Bronchitis

disease, secretion, day, morphia, time, iron and times

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In capillary bronchitis, as in the case of the milder forms of the dis ease, when the cough is quite loose and secretion free, small doses of morphia or paregoric, with ammonia and infusion of senega or serpentaria, will soon bring the disease to a favourable ending. Profuseness of secre tion at a late stage of the illness is an indication for small doses of iron. In infants, perhaps a few drops of sal volatile make the better remedy ; but after this age the administration of four or five grains of the citrate of iron with a drop or two of liq. morphia, and a few grains of the bicarbon ate of soda, is attended with great benefit. So, also, a grain of quinine with a couple of drops of dilute nitric acid, and the same quantity of laud or solution of morphia, given several times in the day, will soon brace up the relaxed mucous membrane and diminish the frequency of the cough: These remedies must of course be confined to the later stage of the disease, after the pyrexia has subsided, and when secretion is copious from want of tone.

In all forms of bronchial catarrh in weakly infants or rickety children the patient should be carefully watched for signs of collapse of the lung. If we notice the child suddenly to become drowsy, and find that this change is associated with lividity of the face, very rapid and shallow breathing, and a fall of temperature to a sub-normal level, energetic measures should be taken to promote re-expansion of the collapsed lobules (see Atelectasis).

A secondary bronchitis, such as that which is apt to occur in the sub jects of rickets, must be treated upon the same principles ; but in these cases alcoholic stimulation is usually required early.

In chronic bronchitis the child should, if possible, be sent away for the winter to a mild climate where he can pass his time out of doors without risk of chill. A sea voyage is very beneficial to these patients. As this form of the disease usually occurs in scrofulous children, the general treat ment which has been recommended for that constitutional condition should be put in force.

The intercurrent acute attacks must be treated upon the principles which have been already indicated. Still, after the disease has returned to its ordinary chronic course expectoration is often very difficult, and the breath ing oppressed ; and with the stethoscope we hear much large bubbling at the bases and for a considerable distance over both lungs. In these cases

the ordinary expectorants seem to exercise little influence unless combined with tonics. Quinine or quinine and iron, given with tincture of squill, ipecacuanha, and a drop or two of solution of morphia will often be found successful in relieving the symptoms. Cod-liver oil is also of great value not only in improving the general health, but also in checking secretion and promoting the expulsion of phlegm. Tar taken internally has sometimes a marked influence in checking secretion and giving a more healthy tone to the mucous membrane. A drop of liquid tar may be given on a small lump of sugar two or three times in the day ; or for children who can take pills the remedy may be given as follows : Inhalations are of service in these cases. The vapour of hot water im pregnated with creasote, carbolic acid, or tincture of iodine (of either twenty drops to the pint), or of oil of turpentine (one drachm to the pint), can be inhaled for half an hour several times in the day from Dr. R. J. Lee's " steam-draught inhaler." The hypodermic injection of pilocarpine is often useful. In the case of the boy referred to above, one-fifteenth of a grain of the hydrochlorate of pilocarpine was injected under the skin twice a day. The remedy caused copious sweating, and produced vomiting by which much mucus was expelled from the lungs. The effect of the drug was decided in diminishing for a time the amount of secretion, although it produced little permanent impression upon the disease.

Counter-irritation of the chest with the tincture or liniment of iodine is often attended with great benefit ; and warm woollen clothing worn next to the skin is essential to improvement. Still, in spite of all our efforts, although the child may appear better for the time, a cure is hardly possible in pronounced cases so long as the patient remains in a cold, damp climate. His only hope of throwing off the disease lies in his removal to a suitable air where he is not exposed to the constant risk of chill, and where no untoward conditions are present to interfere with his favourable progress.

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