PNEUMONIA, Chronic.
In the majority of cases this is but a type of Fibroid Phthisis, though some examples may be seen where the affection arises from a prolongation of an attack of catarrhal or hroncho-pneumonia, or even in rare cases the cirrhosis may directly supervene upon an attack of true croupous pneu monia in which resolution has been long delayed.
In all cases, whether there be reason or not for the suspicion of tuber culosis, the lines of treatment are clear. The cirrhotic process is beyond the reach of drugs, and the management of the case resolves itself into the treatment of symptoms and the maintenance of the highest ideal of hygiene as in the open-air life and forced feeding methods indicated in plIthisis. The patient may advantageously he sent to a properly conducted sanatorium for six \reeks to learn the routine of living there, after which he should, when his means permit of it, he sent to a bracing seaside spot where he can live almost entirely in a pure atmosphere with a large degree of sunshine.
The first aim in every case should be to prevent the cirrhosed lung becoming infected secondarily by the tubercle bacillus omnipresent in the air of cities and where individuals are crowded together in unhealthy workshops and factories.
The main indication for symptomatic treatment is afforded by the degree of cough and the nature of the expectoration. The promiscuous administration of sedatives to stop cough or of nauseating expectorants to bring up the sputum more easily is to be discountenanced. Seldom if
ever will narcotics be indicated for the relief of unnecessary coughing, and the best drug for liquefying the sputum is Iodide of Sodium in 5 to to gr. doses, prescribed with Ammonia. The iodide is likewise employed by those who believe that it exerts some specific absorbent action upon the pathological fibrous tissue, and it is trebly indicated where the cirrhotic process has originated in syphilis. The most important point regarding the management of cough and expectoration is the appreciation of the fact that the cirrhotic change tends in all cases to eventuate in bronchiec tasis. The sputum retained in the dilated tubes soon becomes foul from decomposition, and the main treatment of every case of pulmonary cirrhosis due to whatever cause becomes the treatment of the resulting bronchiectasis. Hence the value of volatile antiseptics internally and by inhalation. The best of these are Creosote and Oil of Eucalyptus by the mouth, and the vapour from heated Tar or Oil of Turpentine. (See article on Bronchicctasis.) In those rarer cases where pneumonia becomes chronic, and eventuates in suppuration or gangrene of the pulmonary substance, the proper treat ment will he found in the articles on Lung Abscess and Lung Gangrene.