Garlic is a most invaluable expectorant. and Minchin has demonstrated its action in a number of respiratory conditions. Many authorities regard it as a specific germicide in pertussis. Teaspoonful doses of the juice may be given to children, and some affirm that by placing a few bulblets inside the patient's socks the absorption is so rapid that in a few hours it is eliminated freely by the pulmonary tract. As the paroxysms become severe and frequent—say up to twenty or more in a day—and when their intensity begins to tell upon the patient's strength, several drugs have a claim upon the physician's attention. These are Bromides or Bromoform, Chloral, Antipyrine, Belladonna, Heroin, Conium, Quinine or Euquinine. The writer names them in the order in which they will, in his opinion, he likely to proved of value.
Bromides are certainly not as efficacious as chloral or antipyrine in diminishing the frequency and intensity of the paroxysms, but they possess the advantage of being practically free from danger when given in moderately large doses; 5 grs. of the Ammonium salt may be added to each dose of the expectorant mixture, or 3 mins. Bromoform may be adminis tered in syrup. The best combination is bromide of soda with the next mentioned drug.
Chloral possesses marked power over the spasmodic element in the disease. The usual rule for dosage is r gr. for each year of the child's age, but it is better to give half this amount, and more frequently—say every 2 hours—and even then a still smaller dose suffices when bromide is added. It should, however, be always remembered that chloral is a dangerous drug in the presence of cardiac weakness, and in complicated cases it must be used with caution. Chloralamide and Chloralose have been also vaunted; they are probably not less dangerous when given freely.
Heroin is certainly preferable to morphia as a respiratory sedative, though II enoch extols morphia in pertussis above all other narcotics. The dose of heroin should not exceed th gr. for a child 5 years old. Its advan tage over morphia lies in its not drying up the sputum. Recently Triboulet and Boye have revived the morphia treatment, and recommend the dose of A gr. morphine hypodermically to infants under a year old, and double this amount to older infants. The writer believes that such treatment would probably be fatal where extensive bronchial catarrh is present.
Belladonna has been long claimed to be a specific ; it is useless alone unless when given in doses sufficient to produce the physiological action of the drug. but when pushed to this extent it often exerts a considerable
influence over the severity and frequency of the paroxysms. In many cases it fails to exert any beneficial action, and must he abandoned owing to its tendency to dry up the sputum. Some authorities prefer Atropine, others the allied alkaloids—Ifyoscine, Ilyoscyamine or Duboisine. These powerful mvdriatics should not be given to infants at first in doses exceeding gr.; after watching the effects the dose of atropine may be increased to „ITT gr. till the pupils dilate in the case of a child i year old. When the full effects of the drug have been produced the dose should he lessened, and though children bear belladonna or atropine much better than adults, nevertheless the use of such a powerful agent is always a source of anxiety to the conscientious physician, and unless in hospital practice, where the effects can be watched from hour to hour, this form of treatment is better avoided. Atropine may, however, be safely combined with several of the before-mentioned drugs as in the following recipe for a child of 12 months of age: R . Liquor. Atropinx Sulbh.
Sodii Bromidi 3iss. Chloral Hydratis ass. Ileroini Hydroch. gr. Syrupi et Aqu(e ad iv. Miscc.
Fiat mist. Cpl. 3j. quater in die.
Antipyrine is a less dangerous drug than atropine, chloral or and it often proves useful in diminishing the number and the severity of the paroxysms, but falls far short in the efficacy reported when first introduced as a specific for whooping-cough. A child under i year may get gr. every 3 hours, and it may be combined with bromides. Eulatin, which is a benzoin-antipyrine compound, has been recently extolled; it may be given in doses of to + gr. 4 times daily to a x-year-old child, and possesses marked influence in diminishing the tendency to vomit. Phena cetin and Antifebrin possess no advantages over antipyrine. Antipyrine may be given in the following combination to a child of 2 years of age: Phenazoni 3j.
Ammonii Bromidi 3j.
Sodii Bromidi 3j.
Syrupi Chloral 3vj.
Aquce Chloroformi ad ;31v. Misce.
Fiat mist. C pt. cock. min. lertils horis.
Conium is now seldom employed, being the least reliable of the remedies already mentioned, and being useless in all cases, unless, like belladonna, it be given in doses capable of producing its physiological effects.