I. Acute Bronchitis

An attack of acute bronchitis is to be treated as regards the diet on the same lines as any other febrile illness. The foods ordered will be milk, soups, egg in milk or coffee, fluid puddings, and milk with small amounts of Benger's, Mellin's, or Savory and Moore's food. The food must be so regulated as to prevent fermentation and flatulent distension in the stomach and bowels. This condition will often follow from a mistaken idea of feeding up the patient. A low diet will be much more beneficial. Milk should be given with lime-water, or mixed with some solid, so as not to form large curds in the stomach. Whey is a form of milk which is specially indicated if there is a tendency to flatulence. Milk foods should be taken slowly, with a spoon, and in small quantities, 4-5 oz. at a time. Drinks of milk should not be given when the patient is thirsty. All soups should be weak, for if concentrated they tend to cause indigestion and overloading of the blood. Regular hours of feeding should be adhered to, every two or three hours according to the severity of the case and the quantity taken at a time.

In the dry stage of pulmonary catarrh, when coughing is persistent and the expectoration thick and scanty, much relief is afforded by the drinking of hot fluids freely and apart from meal times. Hot lemonade (not too much sweetened), linseed tea, weak tea, or hot barley-water may be given freely.

Lemonade may be prepared as follows. Peel a lemon very thin and put the rind into a jug; add the juice of the lemon, 1 oz. (about five lumps) of sugar, and a pint of boiling water. Stand until it is cold and then strain. Instead of plain boiling water, barley-water (made thin) can be used, and if a little additional nourishment is wanted, the white of an egg well beaten up may be added.

Linseed tea may be prepared as follows. Put 1 oz. of linseed 1/2 oz. of liquorice and half a lemon into a jug, and pour over them a quart of boiling water. Let this infuse by the fire for two or three hours, and sweeten with castor sugar or sugar candy. Then stir, strain, and heat the infusion before serving.

On the other hand, when the expectoration is free and loose the intake of fluid should be limited. Even the diet given above may be partly replaced by pounded chicken or fish, with bread crumb, and toast. Alcohol is better avoided during the acute stage of bronchitis, as it tends to increase the pulmonary catarrh, but it may be called for by the supervention of cardiac weakness.

II. Chronic Bronchitis

While the treatment of bronchitis during an acute attack will always proceed on the same lines, there are various modifications of the diet called for in the convalescent stage and in chronic cases owing to the different factors which may induce and maintain the disease. Treatment may have to be directed to some other underlying affection, such as cardiac disease, renal disease, or gout, and the diet will have to be ordered according to the indications thus afforded. In these secondary forms of bronchitis it will be found best to leave the pulmonary condition out of consideration and to treat the primary disease.

A common type of chronic bronchitis is that induced and maintained by an excessive amount of alcoholic stimulation. This is seen not only in drunkards, but in many individuals who are never intoxicated, but who habitually take more alcohol than is good for them. It is not necessarily a question of absolute excess, but of excess relative to the powers of the patient to deal with alcohol. The excretion of alcohol through the lungs leads to pulmonary catarrh, bronchial secretion and coughing. In some individuals this will be produced by a smaller, and in others by a larger amount of alcohol. Many people take alcoholic stimulants as they take bread, without noticing the amount taken. Careful inquiry should be made in a case of chronic bronchitis as to the amount of alcohol taken, and if this is beyond the physiological allowance, it must be reduced. In other cases it will be found that alcohol has been taken because the patient has chronic bronchitis, and because of the temporary relief afforded by the stimulation. This, however, is only adding fuel to the fire. Alcohol should never be regarded as part of the treatment of chronic bronchitis, and under medical supervision only some light beer at meals, or wine well diluted, should be allowed.

Another type of chronic bronchitis frequently met with will have a history somewhat as follows. After passing the age of forty the patient noticed a tendency to put on flesh, and this had been progressive. With the increasing stoutness it was observed that an ordinary cold, which formerly did not pass beyond the naso-pharynx, had a tendency to affect the bronchial tubes. There was also an increasing frequency about these colds. Later, the ascent of a slight incline produced a shortness of breath to which the patient had been unaccustomed. Then, even on a level road, the rate of walking gradually became slower and slower, and the amount of daily exercise became considerably diminished.

There was also noticed a slight or marked wheeze about the chest, along with shortness of breath on any exertion, even when talking, and at night a desire to have the chest propped up in order to secure easy and quiet breathing. Perhaps no more acute symptoms had developed, or it may be that a run to catch a train had produced an attack of acute and alarming dyspnoea. On examining a patient with such a history we shall often find signs of chronic bronchitis and emphysema. The heart may be difficult to define owing to the thickness of the fat in the chest wall, but there are no evidences of cardiac degeneration or of valvular disease. The pulse is regular and good when the patient is at rest, and the arteries and kidneys appear to be healthy.

The patient will admit that his weight has increased two, four, or more stones above his normal. There is a direct relation between the increase of the fatty tissue and the bronchitis. With the development of fat, the peripheral resistance to the flow of blood has been much increased. The difficulty in the circulation is not in the arteries or in the arterioles but in the capillaries, which are increased generally in number, and are everywhere surrounded by soft resistant fat. The pressure exerted by the dense masses of fat on the capillaries hampers very much the flow of blood through these vessels. The result is that the venous pressure is lowered, the propulsive power of the heart being dissipated in driving the blood through the capillaries, and the blood returns to the right side of the heart with difficulty. The venous stasis thus induced affects also the pulmonary circulation, and a catarrhal condition of the lungs is readily set up. The heart is clogged with deposits of fat in its walls, and can but imperfectly carry on its work. The oxidation of the tissues is not complete, and the blood contains an excessive amount of carbonic acid, which throws extra work upon the lungs. These factors will all tend directly to the production of bronchitis.