Bronchitis

child, patient, cough, temperature, danger, six and mixture

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Prognosis.—As long as the catarrh remains limited to the larger tubes the prognosis depends upon the age and general strength of the patient. However slight the disorder may be, we can never feel sure that in a new born, a weakly, or a rickety infant fatal collapse of the lung may not follow unexpectedly. In all such cases, therefore, we should warn the parents of this possible danger, and caution them to watch carefully for lividity, drowsiness, or other sign indicating insufficient aeration of the blood.

In capillary bronchitis the danger is great, however healthy the child may have previously been"; and if the patient be weakly or the subject of rickets, the peril is really urgent. Indeed, few such cases recover. The ex tremity of the danger is indicated by a high degree of interference with the aeration of the blood. If the child become intensely apathetic or irre sistibly drowsy, with blueness of finger-ends, an ashy-gray face, dull and lustreless eyes, and a normal or sub-normal temperature, death can scarcely be avoided. Other signs of unfavourable import are suppression of the cough, great rapidity of the pulse and respiration, smallness of pulse and fulness of superficial veins, with retraction of the base of the chest in in spiration.

Signs indicative of collapse of the lung or of broncho-pneumonia augur ill for the child's chances of recovery.

Treatment.—A pulmonary catarrh in a child, espeCially if the patient be weakly or of a rickety constitution, should never be treated lightly. In the mildest case the patient should be kept in his room and be made to take a saline mixture containing a few drops of ipecacuanha or antimonial wine in each dose. If there is any rise of temperature, he should be at once put to bed. This is essential. Perfect quiet is necessary for a feverish child ; and even if pyrexia be absent, the repose and equable temperature of his cot will hasten the patient's recovery more certainly than the most energetic medication. Indeed, without this precaution treatment loses more than half its value. In the next place we must employ counter-irritation. There is, however, a right and a wrong way even of using a poultice. Weak applications in these cases are better than strong irritants ; for a far more effectual impression is made by acting slowly upon a large surface of the skin, than by producing a more violent irritation of a comparatively limited area. One part of mustard should be diluted with five or six times

its bulk of finely ground linseed meal. The ingredients should be care fully mixed in the dry state and made into a poultice with hot but not boiling water. The application should be sufficiently large to cover the whole front of the chest, and should be allowed to remain in contact with the skin for six or eight hours, or even longer if the child can bear it. A layer of cotton wool should be then applied in its place, and a fresh poul tice of similar strength should be made for the back and be kept on for an equal period of time. An infant will bear this strength well. For an older child a larger proportion of mustard may be used ; but it is seldom wise to employ an application which cannot be borne for at least six hours.

The effect of these measures is seen very quickly. In the milder forms of the disease the hard cough becomes soft and loose, the soreness of the chest subsides, and the pyrexia quickly disappears. Even in the more severe variety a sensible diminution in the distress and the labour of breathing is usually manifested when the skin becomes very red from the action of the irritant.

The diet should consist of milk and broth ; and the child should be allowed to drink freely of thin barley-water.

For medicine, a grain of calomel should be given in a little sugar, and be followed after a few hours by a dose of castor-oil or other mild aperi ent. A febrifuge mixture can then be prescribed, such as citrate of potash or the solution of acetate of ammonia with a few drops of ipecacuanha or antimonial wine. A pleasant form in which these can be given is the fol lowing :— The above is suitable to an infant. For older children the proportions may be increased, or the draught can be given more frequently.

Unless the bronchitis be severe, the bronchial derangement quickly yields to this treatment and the patient is soon convalescent. If the cough continue after it has become loose, and the child's appetite has returned, a few drops of paregoric and tincture of squill added to the mixture will soon effect its removal. Stimulating expectorants are as useful at the later stage of the catarrh, after the cough has become loose and easy, as they are injurious at an earlier period when it is hard and painful.

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