=Definition.=—A rare, acute or chronic inflammatory disease of the
bronchi, in which a fibrinous mould of the bronchus and its branches is
formed. These are expelled in paroxysms of cough and dyspnea. The casts
block the bronchial tubes. When these moulds are large or medium sized,
they are generally hollow, while those of the smaller bronchi are solid.
=Etiology= and =Pathology=.—The causes are unknown. Young men, between
the twentieth and fortieth years, are the usual subjects; but the
disease may occur at any period of life. Lesions occur as in other
forms of bronchitis. The attack occurs most frequently in the spring
months. In some cases there seems to be some hereditary influence.
Chronic pulmonary diseases, like phthisis, emphysema and pleurisy, are
occasionally predisposing causes. It is sometimes associated with skin
diseases, such as herpes, impetigo and pemphigus.
The =pathology= is not known. The masses that are expelled are usually
round and mixed with blood and mucus. The casts are more dense, but the
membrane is identical with that of croupous exudates. This affection,
however, is limited to certain bronchial tubes and recurs at stated or
irregular intervals, sometimes for a period of several years. There is
loss of epithelium in the affected bronchi and the submucous tissue is
often swollen and infiltrated with serum.
=Symptoms.=—Acute cases are rare. The attacks may set in with rigor,
high fever, pain in the side, soreness, severe paroxysms of cough and
sometimes a slight hemoptysis. The symptoms are those of an ordinary
acute bronchitis, but of severer character; aggravated cough and
dyspnea and fatal termination are not uncommon. Death occasionally
results from suffocation. There may be but one attack without any
recurrence, but in the chronic form the paroxysms recur at irregular
intervals, though they are less severe than in the acute form.
The disease may last for ten or even twenty years, the attacks
recurring weekly, or a period of a year or more may intervene. The
onset is marked by bronchial symptoms with or without fever. The cough
soon becomes distressing and paroxysmal in character. The sputum may
be blood-stained and occasionally there is profuse hemorrhage. The
expectoration is in the form of ball-like masses which, when unraveled
are found to be moulds of the bronchi. They may be hollow and laminated
or quite solid. When examined under the microscope they are seen to
consist of a fibrillated membrane in which are imbedded leucocytes,
mucus, corpuscles, fat drops and epithelial cells. Leyden’s crystals
and Curschmann’s spirals are occasionally found.
=Physical signs= are usually those of bronchitis. The weakened or
suppressed breath sounds in the affected territory may occasionally
be determined. There is sometimes a diminished expansion or even
retraction of the chest wall over the affected area. There is no
dullness on percussion, unless the portions of the lung supplied by the
affected tubes collapse. After dislodgement of the casts, the normal
respiratory murmur returns.
=Diagnosis.=—The fibrinous casts alone are sufficient for a positive
diagnosis.
=Prognosis.=—Generally favorable. In uncomplicated cases there is
rarely any danger, even though there may be severe paroxysms of cough
and dyspnea. In fatal cases the lesions of associated or preceding
affections have been found, such as chronic pleurisy, pneumonia and
phthisis. Although this is a rare disease, cases have been treated
with success by osteopathic means. If uncomplicated there should be a
fair chance for a cure, depending, of course, upon the constitutional
condition and the permanency of the lesions.
=Treatment.=—The treatment is largely that of acute bronchitis. The
disorder is more extensive than in acute bronchitis, consequently
severe subluxations of the ribs and vertebræ of the upper and middle
dorsals occur, besides extensive muscular contractions of the chest and
neck. The fibrinous casts are somewhat of the same nature of membranous
exudates elsewhere, therefore the treatment should be directed to a
correction of the hyperemia of the mucous membrane of the bronchial
tubes, thus loosening and disorganizing the exudate. The vagi nerves
supply a part of the innervation to the bronchial tubes and lungs. Any
disorder to them should be corrected when diseases of the bronchial
tubes and lungs exist. They contain motor fibers to these organs, and
to the bronchial tubes they supply, principally the transverse fibers.
In bronchitis of various forms, marked effect can be secured by close
attention and treatment to the inferior laryngeal nerve. This is best
treated at the inner side of the lower portion of the sternocleido
muscle.
The different forms of bronchitis illustrate the point so often noted
in osteopathic etiology and pathology, that the various affections
of the same region should not be studied so much as types of several
diseases or disease entities as different degrees of involvement,
depending on the severity of the causative lesion, the function of the
nerves disturbed, and the character of the tissues. It is straining
a point to diagnose and classify many diseases according to signs
and symptoms instead of studying the process from central causes,
for, at best, peripheral manifestations, micro-organisms, etc., are
really incidental to the importance of the primary source of disturbed
nutrition. Consequently, the same treatment, if scientific, is
frequently indicated for all of the disorders that may affect a given
locality. After all has been said and done, the therapy as well as the
pathology, must hinge upon the fundamental—uninterrupted blood channels
and nerve courses are essential to health. Whether a disease is of
primary or secondary origin, or whether or not it presents different
symptoms in various types, the above basic principle is invariably
applicable. This simplifies etiology, pathology and treatment and
furnishes a backbone to theory and practice, and some day rational
medicine will adopt it.