Prognosis.—In patients beyond the age of infancy and in those not debilitated by senility or serious organic disease re covery invariably occurs. In young chil dren recovery is the rule; but the dis ease is of more gravity than in older children and adults, this gravity increas ing inversely as the strength and age of the child. The chief danger in older children and in adults lies in the tend ency to recurrence and consequent manent change in the mucous mem brane.
Treatment.—Treatment varies some what with the age of the patient. A few general directions apply to all ages.
Equalization of the circulation and ulation of all lagging emunctories are important early measures. In all cases purity of air, equable room-temperature (69° to 70° F.), and a slight excess of moisture in the air are essential.
In young infants the child should be clad rather more warmly than ordinarily, a cotton or woolen jacket should be plied, and the chest should be rubbed twice daily with camphorated oil or a mixture of equal parts of olive-oil and amber-oil or turpentine. A croup-ket tle, to the water in which has been added compound tincture of benzoin (1 fluidrachm to 1 pint) should be em ployed for ten or fifteen minutes every hour or two, and in winter a broad, shallow pan of water should be kept in front of the source of heat in order, by its evaporation, to moisten the air of the room. Morrell has observed great fit from inhalations of warm vapor of wine of ipecacuanha, ten minutes at a time, three or four times a day.
The hot, dry chamber of the Turkish bath has been the means of aborting attacks of bronchitis, and deserves a trial; the patient to be driven in a closed vehicle to and from the bath, and with mouth and nose protected with woolen comforter. I am fully persuaded that the indiscriminate recommendation of the bronchitis-kettle is a great error ; it has contributed to the deaths of not a few to my own knowledge. Alexander Duke (Med. Press and Circular, Feb. 3. '97).
Ordinarily in the early stage a simple fever-mixture with the addition of a small quantity of ipecac will be all that is required. Of the febrifuges the citrate of potash with or without the addition of small doses of tincture of aconite in accordance with the fever and cardiac excitement will be found useful and sim ple. After the formation of mucus has started and the fever has subsided the chloride of ammonium, in doses of to 1 grain, should replace the fever-mixt ure.
Ordinarily no further medication is required except for the use of mild laxa tives to keep the bowels thoroughly opened. In removing the extra covering on the chest care is to be taken that the change be not made too rapidly, but that small portions should be taken away at a time. If at any time marked oppres sion of breathing occurs from accumula tion of mucus, the production of vomit ing by a full dose of ipecac will cause prompt clearing of the tubes. In feeble children stimulants may be required, and where the heart's action is weak the car bonate or aromatic spirit of ammonium may, with advantage, be used instead of the chloride.
Apomorphine, freshly compounded in acidulated mixture, is the best of all relaxing expectorants. In V„-grain doses, at two or three hours' intervals, rarely fails to cause a free sero-mucous flow in twelve to thirty-six hours. Rest is an essential adjuvant. Codeine sul phate in doses, given independ ently, is the best sedative. Thomas Hubbard (N. Y. Med. Jour., July 18, '96).
In acute bronchitis of adults a com bination of acetate of ammonium, spirit of nitrous ether, and ipecacuanha or antimony is commonly used, and no bet ter combination can be employed. But an error is often made with regard to the dose of two of these substances. One should begin with doses of 3 drachms of the acetate of ammonium, and increase the amount to 6 drachms if the skin does not act freely. Spirit of nitrous ether may possibly act in doses, but in doses of 1 to 2 drachms, especially when repeated at short intervals, it has commonly a very distinct effect as a di aphoretic. D. J. Leech (Practitioner, May, '9S).
In older children and in adults a pre liminary hot foot-bath, to equalize the circulation and start the eniunctories, is of value. The application of mustard poultices or turpentine stupes to the chest certainly gives relief and probably hastens cure. The use of a cotton or woolen jacket is not so important as in infants, but is of value. In those beyond the age of infancy ammonia salts can be used earlier in the disease, the chloride acting especially well in combination with compound licorice mixture. Usu ally no other medicine, save possibly laxatives, is required unless the latter part of the attack is prolonged, in which case small and frequently repeated doses of the oil of eucalyptus, gaultheria, or copaiba may be given in capsule.