Licence: Public Domain Mark
Credit: The bronchial catarrh of children / by James Carmichael. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![certain to be brought about. The secretions in the broucliial catarrli of children are generally believed to be relatively more copious and lluid than in adults. Wliatever be their condition the same result obtains with proI)ably equal facility. The only other cause of pulmonary collapse to which I shall allude, is the probability of the temporary occlusion, partial or complete, of the smaller bronchial rainitications by spasmodic contraction. Lcennec, and after him irousseaux, and most other writers on the subject, have alluded to this. Trousseaux, in proof of the existence ol this contraction, has found therapeutically that belladonna, from its well-known action on the vagus in lessen- ing vascular congestion of the mucous surface, diminishing secre- tion, and relieving spasm, is a most efficient drug in treating such cases. In young children, especially those in previously good health, and in whom reflex nerve action is excited with great readiness, it seems probable that this is not an unimportant factor in the production of pulmonary collapse, especially the slighter form of the complication. In fact, it is difficult to account for its pro- duction except on some such theory in the slighter forms of the disease, when there are no signs of any secretion in the tubes. The exact conditions and relations of the bronchial muscles in acute catarrhal conditions require elucidation. One cannot doubt that reflex spasm, as is generally supposed, must seriously affect the ingress and egress of air. A further development of the spasm, ending in more or less paralysis of the muscular wall, especially if accompanied by swelling of the mucous membrane, would tend to produce tlie same effects. In a paper read to this Society lately by Dr M'Bride,^ he alluded to the recent interesting observations of Huck on the erectile tissue of the inferior turbinated bodies in the nose. Stenosis of the nares in young children often plays an important part in the production of pulmonary colhi])se. Nasal catarrh is of common occurrence in infants, and is directly dangerous in proportion to the rapidity and completeness of the occlusion. It is still a debated point whether erectile tissue exists in the bronchial tubes. If it does, there can be little doubt that it would readily account for the rapid temporary closure of the tubes which occurs in the slighter forms of bronchial catarrh in comparatively healthy children. I have said enough regarding the etiology of this condition to show tliat the causes are various and often complex. I he import- ance of a thorough appreciation of these is obviously necessary in view of any rational treatment of the disease. What, then, are the clinical features of these cases ? How do we recognise them during life? From what has already been said, it will be obvious that we meet with varying degrees of pulmonary colhij)se, fioni atelectasis of a limited number of lobules (lobular collapse) to that of larger portions of lung (lobar collapse). As would naturally be » Medico-Chiruryical Tnimariiom, vol. in.](https://iiif.wellcomecollection.org/image/b21695222_0011.jp2/full/800%2C/0/default.jpg)
