When the attack of clyspnoea has subsided or the respiration has become easier, we probably able to examine the patient sufficient ly to form an opinion as to the cause of the distress in breathing. When the clyspncea is due to enlargement of the bronchial glands, or to any of the less common causes which have been mentioned, the general treatment to be pursued is described in other parts of this treatise.
If the case be one of bronchial asthma the child is almost invariably the subject of pulmonary emphysema, and the treatment recommended for that condition of the lung should be scrupulously carried out. All means which invigorate the general health are useful, and cod-liver •oil with iron, especially the iodide of iron, should be prescribed. Fowler's solu tion of arsenic is also often of service, especially in cases where the asth matic symptoms are associated with eczema of the scalp or other part of the body. Dr. Thorowgoocl advocates the use of a tonic during the day, and recommends a sedative at night, such as a dose of the extract of stramonium or tincture of belladonna. Thus, a child of six years old may take three or four drops of the lig. arsenicalis with ten of the tincture of perchloride of iron freely diluted after each meal, and on going to bed twenty to thirty drops of the tincture of belladonna.
The hypodermic injection of pilocarpin.e may be used in these cases, as directed by Dr. Berkart. Children bear this remedy well. For a child of five years old, gr. to gr. s may be injected under the skin when the child is put to bed. In the daytime the arsenic and iron can be continued.
When the attacks of dyspncea come on chiefly at night, the child should be forbidden to eat heartily in the latter part of the day, and should by no means be permitted to go to bed shortly after a full meal. Indeed, care should be taken at every meal that the stomach is not overloaded, and Dr. Thorowgood's caution that moderation should be exercised in the use of farinaceous and saccharine articles is especially wise in the case of a child.
The whole secret of the treatment of these cases consists in employing all available measures for improving the general strength and in guarding the patient carefully from chills. Exercise, gymnastics, and games which further the development of the muscles and promote the action of the skin are all very useful.