68 DISEASES OF THE TRACHEA AND BRONCHI. 



IL ACUTE CATARRH or THE SMALLER BRONCHI. 



A. As it occurs in the Adult. When extensive, the disease often 

 exhibits the signs of sympathy and reaction of the general system 

 against local disorder, already described as catarrhal fever. 



The minuter bronchial tubes have no sensibility; hence, when the 

 catarrh is confined to these alone, there is none of that feeling of itch- 

 ing, nor soreness, felt in catarrh of the larger bronchi. The occurrence 

 of acute pain, at any time throughout the attack, shows the existence of 

 a complication. After a while, however, pain is felt at the points of in- 

 sertion of the muscles upon the chest and epigastric region. This pro- 

 ceeds from overstraining of the abdominal muscles, by whose spasmodic, 

 jerking contractions the act of coughing is effected. . This pain, which 

 is observable elsewhere when muscles have been overstrained, is aggra- 

 vated by any movement of the muscular fibres, but especially so upon 

 coughing, and, during the fit, the sick man sits up instinctively, so as to 

 relax the abdominal muscles. The cough is of far more violent charac- 

 ter than that previously described, coming on in long paroxysms. It is 

 not " loose," that is, the air, driven from the pulmonary vesicles by the 

 spasmodic contractions of the chest, has difficulty in clearing the lesser 

 bronchi of the secretion. Here, too, at first, the sputum is usually 

 scanty ; but it gradually changes, as described above, becoming more 

 copious. As the sputum from the smaller tubes is unmixed with air, it 

 is specifically heavier than water, and sinks in it; but, owing to its 

 tenacity, it retains the shape of the tube from which it came, and by its 

 adhesiveness it clings to the frothy, lighter secretion from the larger 

 bronchi, which is mixed with air and floats. Thus the expectoration of 

 acute bronchial catarrh of the smaller air-passages, when cast into water, 

 forms a frothy layer upon the surface, with fine filaments hanging 

 from it. 



Extensive catarrh of the lesser bronchi is always accompanied by 

 more or less dyspnoea. In adults, however, this rarely amounts to more 

 than a somewhat laborious, or impeded respiration. Air enough can 

 always reach the air-vesicles, and terror and sensation of suffocation are 

 scarcely ever observed. Indeed, it is the mild and insignificant distress 

 caused by this disease in adults, and the great danger and totally differ- 

 ent symptoms to which it gives rise during childhood, which obliges us 

 to describe the two forms separately. It is true that, even in adults, 

 catarrh of the finer bronchi is sometimes accompanied by severe period- 

 ical dyspnoea ; but this very periodicity indicates the existence of a 

 nervous complication, which is causing spasm in the muscles of the 

 smaller bronchi. The sound, upon percussion, is not altered in this 

 form of bronchial catarrh, any more than in catarrh of the larger 

 bronchi. Instead, however, of the sonorous rhonchi, sibilant rhonchi 



