The condition of the heart will require careful attention all through the attack, especially in adult patients, and Strychnine hypodermically will often be indicated all through the illness. For the same reason Alcohol is sometimes required, but should never be administered in doses sufficient to tranquillise the respiratory centre, and 5 oz. Whiskey daily should be seldom exceeded even in patients who have accustomed them selves to the drug. Wine whey in the case of children and feeble infants affords the best means of supplying the stimulant, and may tide them safely over periods of extreme debility and danger.
To patients with valvular disease or marked cardiac weakness Digitalis should be administered from the start, whilst Strychnine is given twice a day hypodermically. The following is a good combination affording a means of supplementing the expectorant with a cardiac tonic and a stimu lant, viz.i Tr. Digitalis 3ij., Spt. Amm. Ar. 3j., Spt. iEtheris 3iv., Sodii Iod. 3ss., and Aqum ad of which ass. may be given every 4 hours.
Lobelia should be employed only when much spasm is present, owing to its depressant action on the heart, and Pilocarpine should never be used.
The physician will be wise in dealing with such a serious disease to confine himself to the use of the well-tried and older expectorants as ammonia, tartar emetic, and ipecac., with the peculiar effects of whose action he is most intimately acquainted. Quinine, frequently recommended as a tonic in the different types of bronchitis, is best avoided; it often dries up the sputum and increases the difficulty of expectoration in adults, though 1\ easham relies solely on this drug given hypodermically in doses of r gr.
for a child one year old morning and evening. In the resolving stage no drug is of such value as the Iodide of Sodium; after a few days under its use the thick purulent expectoration may often he observed to become transparent and almost liquid. Chloride of Ammonium in the opinion of the writer ranks next in efficacy.
The nature of the affection obviously demands that the diet should be of liquid and highly nutritious food administered in small quantities at a time and very frequently. Thus milk, strong soups, beef essences, and meat juice with beaten-up eggs arc clearly indicated. Flatulence and constipation must be guarded against. Sleeplessness is best met by Paraldehyde; all hypnotic drugs which depress the respiratory centre must he avoided. During convalescence great care must be taken to avoid chills. After a serious attack it is advisable when possible to send the patient to a warm seaside resort as Torquay, or on a trip to Madeira or the Canaries.
Croupous or Plastic bronchitis is often little influenced by ordinary expectorant drugs, and there is no treatment known which exercises a specific action over the formation of the fibrinous casts, though steam inhalations and sprays of Lime Water and of solutions of Lactic Acid, Papain, Trypsin and Pepsin have been employed with the view of causing their solution. In the acute attacks Pilocarpine and Tartarated Anti mony may be tried along with other agents, especially Citrate of Potash, useful in the treatment of acute bronchitis, and emetics are useful for dis lodging mechanically the fibrinous plugs.