78 DISEASES OF THE TRACHEA AND BRONCHI. 



condensation of the parenchyma of the lung exclude simple catarrh 

 from the diagnosis. 



3. It is true that acute bronchial catarrh may begin with a violent 

 rigor, but, as the 'disease progresses, the tendency shows itself to re- 

 peated attacks of chilliness. Hence, when we find an asthenic fever 

 without pain in the side, without bloody sputa, and apparently with 

 none but catarrhal symptoms, yet, if the attack have commenced with 

 but a single rigor, we should not be too hasty in diagnosticating a 

 pneumonia notha, or, as we now say " nervous influenza " (typhoid in- 

 fluenza), lest autopsy should bring to light a pneumonia winch would 

 have been recognized, had the single rigor been properly considered 

 and the patient been more accurately auscultated. 



In their appropriate chapters we shall explain the mode of distin- 

 guishing chronic bronchial catarrh, with scanty secretion and great dys- 

 pncea, from nervous asthma, and shall give the diagnostic points between 

 pituitary phthisis and tuberculous phthisis. 1 



PROGNOSIS. The danger of bronchitis depends almost entirely upon 

 the age of the patient. In early life, the younger the child, the smaller 

 the bronchi, so much the more perilous is the disease. In adults, it 

 scarcely ever threatens life, excepting among old persons, where it 

 again becomes a dangerous disorder, especially if accompanied by fever. 



The gravest symptoms are those indicative of impeded oxygenation 

 in the air-vesicles. The most violent cough, the most intense restless- 

 ness, an immense purulent expectoration, and all other symptoms of 

 the acute and chronic form, are of far less significance than the first 

 token of poisoning by carbonic acid. Never forget that life is not really 

 threatened until such symptoms arise. This reflection will form the 

 best safeguard against over-active treatment of children with capillary 

 bronchitis. As long as the pulse remains full and the countenance 

 ruddy, there is no immediate danger. 



TREATMENT Prophylaxis. Upon this head we refer to what has 

 been said as to the prophylaxis against laryngeal catarrh. Cautious 

 habituation to change of temperature, cold washing, cold baths, are as 

 commendable in the one case as in the other. 



Indication as to Cause. This demands consideration both of the 

 predisposing and of the exciting cause. As some of the causes of 

 catarrh are unknown, and as others cannot be allayed, the indicatio 

 causalis, in many cases, cannot be met ; while, in other instances, care- 

 ful regard to known exciting agents is rewarded by the best results. 



This applies, above ah 1 , to the general tendency to catarrh, and 

 especially to bronchial catarrh, engendered by scrofula, and rachitis. 

 There are many pigeon-breasted, big-headed children, with open fon- 

 tanclle, enlarged epiphyses, retarded dentition, and flabby skin, which 



