70 DISEASES OF THE TRACHEA AND BRONCHI. 



small, irregular, and scarcely to be counted. In nearly aD, too, the 

 muscles of the skin are paralyzed, the skin becomes relaxed, and covered 

 by profuse perspiration the death-sweat. The bronchi, too, are pro- 

 vided with muscular fibre ; the discharge of the secretion, which fills 

 them, depends materially upon their contraction. If, too, these muscles 

 are palsied with the others, the secretion accumulates. (Edema of the 

 lung supervenes (see cedema of the lung), the palsied bronchi (not the 

 palsied lung, as is often said) having lost all power to expel their con- 

 tents, and thus finally the symptoms of suffocative effusion arise, which 

 we have depicted above. 



A chronic bronchial catarrh, which, as shown above, of itself relaxes 

 the muscular element of the bronchi, must, of course, aggravate the peril 

 in pneumjonia notha, which is nothing more than a febrile bronchial 

 catarrh in a marasmic subject. 



B. Acute Catarrh of the Smaller Bronchi in Children. While 

 bronchial catarrh of adults is a mild complaint, devoid of danger, and 

 only perilous to old people on account of the accompanying fever, it is 

 one of the most pernicious of diseases of childhood from causes purely 

 physical. Let us first consider that intense form of catarrh to which a 

 great number of children fall victims, especially during the period of den- 

 tition, and which may be called capillary bronchitis provided that this 

 expression shall not be understood to mean a process differing essen- 

 tially from catarrh, which is the basis of all the forms of disease hitherto 

 described. 



Sometimes the disease commences with the symptoms of a catarrh 

 of the greater bronchi, apparently slight and free of danger; but, the 

 further it descends into the smaller and finer canals, so much the more 

 hinderance is there set up against the entrance of ah* into the air-vesicles. 

 It is not limited in this case to that slight feeling of indisposition which 

 adults experience in this disorder, but the feeling of oppression arises, 

 and that nameless dread which always accompanies imperfect oxygena- 

 tion and repressed liberation of carbonic acid. The same restlessness, 

 the same violent efforts at inspiration, the same desperation which we 

 have described in croup, are presented by a child, the tips of whose 

 bronchi are contracted or closed by bronchial catarrh. As soon as we 

 enter the chamber, and while still far from the bed, we hear the whis- 

 tling, wheezing noise which the air produces as it is driven through 

 the constricted canals. It accompanies both inspiration and expiration, 

 and is easily distinguished from the whistling of croup; as we dis- 

 tinctly hear that, it does not proceed from one narrowed tube, but from 

 many. If we husband the strength of the child and do not beset it 

 with blood-letting and emetics, its strenuous exertion may often long 

 remain adequate to the task of inhaling a proper supply of air to the 



