Two cases of bronchiectasis in which great relief was given during the par oxysms, and some more permanent bene fit afforded, by placing the patient lying down on the bed the foot of which was raised twelve or fourteen inches. The immediate result in both cases was a great sense of relief, a diminution in the frequency and severity of the cough, a lessening of the sputum, a complete cessation of the gush of expectoration, and presumably the liberation of the affected pulmonary areas from entan gling slime and from any further plug ging with muco-pus. The postural method is also useful in contributing to the comfort and relief of patients suffer ing from general catarrhal affections with tenacious mucus, as well as in the later stages of pulmonary excavation in phthisis. William Ewart (Lancet, July 13, 1001).
In treating bronchiectasis the meth ods placed in the order of their effi ciency may be classified, as follows:— 1. Inhalations of volatilized antisep tics: (a) creasote vapor-baths; (b) in halations of creasote, oil of peppermint, eucalytus, etc.
2. Subcutaneous and intravenous in jections of antiseptic fluids.
3. Internal medication.
4. Surgical treatment (incision and drainage).
The most successful means of reliev ing the factor, and occasionally, but by no means always, of lessening the amount of the expectoration, is the in halation under certain conditions of crude creasote-vapor, as originally sug gested by Dr. Arnold Chaplin. It is necessary to carry out this treatment systematically and thoroughly.
The details are as follows: A small room, free of any furniture except that of the simplest kind, and without hang ings, is selected. It should have good
ventilation provided mainly by means of a small fireplace, or in summer by means of Tobin's tubes. The patient should be provided with a comfortable wooden chair. On a small table is ar ranged an evaporating dish of the capacity of about half a pint, heated over a spirit-lamp. It is advisable not to consent to the use of a Bunsen gas burner. Into the evaporating basin is put commercial creasote.
The creasote is slowly vaporized, and as the dense fumes begin to rise the patient commences to cough, and not only are the tubes cleared of the offen sive secretions, but the deep inspirations which follow serve to draw the crea sote-vapor into the smaller bronchioles, bringing it into immediate contact with the decomposing pus in the dilated tubes. A twofold object is thus effected: the cleansing of the tubes and the evacuation of their contents. It is in this combination that the creasote vapor-bath is more effectual than any other form of treatment. Until the patient becomes more or less accus tomed to them, the fumes, which are very penetrating, cause a considerable amount of distress, and it is mainly the great benefit which is derived from the treatment which encourages pa tients to continue it.
The volatilization of a large amount of crude creasote makes everything in a mess, and the patient's clothes must be protected, and no ornaments or pictures must be left upon the walls. T. D. Acland (Practitioner, April, 1902).