BRONCHIECTASIS.
The patient should be treated by outdoor living, improved hygienic surroundings, abundant nutritious food, Cod-Liver Oil, and such climatic conditions as are usually indicated in wasting disease caused by chronic disease of the lung inducing dilatation of the bronchi. In all cases an atmosphere as free from septic organisms as possible should be selected, hence an Alpine or a bracing seaside resort is desirable, while the primary disease, as fibroid phthisis, asthma, bronchitis, emphysema, &c., should be dealt with by the remedial agents suitable to each affection.
The special indications for the treatment of the bronchiectasis itself are to sterilise as far as possible the contents of the cavities and to facili tate their thorough evacuation.
For the former purpose volatile antiseptics internally are employed; the best of these for routine administration by the mouth is Creosote, which may be given in 2-3 min. capsules 3 or 4 times a day or oftener; Guaiacol in double these amounts, Eucalyptus Oil, Eucalyptol, Thymol, Terebene, Myrtol and other agents of the same class are also valuable when creosote is objected to on account of its unpleasant odour. Ally] Oil obtained from the leek may also be given in 1-2 min. capsules. W. C. Minchin has demonstrated the great value of Garlic swallowed or used in the form of the volatile oil on a Yeo's inhaler. It is not only an invaluable germicide, but a most reliable expectorant, and, moreover, it is practically innocuous. The garlic may be mixed with the food, taken in capsules of 3o mins. of the juice or in cachets containing the dry bulblets. By keep ing the blood saturated with these volatile substances the multiplication of the putrefying organisms present in the cavities can be considerably retarded, their action being supplemented by the next-mentioned class of agents.
Inhalations.—Any of the before mentioned may be employed; the best is Creosote volatilised by heat. Chlorine, Iodine, Menthol, Eucalyptus, Carbolic Acid, Terebene, Thymol, or Oil of Peppermint may be given as an inhalation with hot water, or placed in any of the respirators made for the purpose. It is a good plan to saturate the air of the patient's room with the vapour of Turpentine or of the Oleum Pini Pumilio or Oleum Krummolzol. Most of the above-named antiseptics may be administered also in the form of spray.
Chaplin's method consists in sterilising the sputum by inhalation. A small evaporating dish is partially filled with the so-called crude creosote obtained by the distillation of coal tar, a small chamber is selected with a closely fitting window and door, and as the fluid is heated by a spirit lamp, dense white pungent fumes are given off which excite severe cough ing, whereby the cavities soon become thoroughly emptied and their lining membranes disinfected. The eyes and nasal mucosa must be protected from the severe irritation; half an hour will be sufficient in length for each sitting, but if the chamber be large and the vapour of the creosote thereby diluted, the inhalation may be extended to double this time or longer. After 5 or 6 weeks in many cases the results are most
successful, and where the dilatations have not been extensive a complete cure may be expected to follow.
Oxygen inhalations by Stoker's continuous method have given ex cellent results, and in a case reported by Herringham, the fetor which had persisted after the use of the creosote chamber disappeared almost com pletely, and the amount of sputum fell from to or 12 oz. tor oz. daily.
Chloride of Ammonium formed by sprinkling salt upon strong vitriol, placed in vessels alongside those containing strong ammonia, is a valuable method of treatment, and the patient can be kept living in a room im pregnated with the nascent fumes for long periods. The formulm usually employed for sprays containing creosote, carbolic acid, menthol, &c., are as a rule worthless, the drugs being in such diluted solutions,and, moreover, the antiseptic spray is liable never to reach the infected cavity at all, and the liquid preparations for sprinkling upon inhalers or for use with boiling water are little better. It is a good plan to have a flannel binder, moistened with Oil of Eucalyptus, placed round the chest and abdomen; the odour of the oil is given off slowly all day, and is inhaled by the patient constantly.
Intratracheal injections have been used with advantage. 5 grs. Menthol and it min. Guaiacol dissolved in 54 mins. Olive Oil may be in jected twice a clay into the trachea through the laryngeal opening, care being taken to secure the flow of the oil into the cavity by arranging the patient's posture on the affected side.
This method and the dangerous one of injecting disinfectants through the chest wall are rendered unnecessary by the employment of the creosote chamber, and the continuous saturation of the blood with garlic as carried out by Minchin.
'Where there is one large cavity, especially if near the middle or base of the lung, which cannot be reached by inhalations and which the patient cannot empty by severe coughing, the propriety of making a free opening from the outside, and providing thorough drainage (especially if the physical signs show that it is near the surface of the lung), is estab lished, though on the whole surgery has failed in this disease, owing to the formation of the permanent sinuses which are liable to follow.
The patient should he educated to assume such a position as will upon coughing enable him to empty the cavity by the force of gravity. This he may do lying in bed and almost inverting his body supported by his hands placed on the floor, whilst his head is lowered almost to the level of his hands. The pus sometimes flows out in a stream when this posture is assumed, and many patients have discovered this plan for themselves in some act of stooping as in the tving of their boot-laces. After the evacuation of the cavity contents it is a good plan to administer the in ternal dose of creosote or garlic, which will thus exert its full power over the lining of the empty dilatation.