BRONCHITIS. 161 



of the apparatus should bo placed about a couple of feet from tin- patient, but it 

 may be. gradually brought nearer. If much iluid collect in tin- mouth, it should 

 i>- spat out and not swallowed, or it may cause nausea 01 "miting. The 



duration of the inhalation will depend on the quantity of spray produced by 

 compression of the elastic ball, and to a certain extent on the susceptibility of the 

 patient to the action of the drug. It is a good plan to begin with about twenty 

 squeezes, and to gradually increase the number at each sitting. It is seldom i. 



to give more than .sixty or seventy squeezes at one time. After every three or 

 four squeezes, especially at the commencement, it is advisable to pause for a while. 

 It is necessary to see that the tongue is not arched up against the roof of the mouth, 

 or it will hinder the passage of the spray into the lungs. The spray should be 

 taken well into the chest, or it will not do much good. The best way is to take 

 a good deep breath, so as to get as much of the vapour as possible. The inhala- 

 tion should be used twice daily, night and morning, for the first week, then once 

 a day for another week, and after that the intervals may be gradually ext. 

 as the patient gets better. 



The benefit derived from the use of the ipecacuanha spray in chronic bronchitis 

 is very great. The shortness of breath is the first symptom relieved. The ni^lit 

 after the first spraying the patient usually has a fair night's rest, although, for 

 months before, sleep may have been broken by shortness of breath and coujghing. 

 The difficulty of breathing on exertion also quickly abates, and in a few days the 

 patient can get about with comparatively little difficulty. A marked improvement 

 takes place after each inhalation, and, unless the patient is unfortunate enough 

 roh a fresh cold, he progresses steadily. Patients have told us that in a week's 

 time they could walk two miles with less distress of breathing than they could have 

 walked a hundred yards before the spray was employed. In some instances two or 

 three days elapse before any noticeable improvement takes place this comparatively 

 slow effect being sometimes due to awkward inhalation, so that but little ipecacuanha 

 passes into the bronchial tubes. The effect on the cough and expectoration is also 

 very marked, these both greatly decreasing in a few days, though the improvement 

 in these respects is rather slower than in the case of the breathing. Sometimes for 

 the first few days the expectoration is rather increased, but it speedily alters in 

 character, so that it is expelled much more readily, and thus the cough becomes 

 easier even before the expectoration diminishes. The patient is soon enabled 

 to sleep at night with his head lower, and in a week or ten days, and sometimes 

 earlier, can do with only one pillow an improvement which occurs in spite of fogs, 

 damp, or east winds ; even, indeed, whilst the weather gets daily worse, and when 

 the patient is exposed to it the chief part of the day. 



Sometimes, just at first, an inhalation may excite a fit of coughing, wliich 

 generally soon subsides ; but should it continue, a weaker solution should be used. 

 The patient soon becomes accustomed to it, and inhales the spray freely into the 

 lungs. At first he often inhales the spray less adroitly than he learns to do 

 afterwards, and he is apt to arch his tongue so that it touches the palate, and con- 

 sequently less enters the chest than when the tongue is depressed. This difficulty 

 may usually be overcome by holding the nose whilst the spraying is in progress. 

 11 



