CHRONIC .BRONCHIAL CATARRH. f5 



, not unfrequently there is general dropsy. As both cyanosis and dropsy 

 vanish as the attack subsides, and the jugulars become unloaded, there 

 can be no doubt but that the symptoms were really due to the catarrh 

 itself, and not to any complication. Their occurrence is by no means 

 difficult to account for, if we can only prove to ourselves that patients, 

 the calibre of whose bronchial tubes is considerably reduced, always 

 contract their abdominal muscles during the act of expiration. Thus, as 

 the exit of the air from the vesicles through the narrow tubes is slow, 

 a considerable pressure is exerted upon the blood within the thorax, 

 and the flow of blood thither from the rest of the body is retarded. 

 Hereafter, when treating of emphysema, we shall show that bronchial 

 catarrh is one of the main causes of cyanosis and dropsy in that 

 disease. 



Alteration in the percussion-sound, if it exist in chronic bronchial 

 catarrh, is never on account of the disease itself, but is due to emphy- 

 sema, one of the most frequent of its sequelae. Upon auscultation, we 

 often hear the sibilant rhonchus, more rarely the sonorous rhonchus, ip 

 other cases small, moist rales (subcrepitant rales). At the same time 

 there may be normal vesicular respiration, or, as sometimes happens, 

 when many of the bronchioles are occluded, the respiration is feeble ; 

 and again, where the swelling of the mucous membrane has diminished, 

 but has not closed the bronchioles, thus increasing the difference be- 

 tween then: calibre and the capacity of the air-vesicles, the respiratory 

 murmur is sharper. 



Few patients ever recover from this malady, yet to very few does it 

 ever endanger life. The old man's cough has become proverbial, and, 

 indeed, these patients may attain a very great age ere they succumb to 

 pneumonia notha, or other intercurrent malady. In other cases they 

 die of the secondary disorders of the pulmonary substance which result 

 from chronic catarrh. (See article on emphysema and interstitial pneu- 

 monia.) A very different character from that of the " catarrh sec," with 

 its more or less tough, scanty mucous secretion, is presented by the 

 variety of bronchial catarrh attended by copious secretion, and often 

 called bronchial blenorrhcea, or bronchorrhcea. In this form the sputum 

 is in coherent masses, which, more or less mixed with air, do not sink 

 in water. Sometimes a pound or more of this yellowish secretion, full 

 of young cells, is coughed up in the course of a day. In winter it is 

 profuse ; in summer it usually diminishes in quantity. 



The secretion being less adhesive, and hence more easy of expecto- 

 ration, the cough is not so persistent and distressing as in the " dry 

 catarrh." The dyspnoea, too, generally is slighter, the more common 

 seat of bronchorrhcea being in the larger tubes, and its tendency being 

 rather to produce diffuse dilatation of the finer bronchi. It is only when 



