Chapter 52

BRONCHITIS, the name given to inflammation of the mucous membrane of the bronchial tubes (see RESPIRATORY SYSTEM: _Pathology_). Two main varieties are described, specific and non-specific bronchitis. The bronchitis which occurs in infectious or specific disorders, as diphtheria, influenza, measles, pneumonia, &c., due to the micro-organisms observed in these diseases, is known as specific; whereas that which results from extension from above, or from chemical or mechanical irritation, is known as non-specific. It is convenient to describe it, however, under the chemical divisions of _acute_ and _chronic_ bronchitis.

_Acute bronchitis_, like other inflammatory affections of the chest, generally arises as the result of exposure to cold, particularly if accompanied with damp, or of sudden change from a heated to a cool atmosphere. The symptoms vary according to the severity of the attack, and more especially according to the extent to which the inflammatory action spreads in the bronchial tubes. The disease usually manifests itself at first in the form of a catarrh, or common cold; but the accompanying feverishness and general constitutional disturbance proclaim the attack to be something more severe, and symptoms denoting the onset of bronchitis soon present themselves. A short, painful, dry cough, accompanied with rapid and wheezing respiration, a feeling of rawness and pain in the throat and behind the breast bone, and of oppression or tightness throughout the chest, mark the early stages of the disease. In some cases, from the first, symptoms of the form of asthma (_q.v._) known as the _bronchitic_ are superadded, and greatly aggravate the patient's suffering.

[v.04 p.0635] After a few days expectoration begins to come with the cough, at first scanty and viscid or frothy, but soon becoming copious and of purulent character. In general, after free expectoration has been established the more urgent and painful symptoms abate; and while the cough may persist for a length of time, often extending to three or four weeks, in the majority of instances convalescence advances, and the patient is ultimately restored to health, although there is not unfrequently left a tendency to a recurrence of the disease on exposure to its exciting causes.

When the ear or the stethoscope is applied to the chest of a person suffering from such an attack as that now described, there are heard in the earlier stages snoring or cooing sounds, mixed up with others of wheezing or fine whistling quality, accompanying respiration. These are denominated dry sounds, and they are occasionally so abundant and distinct, as to convey their vibrations to the hand applied to the chest, as well as to be audible to a bystander at some distance. As the disease progresses these sounds become to a large extent replaced by others of crackling or bubbling character, which are termed moist sounds or râles. Both these kinds of abnormal sounds are readily explained by a reference to the pathological condition of the parts. One of the first effects of inflammation upon the bronchial mucous membrane is to cause some degree of swelling, which, together with the presence of a tough secretion closely adhering to it, tends to diminish the calibre of the tubes. The respired air as it passes over this surface gives rise to the dry or sonorous breath sounds, the coarser being generated in the large, and the finer or wheezing sounds in the small divisions of the bronchi. Before long, however, the discharge from the bronchial mucous membrane becomes more abundant and less glutinous, and accumulates in the tubes till dislodged by coughing. The respired air, as it passes through this fluid, causes the moist râles above described. In most instances both moist and dry sounds are heard abundantly in the same case, since different portions of the bronchial tubes are affected at different times in the course of the disease.

Such are briefly the main characteristics presented by an ordinary attack of acute bronchitis running a favourable course. The case is, however, very different when the inflammation spreads into, or when it primarily affects, the minute ramifications of the bronchial tubes which are in immediate relation to the air-cells of the lungs, giving rise to that form of the disease known as _capillary bronchitis_ or _broncho-pneumonia_ (see RESPIRATORY SYSTEM: _Pathology_; and PNEUMONIA). When this takes place all the symptoms already detailed become greatly intensified, and the patient's life is placed in imminent peril in consequence of the interruption to the entrance of air into the lungs, and thus to the due aeration of the blood. The feverishness and restlessness increase, the cough becomes incessant, the respiration extremely rapid and laboured, the nostrils dilating with each effort, and evidence of impending suffocation appears. The surface of the body is pale or dusky, the lips are livid, while breathing becomes increasingly difficult, and is attended with suffocative paroxysms which render the recumbent posture impossible. Unless speedy relief is obtained by successful efforts to clear the chest by coughing and expectoration, the patient's strength gives way, somnolence and delirium set in and death ensues. All this may be brought about in the space of a few days, and such cases, particularly among the very young, sometimes prove fatal within forty-eight hours.

Acute bronchitis must at all times be looked upon as a severe and even serious ailment, but there are certain circumstances under which its occurrence is a matter of special anxiety to the physician. It is pre-eminently dangerous at the extremes of life, and mortality statistics show it to be one of the most fatal of the diseases of those periods. This is to be explained not only by the well-recognized fact that all acute diseases tell with great severity on the feeble frames alike of infants and aged people, but more particularly by the tendency which bronchitis undoubtedly has in attacking them to assume the capillary form, and when it does so to prove quickly fatal. The importance, therefore, of early attention to the slightest evidence of bronchitis among the very young or the aged can scarcely be overrated.

Bronchitis is also apt to be very severe when it occurs in persons who are addicted to intemperance. Again, in those who suffer from any disease affecting directly or indirectly the respiratory functions, such as consumption or heart disease, the supervention of an attack of acute bronchitis is an alarming complication, increasing, as it necessarily does, the embarrassment of breathing. The same remark is applicable to those numerous instances of its occurrence in children who are or have been suffering from such diseases as have always associated with them a certain degree of bronchial irritation, such as measles and whooping-cough.

One other source of danger of a special character in bronchitis remains to be mentioned, viz. collapse of the lung. Occasionally a branch of a bronchial tube becomes plugged up with secretion, so that the area of the lung to which this branch conducts ceases to be inflated on inspiration. The small quantity of air imprisoned in the portion of lung gradually escapes, but no fresh air enters, and the part collapses and becomes of solid consistence. Increased difficulty of breathing is the result, and where a large portion of lung is affected by the plugging up of a large bronchus, a fatal result may rapidly follow, the danger being specially great in the case of children. Fortunately, the obstruction may sometimes be removed by vigorous coughing, and relief is then obtained.

With respect to the treatment of acute bronchitis, in those mild cases which are more of the nature of a simple catarrh, little else will be found necessary than confinement in a warm room, or in bed, for a few days, and the use of light diet, together with warm diluent drinks. Additional measures are however called for when the disease is more markedly developed. Medicines to allay fever and promote perspiration are highly serviceable in the earlier stages. Later, with the view of soothing the pain of the cough, and favouring expectoration, mixtures of tolu, with the addition of some opiate, such as the ordinary paregorics, may be advantageously employed. The use of opium, however, in any form should not be resorted to in the case of young children without medical advice, since its action on them is much more potent and less under control than it is in adults. Not a few of the so-called "soothing mixtures" have been found to contain opium in quantity sufficient to prove dangerous when administered to children, and caution is necessary in using them.

From the outset of the attack the employment of fomentations, or especially a turpentine stupe, gives great relief, and occasionally in the non-specific form this treatment, combined with a good dose of calomel and salts, may render the attack abortive. Some relief is always obtained by inhalations, and theoretically, an acute specific bronchitis should be successfully treated by inhalation of antiseptic and soothing remedies. In practice, however, it is found that the strength cannot be sufficiently strong to destroy the bacteria in the bronchial tubes. However, much relief is obtained from the use of steam atomizers filled with an aqueous solution of compound tincture of benzoin, creosote or guaiacol. A still more practicable means of introducing volatile antiseptic oils is the globe nebulizer, which throws oleaginous solutions in the form of a fine fog, that can be deeply inhaled. Menthol, eucalyptol and white pine extract are some of the remedies that may be tried dissolved in benzoinol, to which cocaine or opium may be added if the cough is troublesome.

When the bronchitis is of the capillary form, the great object is to maintain the patient's strength, and to endeavour to secure the expulsion of the morbid secretion from the fine bronchi. In addition to the remedies already alluded to, stimulants are called for from the first; and should the cough be ineffectual in relieving the bronchial tubes, the administration of an emetic dose of sulphate of zinc may produce a good effect.

During the whole course of any attack of bronchitis attention must be paid to the due nourishment of the patient; and during the subsequent convalescence, which, particularly in elderly persons, is apt to be slow, tonics and stimulants may have to be prescribed.

[v.04 p.0636] _Chronic bronchitis_ may arise as the result of repeated attacks of the acute form, or it may exist altogether independently. It occurs more frequently among persons advanced in life than among the young, although no age is exempt from it. The usual history of this form of bronchitis is that of a cough recurring during the colder seasons of the year, and in its earlier stages, departing entirely in summer, so that it is frequently called "winter cough." In many persons subject to it, however, attacks are apt to be excited at any time by very slight causes, such as changes in the weather; and in advanced cases of the disease the cough is seldom altogether absent. The symptoms and auscultatory signs of chronic bronchitis are on the whole similar to those pertaining to the acute form, except that the febrile disturbance and pain are much less marked. The cough is usually more troublesome in the morning than during the day. There is usually free and copious expectoration, and occasionally this is so abundant as to constitute what is termed _bronchorrhoea_.

Chronic bronchitis leads to alterations of structure in the affected bronchial tubes, their mucous membrane becoming thickened or even ulcerated, while occasionally permanent dilatation of the bronchi takes place, often accompanied with profuse foetid expectoration. In long-standing cases of chronic bronchitis the nutrition of the lungs becomes impaired, and dilatation of the air-tubes (_emphysema_) and other complications result, giving rise to more or less constant breathlessness.

Chronic bronchitis may arise secondarily to some other ailment. This is especially the case in Bright's disease of the kidneys and in heart disease, of both of which maladies it often proves a serious complication, also in gout and syphilis. The influence of occupation is seen in the frequency in which persons following certain employments suffer from chronic bronchitis. Hirt has shown that the inhalation of vegetable dust is very liable to produce bronchitis through the irritation produced by the dust particles and the growth of organisms carried in with the dust. Consequently, millers and grain-shovellers are especially liable to it, while next in order come weavers and workers in cotton factories.

The treatment to be adopted in chronic bronchitis depends upon the severity of the case, the age of the patient and the presence or absence of complications. Attention to the general health is a matter of prime importance in all cases of the disease, more particularly among persons whose avocations entail exposure, and tonics with cod-liver oil will be found highly advantageous. The use of a respirator in very cold or damp weather is a valuable means of protection. In those aggravated forms of chronic bronchitis, where the slightest exposure to cold air brings on fresh attacks, it may become necessary, where circumstances permit, to enjoin confinement to a warm room or removal to a more genial climate during the winter months.

BRONCHOTOMY (Gr. [Greek: bronchos], wind-pipe, and [Greek: temnein], to cut), a medical term used to describe a surgical incision into the throat; now largely superseded by the terms laryngotomy, thyrotomy and tracheotomy, which indicate more accurately the place of incision.

BRONCO, usually incorrectly spelt BRONCHO (a Spanish word meaning rough, rude), an unbroken or untamed horse, especially in the United States, a mustang; the word entered America by way of Mexico.

BRÖNDSTED, PETER OLUF (1780-1842), Danish archaeologist and traveller, was born at Fruering in Jutland on the 17th of November 1780. After studying at the university of Copenhagen he visited Paris in 1806 with his friend Georg Koes. After remaining there two years, they went together to Italy. Both were zealously attached to the study of antiquities; and congeniality of tastes and pursuits induced them, in 1810, to join an expedition to Greece, where they excavated the temples of Zeus in Aegina and of Apollo at Bassae in Arcadia. After three years of active researches in Greece, Bröndsted returned to Copenhagen, where, as a reward for his labours, he was appointed professor of Greek in the university. He then began to arrange and prepare for publication the vast materials he had collected during his travels; but finding that Copenhagen did not afford him the desired facilities, he exchanged his professorship for the office of Danish envoy at the papal court in 1818, and took up his abode at Rome. In 1820 and 1821 he visited Sicily and the Ionian Isles to collect additional materials for his great work. In 1826 he went to London, chiefly with a view of studying the Elgin marbles and other remains of antiquity in the British Museum, and became acquainted with the principal archaeologists of England. From 1828-1832 he resided in Paris, to superintend the publication of his _Travels_, and then returned to Copenhagen on being appointed director of the museum of antiquities and the collection of coins and medals. In 1842 he became rector of the university; but a fall from his horse caused his death on the 26th of June. His principal work was the _Travels and Archaeological Researches in Greece_ (in German and French, 1826-1830), of which only two volumes were published, dealing with the island of Ceos and the metopes of the Parthenon.

BRONGNIART, ADOLPHE THÉODORE (1801-1876), French botanist, son of the geologist Alexandre Brongniart, was born in Paris on the 14th of January 1801. He soon showed an inclination towards the study of natural science, devoting himself at first more particularly to geology, and later to botany, thus equipping himself for what was to be the main occupation of his life--the investigation of fossil plants. In 1826 he graduated as doctor of medicine with a dissertation on the Rhamnaceae; but the career which he adopted was botanical, not medical. In 1831 he became assistant to R.L. Desfontaines at the Musée d'Histoire Naturelle, and two years later succeeded him as professor, a position which he continued to hold until his death in Paris on the 18th of February 1876.

Brongniart was an indefatigable investigator and a prolific writer, so that he left behind him, as the fruit of his labours, a large number of books and memoirs. As early as 1822 he published a paper on the classification and distribution of fossil plants (_Mém. Mus. Hist. Nat._ viii.). This was followed by several papers chiefly bearing upon the relation between extinct and existing forms--a line of research which culminated in the publication of the _Histoire des végétaux fossiles_, which has earned for him the title of "father of palaeobotany." This great work was heralded by a small but most important "Prodrome" (contributed to the _Grand Dictionnaire d'Hist. Nat._, 1828, t. lvii.) which brought order into chaos by a classification in which the fossil plants were arranged, with remarkably correct insight, along with their nearest living allies, and which forms the basis of all subsequent progress in this direction. It is of especial botanical interest, because, in accordance with Robert Brown's discoveries, the Cycadeae and Coniferae were placed in the new group _Phanérogames gymnospermes_. In this book attention was also directed to the succession of forms in the various geological periods, with the important result (stated in modern terms) that in the Palaeozoic period the Pteridophyta are found to predominate; in the Mesozoic, the Gymnosperms; in the Cainozoic, the Angiosperms, a result subsequently more fully stated in his "Tableau des genres de végétaux fossiles" (D'Orbigny, _Dict. Univ. d'Hist. Nat._, 1849). But the great _Histoire_ itself was not destined to be more than a colossal fragment; the publication of successive parts proceeded regularly from 1828 to 1837, when the first volume was completed, but after that only three parts of the second volume appeared. Brongniart, no doubt, was overwhelmed with the continually increasing magnitude of the task that he had undertaken. Apart from his more comprehensive works, his most important palaeontological contributions are perhaps his observations on the structure of _Sigillaria_ (_Arch. Mus. Hist. Nat._ i., 1839) and his researches (almost the last he undertook) on fossil seeds, of which a full account was published posthumously in 1880. His activity was by no means confined to palaeobotany, but extended into all branches of botany, more particularly anatomy and phanerogamic taxonomy. Among his achievements in these directions the most notable is the memoir "Sur la génération et le développement de l'embryon des Phanérogames" (_Ann. Sci. Nat._ xii., 1827). This is remarkable in that it contains the [v.04 p.0637] first account of any value of the development of the pollen; as also a description of the structure of the pollen-grain, the confirmation of G. B. Amici's (1823) discovery of the pollen-tube, the confirmation of R. Brown's views as to the structure of the unimpregnated ovule (with the introduction of the term "sac embryonnaire"); and in that it shows how nearly Brongniart anticipated Amici's subsequent (1846) discovery of the entrance of the pollen-tube into the micropyle, fertilizing the female cell which then develops into the embryo. Of his anatomical works, those of the greatest value are probably the "_Recherches sur la structure et les fonctions des feuilles_" (_Ann. Sci. Nat._ xxi., 1830), and the "Nouvelles Recherches sur l'Épiderme" (_Ann. Sci. Nat._ i., 1834), in which, among other important observations, the discovery of the cuticle is recorded; and, further, the "Recherches sur l'organisation des tiges des Cycadées" (_Ann. Sci. Nat._ xvi., 1829), giving the results of the first investigation of the anatomy of those plants. His systematic work is represented by a large number of papers and monographs, many of which relate to the flora of New Caledonia; and by his _Énumération des genres de plantes cultivées au Musée d'Histoire Naturelle de Paris_ (1843), which is an interesting landmark in the history of classification in that it forms the starting-point of the system, modified successively by A. Braun, A.W. Eichler and A. Engler, which is now adopted in Germany. In addition to his scientific and professorial labours, Brongniart held various important official posts in connexion with the department of education, and interested himself greatly in agricultural and horticultural matters. With J.V. Audouin and J.B.A. Dumas, his future brothers-in-law, he established the _Annales des Sciences Naturelles_ in 1824; he also founded the Société Botanique de France in 1854, and was its first president.

For accounts of his life and work see _Bull. de la Soc. Géol. de France_, 1876, and _La Nature_, 1876; the _Bulletin de la Soc. Bot. de France_ for 1876, vol. xxiii., contains a list of his works and the orations pronounced at his funeral.

(S. H. V.*)

BRONGNIART, ALEXANDRE (1770-1847), French mineralogist and geologist, son of the eminent architect who designed the Bourse and other public buildings of Paris, was born in that city on the 5th of February 1770. At an early age he studied chemistry, under Lavoisier, and after passing through the École des Mines he took honours at the École de Médecine; subsequently he joined the army of the Pyrenees as _pharmacien_; but having committed some slight political offence, he was thrown into prison and detained there for some time. Soon after his release he was appointed professor of natural history in the Collège des Quatre Nations. In 1800 he was made director of the Sèvres porcelain factory, a post which he retained to his death, and in which he achieved his greatest work. In his hands Sèvres became the leading porcelain factory in Europe, and the researches of an able band of assistants enabled him to lay the foundations of ceramic chemistry. In addition to his work at Sèvres, quite enough to engross the entire energy of any ordinary man, he continued his more purely scientific work. He succeeded Haüy as professor of mineralogy in the Museum of Natural History; but he did not confine himself to mineralogy, for it is to him that we owe the division of Reptiles into the four orders of Saurians, Batrachians, Chelonians and Ophidians. Fossil as well as living animals engaged his attention, and in his studies of the strata around Paris he was instrumental in establishing the Tertiary formations. In 1816 he was elected to the Academy; and in the following year he visited the Alps of Switzerland and Italy, and afterwards Sweden and Norway. The result of his observations was published from time to time in the _Journal des Mines_ and other scientific journals. Wide as was the range of his interests his most famous work was accomplished at Sèvres, and his most enduring monument is his classic _Traité des arts céramiques_ (1844). He died in Paris on the 7th of October 1847.