Of internal remedies used for the relief of the paroxysm all usually are too slow in their action unless, as already mentioned, they be given by inhalation or hypodermically, hut sometimes Hyoscine acts speedily gr. by the mouth), though it also is better given hypodermically.
3o grs. Chloral Hydrate in a draught or a full dose of Cannabis Indica prove useful if given at the beginning of an attack before the breathing becomes very laboured.
Caffeine is a favourite with some patients, but it is liable to aggravate the insomnia which is nearly always present; it is best given in the form of a large cupful of strong black Coffee.
The ethereal tincture of Lobelia, if pushed till nausea supervenes, is often of use, but it is a drug of great power, and may seriously depress the heart.
The strong induced current is recommended by Veo, who places the electrodes over the pneumogastrics below the angle of the jaw in front of the sterno-mastoids; pressure with the fingers or ice-bags laid over the course of the pneumogastrics act in the same way. A blister over this region is more reliable but much slower in its effects.
Euphorbium Pilulifera„ Grindelia, and Gelsemium alone or combined with Nauseating Expectorants or Trinitrin are employed in some cases with marked benefit, and Alum in r5-gr. doses laid upon the tongue has its advocates.
This list, which represents but a small proportion of the agents recom mended for the relief of the asthmatic paroxysm, proves that the treat ment is largely empiric. One remedy after another must he tried till the drug is found which gives most speedy succour, and this as a rule may be relied upon in future attacks in the same individual. Towards the end of the attack, as expectoration begins to show itself, expectorants in full doses hasten disappearance of the spasmodic condition.
Treatment during the Intervals between the already men tioned in speaking of the preventive treatment of the paroxysm, the cause of the attack when found must be carefully avoided. The regulation of the asthmatic's dietary is of importance, quantity being often a more serious matter than quality. The chief point is the regulation of the hours of eating, so that a very heavy meal after a long fast is never to be in dulged in, hence the necessity of doing away with the boa-constrictor plan of one enormous meal in the day late in the evening, and the substitution for it of a light repast every 4 or 5 hours. As a rule animal food should
be sparingly used, fish and chicken with fresh vegetables and cereal, meeting all requirements; wines and beer are objectionable. Constipation must be carefully guarded against. When his means permit, climatic treatment, especially for the spring and winter months, should be con sidered, and from the remarks already made the physician will readily appreciate the possibility of making serious mistakes in sending the asth matic patient on long journeys in search of health when his best sanatorium may be but a few miles from his usual residence. Nevertheless there are a few guiding principles worth consideration; thus where the asthma is obviously cf the catarrhal form a warm, sunny, equable climate suitable for bronchitis should he selected, and Mount Dore and Ilourboule in Puy De Dome are favourite resorts, whose waters also contain arsenic. Where already there is much emphysema, a suitable spot in the Riviera may be selected, as Cannes or Grasse. Where the diseased condition has developed in a low-lying damp region it high elevation Alpine resort usually does \yell for young patients, but old emphysematous cases fare badly in these regions; the climatic treatment of the bronchitis and emphysema is of more importance than the consideration of the asthma in very chronic cases.
Of drugs suitable for administration during the intervals between the attacks there are two about whose value in most cases there can be little doubt, and these may be given as a routine—viz., Iodides and Arsenic. The following mixture may be employed : Sodii Iodidi 5iij. Liquor. rseniealis Vini Ifieeneuanha' 3vj.
Belladonme 5ij.
Aqua Chloroformi ad 5vj. Misco.
Fiat mistura. Sumatcoch. min. bis in die ex a2. p.c.
During the attack the above may be given every two hours if the Fowler's Solution be replaced by 5 iv. Tinct. Lobelia?.
After a few months of the above routine the iodide alone may be given every other month alternating with a month's treatment by arsenic only.