Prognosis. — The prognosis depends greatly upon the surroundings and so cial condition of the patient. If re moval from the chief causative factors (injurious occupations, unfavorable cli matic conditions, etc.) is possible, the condition is curable except for possibly some permanent structural changes in the bronchial walls. Even with these the patient may be, to all intents and purposes, well. In the aged, in those already suffering from cardiac degenera tion, or in cases with serious structural changes (bronchiectasis, emphysema) the outlook as to cure is unfavorable, and as to amelioration is doubtful.
Treatment. — The prime factor in treatment is the removal of the cause (insanitary surroundings, inhalation of dust, etc.). When the patient lives in a changeable or vigorous climate trans plantation to an equable and mild re gion is of itself often sufficient to pro duce cure. Prophylactic measures to decrease the liability to exacerbations are important. The wearing of woolen underclothing, in order to prevent chilling of the surface; the practice of cool bathing on rising, in order to pro mote vascular tonus of the skin; the correction of nasal and pharyngeal anomalies in order to do away with any "weak spots" favoring the "catching of fresh colds"—these are important ele ments in treatment.
At times treatment of the bronchial condition is best carried out by treat ment of systemic faults or of an existing cardiac lesion in combination with more direct treatment of the bronchial ca tarrh. In many cases an important element is the "building-up" of the pa tient. One of the most valuable drugs is strychnine, which acts as a general tonic and is particularly valuable in stimulating the respiratory centre and toning-up the muscles, thus enabling the cough to be more effectual. Its value in the aged is very great.
Expectorant remedies are certainly of value, yet it must be borne in mind that they are very apt to upset digestion. Among them the ammonium compounds occupy a leading place. Where the ex pectoration is scanty and the sputum viscid, the chloride is to be used; where the right heart is laboring, the carbon ate acts best; when there is indigestion and especially flatulent distension the aromatic spirit is preferable.
Iodide of potassium is of great value in liquefying the sputum, while its ab sorbefacient properties may possibly di minish the hyperplasia in the bronchial walls. In gouty cases it is of particular benefit.
Cases of bronchitis of many years' standing cured with ichthyol given inter nally in daily amounts of not less than drachm. It should be administered in gluten capsules in order not to be freed in the stomach. Le Tanneur (Bull. Med., Jan. 24. '09).
Encouraged by the favorable reports on the use of iehthyol in tuberculosis, grippe, etc., W. B. Jennings (St. Louis :Med. and Surg. Jour.) began to use the drug in the common form of bronchitis in children which so often follows measles, whooping-cough, and acute, in fectious diseases in general. He gives the histories of eight cases demonstrat ing the good effects of ichthyol in the above-named conditions. It was admin istered in the following combinations:— Ichthyol, gr. xxxii.
Glycerini, Spt. aurantii, of each, ass.
Aqure, ad 3ij.
The author gives the following con clusions: 1. The first dose often causes nausea and vomiting, but later the child grows inured to the taste of ichthyol. 2. Children under one year of age do not take ichthyol well. 3. To avoid the unpleasant effects of ichthyol it should be given after meals. 4. Increasing (loses are not necessary for good results in children. (Merck's Archives, July, 1902.) Case in a girl of 13, with bronchitis, of six years' duration, following pertus sis, accompanied with dyspnom. bloody expectoration, and spasmodic, violent coughing, which failed to improve on any treatment, including morphine, po tassium iodide, creasote, belladonna, ipecac, sodium benzoate, bromoform, etc. She grew worse and had an attack of luemoptysis. Then powdered ichthyol was given, 15 grains a day. The effect was marvelous. Cough and expectora tion both disappeared rapidly and she quickly recovered. II. de Brun (Jour. des Praticiens, Nov. 20, 1902).
The balsams and various expectorant oils are of much value used by inhala tion and internally. By inhalation they act directly upon the mucous membrane, while when given internally they exert their influence locally upon their excre tion through the respiratory organs. The most useful are the compound tinct ure of benzoin and the oils of eucalyptus, gaultheria, sandal-wood, cubebs, and copaiba. For inhalation these drugs may be used on the Yeo respirator, in a croup-kettle, or in a nebulizer. Crea sote is of value where the stomach will tolerate it. Menthol, used by inhalation, is an excellent expectorant, allaying the violent attacks of cough.