BRONCHIAL CATARRH OF NEW-BORN CHILDREN. 73 



" snuffles " and catarrh of the larger bronchi exist, the illness is indeed 

 trifling. By-and-by the catarrh spreads to the finer bronchial tubes. 

 These, very small by nature, are easily closed. The as yet undeveloped 

 child is unable to make powerful efforts to overcome the obstruction. 

 There is no rhonchus sibilans, which otherwise would occur, to afford a 

 diagnostic mark. Nor does the child cough as often as an older one 

 would do, for a portion only of a cough is involuntary ; the other 

 part is voluntarily made in order to remove impediments to respiration. 

 Experience has not yet taught the child this art, and so the symptoms 

 of carbonic-acid poisoning arise both suddenly and unexpectedly as 

 soon as the minuter bronchial tubes become involved in the catarrh. 

 In the bodies of such children, we often find the air-vesicles collapsed, 

 to which the obstructed bronchi led. (Atelectasis, see disease of the 

 lung, Chap. II.) The described symptoms, however, are just as capable 

 of occurring without collapse of the lung, and the latter, as well as 

 carbonic-acid poisoning, is a consequence of bronchial catarrh. 



If we can succeed in making the baby cry or vomit, and thus bring- 

 ing about energetic respiratory movements, fresh air once more enters 

 the lung. The carbonic-acid poisoning vanishes, the symptoms of palsy 

 cease, and as the heart now contracts again with vigor, blood anew 

 streams from the veins into the arteries, and into the empty heart 

 Circulation is reestablished, and with it normal color and warmth return 

 to the skin. 



The attacks are very apt to recur. It may not be possible a second 

 time to render the air-passages pervious, and the children may perish in 

 a subsequent seizure. If the autopsy be conducted without care or 

 science, the cause of death often remains concealed, unless accompanied 

 by extensive atelectasis; since an accurate examination of the bronchi 

 is not attempted, the more ordinary symptoms of bronchitis not having 

 been observed during life. 



III. CHRONIC BRONCHIAL CATARRH. 



The symptoms which we have ascribed as belonging to acute bron- 

 chial catarrh are only slightly modified in chronic catarrhal bronchitis, 

 an extensively prevalent disease. The seat of the affection is not usu- 

 ally confined to solitary portions of the bronchial mucous membrane, as 

 in the acute form, but the anatomical changes given above reach from 

 the trachea, in greater or less degree of development, into the ramifica- 

 tions. 



The disease almost always develops from a frequently relapsing and 

 protracted catarrh, which has habitually recurred every spring and falL 

 At first, during the summer, the patients remain exempt, until, finally, 

 die symptoms become perennial, although somewhat moderated in in- 



