In the aged it is important to sustain the general strength and especially to watch the condition of the right heart. Stimulants are usually necessary; and it is important to change the patient's position at short intervals in order to facilitate expectoration and to avoid the effects of gravity in causing congestion or atelectasis of dependent parts of the lung. Many expectorant drugs other than those mentioned above are em ployed, but it is a question whether their action upon digestion does not offset any possible good effect upon the bronchitis.
The use of oxygen in inhalation is sometimes objected to on the ground that it is not a really curative agent. This is true, but the inference that it is not worth giving is believed fallacious. It does often remove cyanosis, and a con tinuous condition of cyanosis must be an evil. It is probable that the inhala tion of oxygen is generally commenced too late. Belief that its early use pre vents the advent of that pronounced cyanosis so often seen, and which, when it is once established, may be only slightly benefited by oxygen.
It thus gives patients an additional chance of life, and, furthermore, in most cases it gives marked relief. If we ob jected to give drugs in ailments unless they had a direct curative influence, our use of the pharmacopmial remedies would be very limited. D. J. Leech (Practi tioner, May, '98).
Yerba santa is extremely efficacious in the treatment of the second stage of bronchitis; it seems to diminish the watery and mucous constituents of the phlegm proportionately, so that this does not become more difficult of expectora tion. The dose is 15 to 45 minims of the liquid extract. It forms a somewhat muddy mixture with water, but the addition of ammonium carbonate or bicarbonate of soda makes it clearer. Bronchial spasm in the course of the second stage of bronchitis is best treated with caffeine or iodide of potassium. F. H. Edgeworth (Bristol Med.-Chir. Jour., Sept., '99).
In children true asthma is very rare, and chronic bronchitis (toes not occur. Bronchitis often recurs, or may be pro longed, but it never becomes chronic. Emphysematous bronchitis is the most common form in children. There is al ways some dyspncea, yet never marked asthmatic paroxysms. When a child has many attacks, his bronchi become distended from loss of elasticity. This bronchitis is commonly observed with the infectious diseases, and in rachitic, lithmmie, or tubercular children. From 5 to I5 drops of I-per-cent. solution of
iodide of arsenic thrice daily, with meals, has proved valuable in this con dition. R. Saint-Philippe (Jour. de de Bordeaux, May 5, 1901).
Arsenic iodide is the best remedy in that form of infectious bronchitis which occurs in scrofulous children after grippe, measles, or whooping-cough. When taken with food it is said to he practically tasteless, easily digested, and well borne. The following formula is used:— Arsenic iodide, 0.3 gramme (5 grains).
Distilled water, 30.0 grammes (1 fluidounce).
Dissolve without the aid of heat. Five drops of this solution are given in a glassful of milk with each meal, the (lose being increased by 1 drop morning and evening until 15 or even 30 drops are being taken as a dose. lhe maximum dose is given for about a month, then gradually reduced to 5 drops, and this quantity is continrwil fur a week, and then again increased a- before. Saint-Philippe (Jou•. des Pratieiens, xvi. No. IG, 1002).
The following combination is Syr. seillie, 1 ounce.
Ext. lobelia! lid., 1 drachm.
1Met. opii. 2 '/, drachms.
Ext. ipecac fld., 15 drops.
Syr. pruni Virg.. 1 7„ ounces.
picis liq., q. s. ad 4 ounces.
AI. One teaspoonful in water four times a day. (Jour. Amer. _lied. Assoc.. -Tan. 31. 1903.) Chronic Bronchitis.
Symptoms. — The onset of chronic bronchitis is usually insidious. It may follow' immediately upon an acute at tack which fails to subside or it may be gradual in its beginning, as a in cases 'T q sulting from the long-continued inhala tion of irritating material, such as me tallic or crystalline dust or chemical vapors. Cough is the most prominent symptom. It is usually worse in the morning and after meals, but may give most trouble at night. It is usually ac companied by free expectoration of thick muco-purulent material of white, ye] lowish-white, or green color, at times twinged or streaked with blood. In a small proportion of cases there is no ex pectoration (dry bronchitis).
Cough and expectoration are for a long time the only symptoms, but in ad vanced cases (especially in elderly peo ple) the right heart feels the strain of overcoming the increased tension in the pulmonary circuit, becoming dilated and causing circulatory embarrassment in the other organs (stomach, liver, and kid neys). Pulmonary emphysema, bron chiectasis, and asthma are the other sequelm encountered. Exacerbations are readily excited, obstinate, and prone to leave increased organic change.