488 MATERIA MEDIC A AND THERAPEUTICS. 



adopting the sitting posture) , and the arms must be capable of 

 being fixed, if necessary. The circulation also must be spared 

 by absolute rest and other measures. 



Medicinal treatment must then be ordered, the first end to 

 be secured being the rapid clearance of the respiratory passages 

 of the products of disease. This is done by stimulating the 

 natural provisions for relief, namely cough and expectoration, 

 by means of expectorants. The cough must not only be 

 induced or strengthened, but accompanied by a more profuse 

 flow of watery mucus, so as to facilitate discharge of the sputa. 

 Fortunately, most expectorants produce the second effect as 

 well as the first ; and we are left free to select our remedy, 

 more from a consideration of its concomitant effect upon the 

 circulation, i.e. according as a sedative or a stimulant effect is 

 desired. Cardio-vascular sedatives, such as Antimony, Ipecacu- 

 anha, Iodides, and Alkalies, or a combination of these, will be 

 preferred as expectorants in the first stage of inflammatory 

 obstruction of the passages (acute bronchitis), salines being 

 specially valuable as liquefying the mucus ; whilst stimulants, 

 such as Ammonia, Scilla, and the large Aromatic group, will be 

 indicated at a later stage when the heart threatens to fail, or at 

 any period in weak subjects. The Aromatics, such as Camphor, 

 the Balsams of Benzoin, Tolu and Peru, Ammoniacum and 

 Turpentine, also act as disinfectants, if the products have be- 

 come purulent and tend to decompose. In every instance the 

 value of warm liquid food must be taken advantage of. 



Emetics may be employed to empty the respiratory passages 

 when blocked by a comparatively large and solid mass, such as 

 a croupous membrane ; to empty dilated bronchial tubes when 

 these and the lung-tissue have lost their elasticity from age 

 and debility ; and occasionally, when the necessary cough can no 

 longer be induced on account of extreme weakness, and asphyxia 

 is threatening. In the last-named case much danger attends 

 such a depressing method of treatment ; and in every instance 

 comparatively mild and yet certain emetics must be selected 

 for respiratory purposes, such as Ipecacuanha and Carbonate of 

 Ammonia, or Sulphate of Zinc if these fail. 



Posture is frequently of value in emptying the bronchi, or 

 cavities communicating with them, of pus and other products. 

 The body may sometimes be even inverted with success. 



If asphyxia occur, artificial respiration must be carried out. 



Dyspnoaa may also be relieved by the abstraction of blood, 

 or by its diversion from the thorax into the abdominal vessels, 

 where its volume can be reduced by a free purge. This 

 sometimes affords great relief at the commencement of 

 acute bronchitis. Diaphoretics and diuretics are valuable 



