Sal Volatile is a reliable cardiac stimulant and may be given in i-dr. doses freely diluted instead of or in combination with the alcohol.
Sparteine, Caffeine, Cactina pillets, Strophanthus, and other cardiac tonics have been from time to time employed, but they possess no advan tage over the remedies already mentioned.
Normal saline solution has been frequently administered with advantage by the bowel, hypodermically or by the veins. 20 to So oz. may be given by any route. It is obviously contra-indicated when there is great distension of the right heart from blocking of the circulation in the lungs. But even in this case it may save life if certain precautions are taken. The benefits obtainable from serum injection are not immediately due to any tonic action upon the cardiac muscle; the serum dilutes the blood appreciably, and thus diminishes the amount of toxins going to the poisoned heart and nerve centres. The rational use of this agent will therefore be found in its power of washing the blood, and in cases where severe or profound toxemia dominates the clinical picture it is the only remedy to be depended upon. By opening a vein 20 to 25 oz. blood should be withdrawn and twice as much serum injected either into the open vessel or by the hypodermic method. In this way a large enough quantity of the toxins may be removed from the body to turn the scale in favour of recovery. heart is immediately relieved by the diminution of the amount of poison circulating through its own vessels, and the elimination of the toxins is further increased by the powerful stimulation given to the skin and kidneys to throw out the superfluous serum injected. When large amounts of the saline are injected without bleeding having been previously performed, much toxin may be simultaneously removed by smart purging with Magnesium Sulphate two or three times a day.
In those cases of dyspicea often associated with cyanosis where the embarrassment of the breathing may be mainly due to the obliteration of the large amount of lung substance by the process of consolidation, even before the heart begins to fail, Oxygen inhalations are most beneficial.
The somewhat puerile objection to the use of oxygen—that it cannot reach the blood through the blocked air cells of the solid lung—may be dismissed: a large amount of the gas will be absorbed by the blood circulating through the unaffected pulmonary tissue. A free supply of oxygen is also a powerful factor in neutralising the toxins and in stimulating the heart. The gas should therefore be used early and not kept in reserve till too late. It is inadvisable to employ it by a mask or inhaler; it may be permitted to escape slowly from the cylinder through a rubber tube of moderate calibre held several inches from the patient's mouth, and when so admin istered there is no necessity for heating the gas by passing it through a bottle of warmed water.
Cough should seldom be interfered with; it can be quickly silenced by the administration of narcotics which lull the respiratory or cough centre —a practice fraught with disaster in the later stages of the affection, though occasionally justified at the onset of the disease when the cough is dry and painful, the result of the local pleural irritation. The routine practice of drenching pneumonic patients with large doses of the nauseating expectorants is most objectionable. The presence of an abnormally adhesive or tough secretion in the bronchial tubes is best met by 5 to ro gr. doses of Iodide of Sodium combined with 3o-min. doses of Sal Volatile well diluted with water. When opiates must be administered for the relief of painful cough, Strychnine should at the same time be injected to stimulate the respiratory centre.
Much has been written of late years about the advisability of giving Citrates to decalcify the blood in order to limit or prevent the the consolidation in the affected lung, and enormous doses of Iodides are recommended to increase the fluidity of the circulating fluid, but the practice cannot be said to have proved of use. Brunton recommended Calcium Chloride as a powerful cardiac stimulant and tonic when the heart power is failing, notwithstanding the hyperfibrinous state of the blood.