80 DISEASES OF THE TRACHEA AND BRONCHI. 



taken morning and evening so as to produce a sufficient daily alvine 

 evacuation, is a remedy much praised by the patient, and readily taken. 



If the cause be a direct irritant to which we know the mucous mem- 

 branes are daily exposed in certain trades or avocations, the causal indi- 

 cation cannot be met, as these patients are not usually in position to 

 give up their occupations, and to avoid these noxious agents. As we 

 have explained above, chronic bronchial catarrh is undoubtedly exacer- 

 bated if the patients subject themselves to the action of very cold, dry 

 air. We should bear this knowledge conscientiously in mind, and 

 make the patient keep his room for weeks or months during a cold win- 

 ter, and establish a uniform temperature in his chamber. Experience 

 demands our recourse to this procedure all the more, as patients with 

 chronic catarrh of the bronchi, after suffering an intercurrent acute 

 attack, often indulge in the idle hope that the disease just passed away 

 has had some critical influence upon the chronic evil, and that they now 

 cough much less, and are much less oppressed about the chest, than 

 before. 



Their error becomes evident as soon as they expose themselves anew 

 to the air. Chronic bronchial catarrhs, which have arisen under the in- 

 fluence of a severe climate, require, where circumstances permit, a change 

 of abode. Let the patient avoid the winter that is, send him, during 

 the cold season, into some milder climate. During spring and autumn 

 advise residence in some peculiarly-sheltered place, Baden-Baden, Wies- 

 baden, Soden, etc., or in the highly-oxygenated atmosphere of the pine- 

 woods, in which convenient accommodations have long been established 

 for the "pine-needle-bath institutions." As a rule, hign dry places are 

 more suitable for the catarrhus pituitosus, while we must send patients 

 who suffer from the dry catarrh to the wooded coasts, or to promenade 

 upon the salt-works. In epidemic catarrh, the cause cannot be ob- 

 viated. 



INDICATION IN TREATING THE DISEASE. Even the mighty bleeders 

 of the school of Bouillaud, who make little of a pcund or two of 

 blood, claim nothing for blood-letting in catarrh of the respiratory 

 organs. Let us bear this fact in mind, lest we be induced to bleed at 

 the sight of severe infantile dyspnoea, from hyperaemia, and swelling of 

 the bronchial mucous membrane; and let us also remember that the 

 danger from the so-called capillary bronchitis of childhood arises merely 

 from the situation of the disease. In the vast majority of these cases, 

 and it is in these alone, of the many forms of bronchial catarrh, that we 

 might be misled into bleeding, instead of averting the danger of car- 

 bonic-acid poisoning by so doing, we should enhance it. The swelling 

 of the mucous membrane will not subside, and although hitherto, by 

 dint of strenuous efforts, the child may have been able to draw air 



