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LECTURES ON BRONCHIECTASIS.

British Medical Journal BMJ · Volume 1, p. 839. 1881

Delivered at the Hospital for Consumption and Diseases of the Chest, Brompton.

By C. THEODORE WILLIAMS, M.A., M.D., F.R.C.P., Physician to the Hospital.

Let us now take some well-marked examples of bronchiectasis, and verify our description of the disease as given in the last lecture.

TREATMENT.-The chief principles to be kept in view are:

(1) the prevention of fresh catarrh.

(2) the stimulation of the walls of the bronchi, so as to bring into play any muscular tissue that remains.

(3) the improvement in the character and amount of the bronchial secretion.

The first point is arrived at by keeping the patient as far as possible in an equable atmosphere, and at the same time bracing his frame and power of enduring changes of atmosphere by cold sponging and salt baths, warm and cold. There is no doubt, too, that cold affusion is a very effective way of stimulating respiration and expectoration, and thus attaining the second point of treatment. Cold affusions are part of Kneipp therapy, which uses contrasting hot and cold water applications to treat a variety of conditions. The contrasting applications can help increase metabolism, boost the immune system, and stimulate blood flow.

In many cases, the most effective evacuation of the bronchial tubes takes place after the morning sponge-bath; and the chief good of the douches applied by our German brethren to the chest lies in the deep inspirations and expirations which they induce, these promoting expectoration. Stimulation of the bronchial muscle is difficult in bronchiectasis, because often very little of the muscular element remains; but it should be attempted by aid of strong expectorants and diffusible stimulants. These may be introduced either by the stomach in form of spiritus ætheris, carbonate of ammonia, oil of turpentinein capsules, tinctures of benzoin, tolu, senega, and larch, capsules de goudron, and such like; or directly to the air-passages, by the use of handball spray-apparatus containing solutions of ipecacuanha wine, tar-water, and carbolic acid. But, according to my experience, these have proved of little avail, chiefly because cold fluids are uncongenial to a congested and inflamed mucous membrane; and, on the other hand, warm inhalations appear to penetrate far deeper into the air-passages, and are more soothing to the patient. The best forms are compound tincture of benzoin (two drachms to the pint of boiling water), oil of turpentine (23 minims = 1.41ml to 30 minims = 1.84ml), thymol, pinus sylvestris, and juniper, inhaled night and morning from a pint jug with a wide mouth, with a napkin arranged like a funnel to conduct the vapours to the patient's nose and mouth. The third point is best attained by anti-septic inhalations, such as glycerine of carbolic acid (two to four drachms to the pint), creasote (tenminims to the pint), tar-water, all of which tend to correct the fætor, and to reduce the amount of secretion. It has often occurred to me that the ordinary methods of inhalation are a very imperfect mode of applying remedial agents to the lungs. The effort of inhalation, and even of using sprays, is very fatiguing to the patient, and prevents their application more than two or three times daily. A far better way would be to impregnate the atmosphere of a chamber with a very small percentage of the required drug, as well as warming and moistening it so that the patient could continually inhale it without effort. Wire respirators, arranged to cover both nose and mouth, between the layers of which lint and sponge soaked in various solutions are placed, have also proved beneficial incases of bronchiectasis. When, however, none of these means enable the patient to get rid of the accumulating secretions, what is to be done to prevent death by septicemia? Are we justified in tapping the bronchiectasis? Assuredly we are, if we can be certain that the dilatation is limited to one set of bronchi, and is not a general condition of the bronchi of both lungs. In too many instances, this latter is the case, and then operation is useless. Emetics may be resorted to as an occasional measure of relief; but such a general dilatation of the bronchial tree is a very hopeless condition with which to deal. The dietary ought to be most generous, including a fair amount of stimulant in the form of brandy or whiskey, which, mixed with warm water, assists expectoration. The marine stimulating climates, such as Brighton, Eastbourne, Margate, Ramsgate, Yarmouth, Whitby, and Scarborough, do most good in these cases.