CAPILLARY ERONCHITIS.
Catarrhal inflammation of the fine bronchial tubes must be treated more actively owing to its greater gravity and urgency, especially as the disease is more commonly met with in children, who may rapidly succumb to the asphyxia liable to supervene upon the blocking of the small bronchi by secretion and by collapse of the air cells as in the form of the affection liable to follow the bronchitis of measles and whooping cough, which is usually designated catarrhal pneumonia. Here, in addi tion to warmth in bed and copious steam inhalation in a room whose temperature must be kept at 65° F., Morphia must be most cautiously exhibited, if given at all, and in the old or very young it must be withheld altogether.
If the tubes are found already full of liquid secretion the administration of diaphoretics and expectorants is not indicated. An emetic should be given without delay; in the case of a child a teaspoonful of Ipecac. Wine, and for an adult 3o grs. of Carbonate of Ammonia well diluted may be given. In urgent cases Apomorphia may be given hypodermically, but not till a previous injection of Strychnine has been employed to avert cardiac depression. Sinapisms to the front and back of the thorax should be applied, and as a rule continuous poulticing by Linseed Meal is not advisable, though it may be resorted to from time to time if the breathing be found to be benefited.
Where the secretion is tough or adhesive, expectorants are clearly in dicated, and Antimony as in the milder form of bronchitis is the most reliable; it should always be prescribed from the first in combination with full doses of Ammonia or Ammonium Chloride, and continued till lique faction of the sputum is effected, and a mild degree of nausea is excited.
'in. A ptint. 5i v.
stt. Ammon. Annual.
Sp/. Ch/orof. 5iv.
Aquce Ammon. Acct. :31j. Aqua. ad 5viii Misce.
Ft. mist. secunda Dimino horn ex aqua.
A safe expectorant for children is Ipecac. Wine in 20-30 min. doses.
The condition of the sputum will give valuable information as regards the dosage of expectorants. When this becomes excessive their use should
be suspended, to be resumed again when the secretion becomes scanty. As a rule emetics are seldom indicated in the acute suffocative catarrh of adults, but their use must be a part of the treatment in every case of the disease occurring in children where usually the mechanical expulsion of bronchial secretion is often defective. The child should be made to vomit occasionally by doubling or quadrupling the dose of the expectorant mixture containing the Ipecac., and this may be repeated once or oftener during the 24 hours, as little depression follows the act of emesis in child hood, and sometimes it may be found necessary to awake the patient, should the breathing become laboured during sleep.
Ewart advocates mechanical aiding of the expiratory act by the pressure of the attendant's hands placed over the axillary bases of the lungs at the end of the expiratory act. It may be sometimes necessary in very young children to resort to artificial respiration or alternate hot and cold douches or to dash a little cold water over the chest to assist inspiratory effort in the presence of suffocative or cyanotic symptoms. Dry-cupping or the application of a small blister often does good, and should symptoms of pulmonary engorgement occur in the adult a vein may be opened; leeching is valueless. Sometimes the breathing difficulty may be relieved when spasm is present by causing the patient to inhale the vapour of boiling water to which a teaspoonful of Tr. Benzoini or Succus Conii has been added, and sprays are often useful.
Asphyxia is to be anticipated in all severe cases, and Oxygen should be ready for administration as soon as the cyanotic condition gives warning that the aeration of the blood has become seriously interfered with; the rubber tube attached to a cylinder of the gas may be held a few inches from the patient's mouth, and the inhalation from this small jet may be continued for ten minutes at a time at frequent intervals.