Case in which the patient had suffered from the disease for some years, and was expectorating bronchial casts. All the cover-slips from the casts showed streptococci; the inner surface showed micro-organisms of varying kinds, probably coming from the saliva. The disease due to the streptococcus: Marmo•ek's antistreptococeic serum used. After two months' treatment the patient was discharged much improved. The reaction to the antistreptococeic serum a further proof of the nature of the disease. Claisse (Comptes-llendus de la Soc. de Biol., Apr. 3, '90).
Histological appearances in the bron chi of a patient suffering from this dis ease who died of cardiac failure. Neel sen had found them to consist of mucus: a view which had hitherto met with no support. In this case the casts were found to consist apparently of fibres inclosing masses of leucocytes and large, swelled, round epithelial cells. Weigert's fibrin stain gave no colora tion, thionin a faint pink; Curschmann's spirals were absent, this being the sole point of difference from Neelsen's re sults. The casts were thus composed of mucus, and not of fibrin. With re gard to the bronchi, the epithelium was intact except in a few spots; Weig,ert pointed out many years ago that fibri nous exudates only arose where the epithelium had been shed over large areas. In the case under notice the goblet-cells were unusually numerous. and the glands had undergone mucoid degeneration, their ducts being filled with mucus. The origin of the casts was thus obvious. Grandy (Centralb. f. allgem. Path., vol. viii, No. 13, '97).
Examination of two cases secondary to valvular disease. Stained by Wei gert's method, they showed very fine fibrin-fibres, most of the casts not tak ing any stain (lithium carmine.) Chem ical examination also showed the ab sence of fibrin, but proved that the casts were made up chiefly of muein. The casts were of acid reaction, and the writer thinks this is the cause of the coagulation. According to his view something, probably the action of bac teria, causes the bronchial secretions to become acid. The mucus then coag ulates. The same explanation appeared to the casts sometimes expectorated in croupous pneumonia, and was able to confirm his view in a ease of the latter disease. A. Habel (Centralb. f. inn.
Med., No. 1, 'OS).
Case in which microscopical examina tion of the lungs showed a rather exten sive tuberculosis of the pulmonary tissue, hut no tuberculosis of the bronchi. In fact, the mucous membrane of the bron chial tubes was practically normal. In the pulmonary tissue a considerable quantity of fibrin was also present. Bac teriologically, only streptococci were found. Apparently there is desquama tion from the alveoli of the lung, and masses of fat and epithelial cells are sometimes found in the casts. These con ditions occur acutely and by a process analogous to that in cases of asthma: that is to say, as a result of desquama tion itself, an exudation due to nervous influence, and a subsequent coagulation. The nature of the irritation is very various. Schittenhelm (Dent. Archiv f. klin. 3fed., B. 67, H. 3 and 4, 1900).
Treatment.—The treatment does not differ from that of other forms of bron chitis except the fact that alkalies (po tassium iodide and carbonate) and alka line steam-sprays are of more decided value. The iodide of potassium acts by stimulating secretion and thus assisting in the elimination of the pseudomem brane. It must, however, be given in large doses.
Inhalations of alkalies recommended. Especially valuable are aqua midi:. alone or with equal parts of water, or with 2 to 5 per cent. of carbonate or bicarbonate of sodium, in which the casts are soluble. ,Stirling (London Pract., June, '89).
Case in which 45 grains in divided dose was administered daily to induce mucoid exudation in the bronchi and facilitate the ejection of the casts. which, in the present case, were found to consist mainly of mucin containing staphylococci and a special bacillus. The patient was permanently cured. Hnchard (:.iemaine 316d., July 28, '95).
Potassium iodide is probably the most useful remedy in all forms of the dis ease, as it increases the bronchial secre tion when given during the acute parox ysm, and thus aids in expelling the casts. It also seems to lessen the tendency to recurrence of attacks if rdven in full doses and for a long period