Symptoms

Broncho-pneumonia is common at the extremes of age, in the very old and very young. The mortality is greatest in children under two years of age. It is the sequel to many of the acute diseases of childhood, and is also produced by the tubercle bacillus and by the inspiration of particles of food or fluid which are drawn through the larynx to the bronchi by inhalation during the act of swallowing. The latter variety may occur as a result of drawing seeds or other hard substances into the bronchi; from operations about the mouth and upper air passages after tracheotomy; and from the conditions which impair the normal sensitiveness of the larynx and the reflex action of the epiglottis and vocal cords, such as profound uraemia or apoplectic or alcoholic coma, and post-diphtheritic or laryngeal paralysis. A few cases have been produced by carelessness in the passing of the oesophageal catheter into the larynx and pouring liquid food into it.

Dietetic Treatment

Broncho-pneumonia is always a very critical disease and the utmost care is required in nursing and feeding. The diet should consist of such articles as meat juice, predigested milk, and egg albumin. Stimulation is early required and in considerable quantity. Brandy or whisky sweetened with a little sugar and cold water should be systematically given, especially to young children, who are unable to make their want of drink known. Hot milk and Vichy, in the proportion of one part of Vichy to two of milk for older children, or half-and-half for young infants, may have the effect of loosening the tenacious mucus and easing the cough. If there is any tendency to flatulency, aerated waters had better be avoided.

When the disease occurs in children the diet should be adapted to foster the strength and tax the digestive organs as little as possible. At first food should be given every two hours, and milk is usually all that is required. Later it may be alternated with or supplemented by egg albumin, expressed meat juice, plain beef or mutton broths, arrowroot, or other gruels.

Pleurisy

Of the various forms of pleurisy, those which are chiefly influenced by diet are pleurisy with effusion and empyema. In pleurisy with effusion the objects to be attained are to preserve the strength of the patient and promote the reabsorption of the fluid in the pleural sac. A diet is therefore advised which shall consist of nutritious solids with a minimum amount of fluid, in order that the blood may become more dense and that favourable osmosis may occur from the pleuritic cavity into the blood vessels; at the same time free action of the kidneys should be promoted. To still further favour the absorption of fluid, a special dry diet has been recommended in which, as in case of aneurism, the patient is encouraged to take as little fluid as possible and to eat table salt by the teaspoonful, the idea being to increase the density of the blood both by withholding fluid and adding salt, and that the latter may also promote osmosis. This treatment has been attempted in several of the New York hospitals and elsewhere, but has not met with success, mainly, no doubt, on account of the difficulty of overcoming the thirst of the patient, which is doubly aggravated by the lack of fluid and the supply of salt.

An extreme dry diet known in Germany as "Schroth's Method " has been indorsed by Niemeyer, Pimser, and others. The patient is fed upon lean roast veal and stale rolls (Butterbrod) without fluid of any kind but a little water until the third day, when half a pint of red wine is given. At the end of a week a pint is allowed. Very few patients will submit to such treatment in this country, and it certainly is severe. A reasonable abstinence from fluids, especially water, is all that can be expected. Practically, many patients are found to go on reabsorbing pleuritic exudation while continuing a milk or other fluid diet which is necessitated by some complication in the digestive system.

Several French writers, as Serre and Eloy, advocate an exclusive milk diet, giving from three pints to three quarts daily, to be sipped in small quantities every hour or two. They rely upon the diuretic effect of the milk, and give it in any form most agreeable to the patient. The treatment is continued for a week or more after the exudation has been absorbed, and return to a solid diet must be gradual.

This method is obviously directly opposed to the dry diet, and possesses no advantages over it, excepting sometimes in cases complicated by chronic valvular heart disease, gastric catarrh, or advanced anaemia. In England and Europe thoracentesis appears to be much less practised than in this country, where it is performed with but little hesitation.

If the pleuritic exudation accumulates in sufficient quantity to severely embarrass respiration or the action of the heart, it is so easy to absolutely withdraw it by the aspiration needle when antiseptic precautions are taken that annoying the patient by experimental dietetics is hardly justifiable, and I have found solid diet with reasonable restriction to be, on the whole, the most satisfactory. Patients who are fairly robust will naturally endure privation of food and drink better than the feeble and anaemic.

Empyema

The dietetic treatment of empyema is based upon the need for nutrition to supply the drain on the system of the constant excretion of pus, and fatty food, such as butter, cod-liver oil, and cream, should therefore fill a large portion of the dietary. The general supporting treatment prescribed for the early stages of pulmonary tuberculosis is recommended (p. 468).