Bronchitis

free, patient, cough, membrane, ammonia, chest and disease

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In capillary bronchitis the child should wear a flannel night-dress, and the temperature of his room should be kept at 70° or 75°. It is also ad visable to moisten the air round his cot by vapour from one of the many varieties of bronchitis kettle, or by Dr. R. J. Lee's "steam-draught inhaler." The poulticing of the chest should be carried out energetically ; and when the skin can no longer bear the irritant, the chest should be wrapped in cotton wool.

In this severe form of the disease stimulant expectorants are not only useless as remedial agents, but tend directly to increase the congestion and irritation of the mucous membrane. However feeble the child may be, if the cough is hard and the chest tight, ammonia, squill, tolu, and other remedies which exercise a stimulating effect upon the mucous membrane should be avoided. In such cases the distress of the patient is most cer tainly relieved and his strength improved by medicines, such as salines with ipecacuanha, which promote free secretion from the tubes. If neces sary, this treatment can be supplemented by general stimulants, such as alcohol ; and in weakly children it is very necessary to counteract any de pressing effect of the remedies upon the system by the free administration of brandy-and-egg. In young children whose strength is good it is often useful at the earlier periods of the disease, when the cough is hard and much soreness is complained of in the chest, to give two or three grains of powdered ipecacuanha in a teaspoonful of mucilage twice a day on an empty stomach. The emetic in these small doses excites vomiting with very little effort, and causes the expulsion of much mucus from the stomach and lungs. After a few doses of this remedy the character of the cough often undergoes a marked change for the better, and the distress of the patient is greatly relieved. So long, therefore, as there is fever with hard cough, tightness behind the sternum, and lividity of the face, we should confine ourselves to ipecacuanha or antimonial wines Oil v.—x.), citrate of potash (gr. solution of acetate of ammonia (rri x.—xxx.), spirits of nitrous aher Cat x.—xxx.), and similar remedies.

Although the medicines recommended are all such as aid the free secre tion of mucus, they are not given with any object of producing depression.

On the contrary, we should watch the patient carefully for signs of prostra tion, and hold ourselves in readiness to correct any undue sedative influence by alcoholic stimulation. We must not, however, be iu a hurry to give wine or brandy. A small feeble pulse will be often found to become fuller and stronger as secretion from the inflamed mucous membrane becomes more copious and the congestion of the pulmonary vessels declines.

In children of four or five years old and upwards a grain of calomel with two or three grains of jalapine at the beginning of the treatment is always useful. It is unnecessary to keep up a free action of the bowels, for these cases appear to be little benefited by purging; but a thorough unloading of the liver is very useful as a preliminary measure. Even in infants half a grain of calomel followed by a teaspoonful of castor oil often seems to render the after-course of the disease milder and more tractable.

The above method of treatment will usually be found successful in cases of primary capillary bronchitis, when the patient is seen before collapse of the lung has occurred or the disease has passed into a chronic broncho pneumonia. It is important that we should not allow ourselves to be tempted, by the apparent prostration of the patient, to prescribe ammonia and other stimulating drugs. When the pulmonary vessels are congested and the obstruction to the circulation is extreme, the heart labours, the face is livid, and the pulse is small and feeble • but these symptoms con stitute no real indication for ammonia. We shall best relieve the impedi ment to the pulmonary circulation and promote the aeration of the blood by measures which relieve the congestion by producing free secretion from the overloaded vessels.

Opium should not be given unless the restlessness is great, and even then the remedy is hardly a judicious one ; for anything which dulls the sensibility of the bronchial mucous membrane hinders the expulsion of the phlegm and favours collapse of the air-cells. Aconite, veratrum viride, and other powerful cardiac sedatives are only admissible during the first forty-eight hours, and must on no account be given to young infants.

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