As the disease proceeds there occur further complications, which end some times in death. In many cases ulcera tion of the bronchial tubes supervenes. In the bronchial tubes the retained secretions become putrid, full of micro organisms, forming the foul sputum characteristic of such cases. often this goes on till ulceration takes place, and when once ulceration occurs any form of septic disease as a final cause of death may appear. Very common causes are found to be septic pneumonia and septic abscess in other parts of the body. Above all, abscess in the brain seems to be one of the commonest causes of death occurring in such cases. Besides septic pneumonia, death may take place from acute catarrhal pneumonia, especially where the patient has been subject to chronic bronchitis associated with rather frequent attacks of acute broncho-pneu monia. (Habershon.) Autopsy in a case of fibroid-lung bronchiectasis.
Lung: Showing fibriod induration. The upper lobe is uniformly solid, gray, and very firm. The middle lobe is not so firm. The lower lobe is congested and shows an area of fibrous induration in the lower part. Extending through these solidified portions are tubular bronchiectasic cavities with blood stained walls.
Brain: Section through the right hem isphere of the brain about the paracen tral convolution. in the upper part of which is an abseess-eavity the of which are irregular.
The association of brain-abscess with bronehiectasic cavities has frequently been noted. Williamson has recently reported that out of 39 cases of brain abscess, 17 were associated with putrid bronchieetasis. Livingood (Johns Hop kins Hosp. Bull., Dee., '97).
Treatment. — A very important point in the treatment of brouchiectasis is to see that the cavity or cavities are fre quently emptied. This can generally be effectively done by partially inverting the patient, at first two or three times a day, and later once a day. The simplest plan to adopt is for the patient to hang himself over the edge of the bed or couch so that his legs rest on it and his body is supported by his hands on the floor. This partial inversion is followed by cough and the evacuation of a consid erable amount of offensive sputum. (Hector Mackenzie.) Quincke's suggestion of treating bron chitis and bronchiectatic processes by posture favored. In acute processes the measure is useless. In eases of foetid bronchitis the relief obtained is marked.
The posture is the dorsal one with the foot of the bed gradually raised by means of bricks. It is practiced morning
and evening for an hour each. In fifteen minutes some result should be achieved; if no sputum is obtained by this time, the procedure is usually useless. In ordinary eases the entire day's secretion may thus be evacuated, O. Jacobsohu (Berliner klin. Woch., Oct. 8, 1900).
The above sufficiently illustrates the inadvisability of giving remedies such as narcotics to arrest the spasmodic cough ing: a mechanical device employed by nature to rid the dilated areas of ac cumulated purulent liquids. The so called expectorants are useless, and the disinfectant aromatics but serve to mo mentarily check the fcetor of the breath, whether applied by means of respirators or atomizers. The vapor or spray so produced hardly penetrates beyond the trachea. The medicaments employed must reach the diseased areas either directly or through the blood-current.
The intralaryngeal injection of anti septic liquids recommended by Grainger Stewart accomplishes to a degree the de sired result in the small proportion of cases in which the dilatation only in volves the larger bronchi.
A drawback connected with methods in which professional dexterity has to play a role is that the patient does not always receive as many applications as his condition would require in order to obtain the best results. Measures which the patient can carry out himself are therefore always to be preferred.
A method at once beneficial and easily carried out is to resort to the prone posi tion, as described above, and to admin ister drugs which are eliminated by the lungs.
The allyl compounds are very effect ive, and Vivian Poore has recommended garlic as especially valuable. A "clove" of garlic is to be chopped up and boiled in beef-tea and given three or four times a day. Hector Mackenzie found garlic most useful for diminishing the fcetor of the breath, and recommends in the case of children the syrup of garlic of the United States Pharmacopoeia. A drachm of this may be given to a child three times a day with an equal amount of syrup of Tolu. For an adult 2 or 3 grains of powdered garlic may be given in a cachet, or 2 to 4 drachms of the syrup.
The balsams also possess curative properties, but do not reach the diseased areas when applied by means of the atomizer.
Molle has observed rapid improve ment, amounting practically to cure, in children by the use of the following mixture: 4 Eucalyptol, 10 parts. Creasote, 25 parts.