The diagnosis is made from the above described symptoms, of which the persistent rales over a circumscribed spot, periodical attacks of cough ing with enormous expectoration, besides a tympanitic percussion note, and bronchial breathing over a circumscribed area, are the most impor tant. Fetid bronchitis often follows a similar course. but is: without any special local symptoms. The course of gangrene of the lungs is much more acute and serious, the expectoration containing pieces of discol ored parenchymatous tissue, the breath having the usual characteristic odor. Abscess of the lungs yields a pure purulent expectoration without offensive odor. It is often impossible to distinguish it from a localized emphysema with which it may be confounded, even after ex ploratory puncture (Koplik) or after rupture through a bronchus. In contrast to tuberculous cavities (rarely large in children) there is in bronchiectasis less disturbance of the general health, and an absenc.e of tubercle bacilli in the expectoration. Thickenings and adhesions are also in favor of bronchiectasis.
The prognosis is on the whole bad. The disease may be stationary
for years, but recovery is rare.. Dangerous complications always threaten, and the fatal termination is mostly in the form of pseudophthisis.
The treatment is directed to increasing the strength of the patient, combating the aniernia with nourishing food, and whenever possible with out-of-door life in the country, mountains, sea-shore, and in the south during the winter.
in addition to the occasionally' administered expectorant (liq. anunon. anisat.) for the purpose of promoting the expectoration, beside cough-producing positions, systematic expiratory compression of the thorax (Gerhardt) should be practiced. To limit the amount of secretion, inhalations of ol. terebinthin., ol. pini pumilion., aq. picis, ferric chloride ;}. per cent.; internally, creosote, guaiacol carbonate, terpin hydrate, balsams, are. to be recommended. Vierordt has recently obtained very encouraging results from mobilization of the thorax (multiple resection of ribs). Formerly, the results of operative interference were unfavor able (Tuflier).