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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![there is an aggravation of all the symptoms. The pulse is much accelerated, the respirations rim up to 50 or 60, or even higher, the countenance becomes dusky and livid, and the alae nasi act visibly, the cough at the same time is more frequent and distress- ing, the mucous rales more co].)ious and general. Signs of gastro- intestinal disorder are generally present,—a coated tongue, un- healthy evacuations, often diarrhoea. The greater tendency of the catarrh to extend to the minute bronchi, and the almost inevitable occurrence of further complications, are leading characteristicsof,and constitute the great danger in, this disease in children. The com- plications likely to arise as a secondary result of bronchial catarrh invest the disease as occurring in early life with peculiar interest, and it is to warding off these that all our efforts as physicians should be directed. The complications alluded to, I need hardly say, are pulmonary collapse, with its compensatory emphysema and catarrhal pneumonia. A consideration of the clinical features of pulmonary collapse will, therefore, naturally engage our attention. Acquired atelect- asis, as it is called,- is of common occurrence—perhaps more fre- quent than is generally supposed, except by those who are much engaged in the treatment of disease in children. It is a condition which is generally associated with the more extensive and severe forms of bronchial catarrh, but is not unfrequently met with in young children even in the milder forms of the disease. Perfect recovery and reinflation of the collapsed lobules may take place. On the other hand, these portions of lung may either remain in a permanently atelectic condition, or catarrhal pneumonia be ulti- mately developed in them. An early recognition of the occurrence of collapse is of primary importance, as prompt and energetic treatment is successful in a certain proportion of cases in inducing reinflation, and preventing the occurrence of further complications. The causes of pulmonary collapse are mainly of a physical nature. It may be stated generally that anything which mechanically inter- feres with the normal mechanism of the respiratory act in a child will tend to produce it. In considering the etiology of this condition it is desirable to allude, in the first place, to the pathology of cough. Cough, being essentially a reflex and involuntary act, may be con- sidered salutary in so far as it assists nature to clear the tubes and get rid of viscid or irritating mucus. In the adult this involuntary act is largely supplemented by voluntary effort: in the young child such is not the case, and the patient is placed at a distinct dis- advantage so far as the extra effort is concerned. There can be no doubt that the absence of this voluntary power is a not unimportant factor or link in the chain of causes tending to in- duce pulmonary collapse. In enumerating the causes of defective breathing power, we must look to the entire respiratory apparatus, and here, we find, that in any part of it altered physical condi- tions may arise which tend to produce atelectasis. Thus, in the](https://iiif.wellcomecollection.org/image/b21695222_0008.jp2/full/800%2C/0/default.jpg)
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