76 DISEASES OF THE TRACHEA AND BRONCHI. 



an acute attack supervenes upon the chronic one that there is much 

 dyspnoea, which then depends upon the amount of swelling of the mu- 

 cous membranes. 



During these exacerbations the cell-production goes on with less 

 activity, so that the secretion of the mucous surface is reduced in quan- 

 tity. This causes the patient to imagine that the expectoration has 

 become " tight, and must be loosened," a view in which, here and there, 

 the doctors participate, who, upon increase of the dyspnoea, with arrest 

 of secretion, forthwith diving into their arsenal of expectorants, com- 

 pose a recipe of the most heterogeneous substances. 



Upon auscultation, in this form of chronic bronchitis, we sometimes 

 hear the coarse rhonchi, sometimes coarser, or finer rdles. 



This disease, too, upon the whole, is wonderfully well borne. The 

 patients not unfrequently attain an advanced age ere pituitary catarrh, 

 phthisis pituitosus, develops from blennorrhcea of the bronchi. While 

 the dry catarrh is more prone to the production of emphysema of the 

 lungs, the tendency of bronchorrhcea is to cause bronchiectasis. The 

 patients more frequently die of acute intercurrent disorders than of ex- 

 haustion through the persistence and abundance of the discharge. 



The general characteristics of chronic bronchorrhoea are not, in all 

 cases, nor even in the majority of cases, so much modified by diffuse 

 dilatation of the bronchi as to enable us to recognize this complication 

 with certainty. Sometimes, however, the peculiar nature of the sputa 

 warrants our forming a diagnosis at least of its probable existence. 

 Experience has taught that, as long as the bronchi retain their normal 

 calibre, the secretion of their mucous membrane seldom undergoes 

 putrefactive decomposition, while in the diffuse and sacculated bronchi- 

 ectasis it very often becomes putrid. The fact that the contents of a 

 sacculated bronchus frequently putrefy, far more frequently, indeed, 

 than the contents of a tuberculous cavity, is a matter for our future 

 consideration. 



That the secretion formed in tubes which have become diffusely en- 

 larged should also show an increased tendency to putrescence would 

 seem to indicate, with some plausibility, that besides the ciliary motion 

 and the cough (which appears to have little effect in clearing the minuter 

 bronchi), contraction of the bronchial muscles also plays a part in ex 

 pectoration, so that palsy of these muscles, which, undoubtedly, is one 

 of the main ca .ises of dilatation in the tubes, also favors stagnation, and 

 consequent putrescence of the secretion which they contain. If, then, 

 the copious puriform sputa hitherto ejected become unusually liquid ; if 

 both sputa and the breath of the patient begin to emit a penetrating 

 stench ; if the more solid components of the sputa sink to the bottom 

 of the cup, and there form a greenish-yellow sediment, being no longer 



