Large doses of belladonna valuable in broncho-pneumonia in children. Out of about sixty cases treated by this plan only two deaths occurred. In addition to the large close the extract of the late British l'harmacopceia is especially recommended. This is given in 'A-grain doses, every three or four hours, irre spective of the age of the infant. In a very few cases these doses induce light delirium, which is quickly relieved by lessening the dose. In a large majority there is some flushing of the skin, iu some a definite scarlet rash. The chil dren under this treatment are irritable. J. A. Coutts (Brit. Med. Jour., Jan. 23, '99).
Belladonna is of great value in the broncho-pneumonia of children, preceded by doses of calomel every hour until the bowels are moved. The tinct ure of belladonna is used, 2 minims being given every hour. In these small doses it is mildly narcotic, it is a heart-tonic, a respiratory stimulant, and it produces dilatation of the superficial capillaries, thus relieving the congested lungs. Most important, however, is that it diminishes the secretion in the bronchial tubes and the pulmonary tissues. The drug is espe cially applicable when the bronchial se cretion is abundant. Hodghead (Pedi atrics, Sept. 1, '99).
In children, and especially if the symp toms be those of suffocative catarrh, it is well to cause occasional emesis, for which purpose syrup of ipecacuanha, alum in syrup of ipecacuanha or in honey, or, if these fail, apomorphine may be employed. Turpeth mineral has been commended, but I have never used it. Following the emesis there is sometimes much prostration. I have found the in halation of amyl-nitrite, cautiously ad ministered, of great service at this time; and also when suffocation cannot be re lieved by emesis. In such cases, too, some more active expectorant than the ammonium preparations may be continu ously necessary; and syrup of senega, squill, or ipecacuanha may be used. In mild cases, a useful mixture is made with 10 minims, each, of syrup of ipecacuanha, aromatic spirit of ammonia, and pare goric, in water, which may be given every second or third hour.
In the broncho-pneumonia of influenza in children the use of emetics is con demned, as being a powerful factor in the production of pulmonary collapse and in the increase of the general pros tration. Indication is to use stimulating expectorants early, and to reanimate the innervating powers by means of alcohol, caffeine, and injections of camphorated oil. This treatment must be pursued energetically from the very onset of the attack. Clemente Ferreira (Revue Men_ des Mal. de l'Enfance, Mar., '95).
In influenza sodium benzoate and cin ehonidine salicylate are useful, and are to be combined with or substituted for other drugs mentioned.
In tuberculosis, the guaiacol salts, car bonate and salicylate, are to be employed; or, if the stomach will bear it, creasote may be given. Creasote carbonate may often be given in large doses when crea sote cannot be taken.
As recovery takes place, the medica tion, whatever it may have been, should be gradually withdrawn. Should resolu tion be sluggish, it is well to give am monium iodide, preferably in a vehicle containing pepsin, and followed by a large draught of water. The dose should be small at first, 5 grains for an adult, and gradually increased. The application of
hot poultices for a few days is again likely to be useful.
When recovery is unduly delayed the application over the affected areas of mercurial ointment, or of iodine in lano lin (20 grains to the ounce) well rubbed in, often seems to hasten it. Calomel in small, frequently repeated doses for two or three days, just avoiding salivation, is not rarely useful at this time.
Should there be suppression of urine, bloody urine, or albuminuria, it is well to suspend all medication except some bland alkaline diuretic, and take blood, either from the arm, or by wet cups over the kidneys, after which warm (100° F.) physiological saline solution should be introduced either by a vein or under the skin. High irrigation of the colon with hot physiological saline solution (110° F.) may temporarily substitute the ve nous or subcutaneous infusion. When the condition of the patient is markedly sep tic or toxaemic, as shown by muttering delirium and general depression, the same measures should be used.
Leeching back of the ears may be the best method of depletion in cerebral cases. When the chief difficulty seems to be in the circulation, judgment must be exercised, in view of all the circum stances of the case, as to the employment of these measures. If one can be sure that the obstacle to circulation is not merely the weakness of the heart, but that the latter is simply an indication of peripheral difficulty, blood-letting by wet cupping over the chest or even by vene section is justifiable; and the introduc tion of saline solution may usefully fol low. Sometimes the use of nitroglycerin internally suffices.
When the respiratory obstruction seems to be great, as shown by cyanosis, dyspncea, rapidity of breathing, short, hacking, incessant, unproductive cough, there is no measure so useful as the in halation of oxygen. At first this must be as nearly continuous as possible. As improvement takes place, the intervals and duration of inhalations are modified accordingly. It is especially in children, in the aged, in cases following the exan themata, and in septic cases generally that I have seen oxygen save life. Con valescence must be skillfully managed to avoid the development of chronic broncho-pneumonia, or the supervention of tuberculosis in non-tuberculous cases. Food, fresh air, cold-water bathing, and friction of the skin, with perhaps, in some cases, roborant medication by means of iron, arsenic, hypophosphites, and the like, and regulated pulmonary gymnas tics meet the indications.
Chronic broncho-pneumonia calls for good general hygiene and nutrition, the application of fly-blisters over the chest, and systematic expansion of the chest by inhalation of compressed air or other ef ficient means. Internally iodine com pounds are to be given. Pills of iodo form; or of iodoform and iron; or of iodoform, iron, and arsenic may be alter nated with ammonium iodide or syrup of hydriodic acid. Small doses are to be given at first, and gradually increased to the point of tolerance. If the cases prove rebellious to this line of management, a sea-voyage should be recommended, and, this failing, change of residence, tem porary or permanent; to an altitude in the case of one young and robust; to a warm, but equable, region in the case of the aged.