The treatment of bronchiolitis and bronchopneumonia is practically the same. Of the numerous remedies winch are employed I regard the chest compress, baths, stimulants, inhalations of oxygen, and thorough moistening; of the air, as the most important. In acute cases, both for the pulmonary symptoms and the temperature, wet compresses ancl luke warm baths in the beginning prove most efficacious. in cases of high temperature, chest compresses (water at the temperature of room) are ap plied eve.ry 1-2 hours during the day; in older children with a very high temperature they are changed every half hour or even every quarter hour, the water being at a temperature of 12° R. (64° F.). In severe cases compresses are also employed during the night. In addition a lukewarm bath of 27°-25° R. (93°-89° F.) is given morning and evening for 6-10 minutes. The skin, especially the arms and legs, is to be rubbed during the bath, the forehead and face sponged with cold water. The physician must, at least at first, supervise the application of the com presses and baths ancl satisfy himself as to the proper application and action. Frequently, mostly in nurslings, di.scomfort, cold skin, and cyanosis occur after the use of the compresses. In this case, the cotnpresses are dispensed with and only warm baths of from 28°-30° R. (98°-100° F.) given. Koplik even recommends baths of front 32° 33° R. (105°-106° F.). Ifot baths of 15 minutes duration twice daily from the onset of the disease are praised by Renault, who claims that the pulmonary congestion is reduced thereby and a favorable action obtained on the heart and temperature.
In cases where the fever is mild, or absent, Nvarm conipresses about the chest and covering them with rubber are, according to my experi ence, of utility, as well as often in protracted febrile forms. In acute febtile forms, and in delicate and young infants, the warm compresses as recommended by JOrgensen, often give better results than the cold. In addition to these, the cool skin is warmed dry frictions, and the thorax is rapidly sponged with cold water every time the compresses are changed, thus producing deep inspirations.
I have frequently convinced myself that the routine application of cold compresses and cool baths in delicate and weakened individuals has leacl to cyanosis, acceleration of pulse, cold extremities, etc., while hot baths of from 30°432° R. (100°-102° F.), even when fever is present, have apparently acted well and quieted the patient.* Besides the baths and compresses, the f ever requires no direct treat ment. Frequently cold applications to the head and cold spongings of the extrenaities followed by dry friction are agreeable. If a febrile rem edy is desirable quinine may be given in small doses per rectum. (Qui nine muriat 1.0 Gm. (15 gr.) acid muriat. dil. q.s. ad. solut., aq. destill. ad 100.0 c.c. (3 oz.) for three or four enemata).
With the onset of numerous rates, expectoration must be vigor ously stimulated. Lig. ammon. anisat. (P. G.) 2-8 drops three to five times may be given, or elix. e. sueco liquirit. (P. G.) 10-40 drops three to five times. Where there is considerable accumulation of mucus, a decoction of senega root acts more energetically.
Decoct rad. senegre ..... gr. xxx-5iss to ,3 Lig. ammon. gr. xv—gr. xxxviii 5 Gin. dr.) cver3: 2 hours.
In cases of failure of respiration and weakness, camphor with benzoin is to be given (camphorT trit. 0.01-0.03 Gm. (I—I gr.) with flor benzoes 0.01 Gnt. (1, gr.), every one to three hours. In cases of disturbances of digestion all these remedies had better be omitted, and camphor or caffeine be given subcutaneously. Caffeine natrobenzoic 1.0 Gm. (15 gr.) aqua destill. 10.0 Gm. (3 dr.), I to 1 syringeful two or three times daily. Nar cotics often act directly very injuriously by diminishing the expectoration.
For the purpose of emptying the bronchi thoroughly an emetic is recommended by some in the beginning of a violent capillary bronchitis. It is best to give ipecac in full doses, but not when the stomach is empty, i.e., rad. ipecac pulv. 0.5 (8 gr.) in syrup. Should vomiting not take place, the same dose is repeated after ten minutes, and if necessary again in another ten minutes. Vomiting is hastened by allowing the patient to drink plenty of water.
According to my personal experience, I have never seen any par ticular good results from the use of emetics. At any rate an emetic may only be given to a robust infant and in the beginning of the illness. If weakening and carbonic acid poisoning are already present, vomiting will not take place, but more likely a serious collapse.
In very young infants, Schultze's method also acts well by empty ing the bronchi (Engel).
Although mustard baths have long been in use, recently Heubner very warmly recommends a more energetic method of application in the shape of a mustard pack. The procedure may be adopted as soon as a diagnosis of bronchiolitis has been made.
About 3 tablespoons of fresh mustard flour are stirred in 1I litres (3 pints) of warm water (104° F.) for about 10-15 minutes until the odor becomes perceptible from the development of the mustard oil. A cloth is now dipped in this mustard mixture, wrung out well, and the patient enveloped from the neck to the feet, and wrapped in a woolen blanket. The head only is allowed to remain free. Thc neck is still more carefully covered so that the pungent odor of the mustard vapor does not irritate the lungs. The patient is allowed to remain in this pack for 10-20-30 minutes until he is as "red as a lobster." after which the pa tient is removed from the pack, cleansed with lukewarm water, or given a lukewarin bath at 28° R. (98° F.), and kept from one and a half to two hours in an ordinary long moist pack so that the hyperfemia of the skin may be maintained as long as possible. Afterwards the patient is again bathed and if necessary is given a cold sponge, dried, and allowed to lie quietly. The hyperrentia of the skin which has been attained (which probably acts by depletion of the lungs) often lasts for several days. The procedure is carried out not more than once a day. I have also several times seen surprisingly good results from the use of these energetic mustard packs in acute cases.