TREATMENT OF DYSPNCEA. 489 



under similar circumstances. But instead of reducing the 

 volume of blood, or in addition to this means, we may prevent 

 its accumulation in the lungs and right side of the heart by 

 stimulant measures. Thus Carbonate of Ammonia not only 

 irritates the nerves and glands of the bronchial mucosa, liquefies 

 the secretion, and strengthens the respiratory centre, but is a 

 powerful cardio-vascular stimulant, aiding the ventricular 

 contractions, emptying the veins, and filling the arteries. 

 Other circulatory stimulants which may not possess expectorant 

 action are so far also indicated in respiratory distress, such as 

 applications of mustard to the chest- wall and warm alcoholic 

 drinks. 



In dyspnoea from consolidation of the lung in acute 

 pneumonia, i.e. from diminished respiratory area, the plan of 

 treatment must be considerably modified. Here there is 

 neither lack of air nor lack of blood ; only they cannot come 

 into mutual contact. The respiratory rate is greatly accelerated, 

 and the air thus constantly changed ; the cardiac rhythm is 

 also accelerated, and the blood thus constantly renewed. The 

 therapeutist appreciates this natural provision, and directs his 

 measures to the support of the powers thus severely taxed : to 

 maintain the strength of the respiratory muscles, and, most an- 

 xiously of all, to sustain the heart, by failure of which death is 

 most likely to occur. Whilst, therefore, the strength is spared 

 in every way, food is to be freely given with Alcohol, Scilla, 

 Ammonia, and Digitalis; the atmosphere maintained as pure 

 and fresh as possible ; and the accompanying fever, which is 

 attended by cardiac depression, steadily combated by suitable 

 non-depressing measures. 



Dyspnwa with spasm is so far to be treated on the same 

 principles as other forms of obstructive dyspnoea, but the 

 spasmodic element must be separately considered. Practically, 

 by far the most rapid and powerful antispasmodics are, as 

 we have seen, certain expectorants, including Tobacco, Ipeca- 

 cuanha, etc., which provoke greater spasm, violent cough, and 

 profuse watery secretion, thus instantly clearing the passages 

 and relaxing the mucous membrane. A milder and equally 

 rational class of antispasmodics to be employed in asthma are 

 the direct depressants of the nervo-muscular structure of the 

 bronchi, the chief of which are Belladonna, Hyoscyamus, 

 Stramonium and their Alkaloids, Tobacco, and Lobelia, whether 

 in solution or in the form of smoke. Conium is much less 

 useful. Moist warm air or steam may be of great service as 

 the only available remedy. Opium, Chloral, Cannabis Indica, 

 and other narcotics, will frequently relieve spasm, but such 

 powerful respiratory depressants are highly objectionable in 



