which seldom exceeds the number of eighty to a hundred beats 

 per minute. In children, and irritable subjects, delirium sometimes is 

 added to these symptoms, and in very rare instances, and in exceedingly 

 sensitive children, convulsions may take place. The mother, and even 

 the physician, may be temporarily alarmed by these manifestations, until 

 a profuse flow from the nose, or repeated sneezing, allays the dread of a 

 sommencing disease of the brain. In such a case the doctor, who, the 

 iay before, with a long face, has been applying leeches to the head, 

 may find his position embarrassing, now that the harmlessness of the 

 case has become obvious, even to the bystanders. 



Catarrh of the trachea and larger bronchi is not always attended by 

 "ever, often running its course from beginning to end without it. In 

 most cases of severity it is accompanied by perverted sensations along 

 the course of the air-passages and under the sternum. Hence the sensa- 

 tion of tickling after inhaling acrid vapor, and the feeling of soreness 

 and burning in the chest. Not uncommonly, the integument of the 

 sternum is unduly sensitive, and the cause of this phenomenon is sup- 

 posed to be an excitement transmitted to the skin through central 



