PSEUDO-MEMBRANOUS BRONCHITIS. . 839 



PSEUDO-MEMBRANOUS BRONCHITIS. 



The pseudo-membranous forms of bronchitis, formerly termed 

 "croupal or diphtheritic bronchitis,"' are rare. They develop suddenly 

 or follow pseudo-membranous laryngitis. Like the latter, they are due' 

 to a specific infection, possibly aided by accidental causes. 



Their causation is imperfectly understood, and they cannot be com- 

 pared, still less homologated, with diphtheritic disorders in man. They 

 are characterised by the formation of false membranes, which develop on 

 the mucous surface, mould themselves over the internal surface of the 

 large bronchi, and ramify throughout the bronchial channels like 

 branches of trees. They are of greyish-yellow colour, and appear to be 

 formed of fibrin, coagulated albumen, and epithelial debris cemented 

 together with mucus. 



Symptoms. At the outset these pseudo-membranous forms of 

 bronchitis have the same characters as acute bronchitis, which at the 

 crisis would be marked by the expulsion of fragments of false membrane 

 by coughing. Most frequently it seems that the bronchitis follows its 

 regular course, and in such case it is only during convalescence or a 

 considerable time afterwards that the membranes begin to be discharged 

 during paroxysms of coughing. 



The patients are subject to intense dyspnoea, appear about to suffo- 

 cate, and during the efforts then made the false membranes are dis- 

 charged in the form of half-organised layers, or, on the other hand, in 

 branched masses, resembling twigs. 



The dyspnoea at once ceases. Despite the development of these 

 false membranes in the bronchi, no alarming symptoms are produced, 

 which is explained by the fact of the false membranes being adherent 

 only to the inner surface of the principal conduits, without closing or 

 even markedly obstructing them or the smaller passages leading to 

 the pulmonary alveoli. When, however, they are displaced, violent 

 reflex spasms are produced as soon as the fragments approach the 

 larynx. 



Diagnosis. The diagnosis rests entirely on examination of the 

 expectorated material. 



So far as the prognosis is concerned, it is less grave than might be 

 supposed from the symptoms. The gravity arises from the fact that this 

 disease has a certain tendency to become chronic. 



Treatment scarcely differs from that of ordinary bronchitis. Tar, 

 creosote in doses of 2^ to 5 drachms given in oil ; terpine in doses of 

 ^ to I drachms per day can be recommended. Iodide of potassium also 

 has certain advantages. 



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