Heroin is a valuable therapeutic agent which allays cough and eases respira tion. It reduces the number of respira tions, but increases their force and the volume of inspired air. Aside from its almost specific effect in relieving cough, which has now been fully established, heroin also exerts a distinct influence in allaying dyspncea.
As to the use of the remedy in the treatment of whooping-cough, Dr. A. Iloltkamp reports 5 cases in children 2 to 7 years of age. The drug was given guardedly in doses of to grain, usually three times daily. Un der its administration the attacks were diminished both in severity and fre quency. Floret describes 3 cases of whooping-cough in children, respectively, 3, 4, and S years old. The doses admin istered varied from to grain. It was always well tolerated, and rendered the attacks much more infrequent and less violent. There was also improve ment of the general condition of the patients.
Referring to the statement made by von Huff that the removal of the de posits of mucus on the posterior laryn geal wall aborted the attack, the action of heroin renders this removal easier by allaying spasm and causing the mucus to he more easily expectorated. Thus, in a nutshell is found explained the bene ficial action of heroin in whooping-cough. The mucus accumulates on the posterior laryngeal nerve (the nerve of cough), irritating this nerve and producing most intense cough. If these paroxysms can be aborted by the removal of the mucus from this area the patient is rendered less liable to fall a victim to the serious complications of the second stage, and from the antispasmodic and expectorant qualities of heroin are obtained the de sired results. H. F. Thompson (Phila. Med. Jour., Jan. 12, 1901).
Bromoform has been very strongly recommended by many writers. It is generally given in alcoholic solution made into an emulsion with gum arabic and syrup, but much caution must be ex ercised, as the bromoform is liable to be precipitated and thus be present in poi sonous amount in the last doses in the bottle. A better plan is to order it to be dropped on a lump of sugar and given in this way to the child. It is not suit able for young infants.
Bromoform is superior to any remedy yet proposed for whooping-cough. Fol lowing formula employed in seventy cases with good results:— Bromoform, 10 grains.
Alcohol, 1 drachm.
Syrup, V, ounce.
Aquae, 3 ounces.
Sig.: One teaspoonful every hour. Stepp (Allgemeine med. Central-Zeit., No. 62, '89).
Bromoform is one of the most valuable drugs in pertussis. As it is soluble only in alcohol and glycerin, its administra tion is sometimes a little difficult, but it can be prescribed with an emulsion of almond-oil and mucilage flavored with orange. The child may get up to 3 drops if about 6 months old; S drops when 2 years old; and when over 5 years of age from 20 to 30. First symp tom of intolerance is drowsiness. During the first stage of its administration the attacks of whooping-cough may be slightly more marked, after which they subside. Bromoform has no injurious action upon the broncho-pneumonia. Cases of whooping-cough should remain absolutely in-doors, but it is advan tageous to change the case into a differ ent room for the night. So soon as the whooping character of the cough has dis appeared, change of air is recommended, especially to the sea-side. Marfan (Jour.
de Med., Mar. 10, 'OS).
Whooping-cough treated with bromo form for the last six years with remark able benefit in some cases, while the drug did rot seem to affect others. The poisonous effect of the drug must be strenuously guarded against. The prac tice of giving it in drop form is not safe. Cohn (Then Slonats., Jan., '99).
Bromoform poisoning in a number of children in the same house, and of nearly the same age, who were being treated for whooping-cough with doses of bromoform three times a day suspended in mucilage of tragacanth. When called to two of the children about 12.30 P.m., they were found unconscious, lying side by side, with breath smelling strongly of bromoform, with faces pale, eyes closed, pupils contracted, and limbs flaccid. The respiration was feeble in the elder child (aged 4) and stertorous in the younger (aged 2); about 12.40 P.M. respiration ceased in the younger child, and artificial respiration was resorted to, and a few minutes later artificial respiration had to be resorted to for the elder. Each of the children was given about tea spoonful of brandy hypodermically, and then three injections of strychnine each at intervals of fifteen minutes; to the elder grain and to the younger grain each time. Their stomachs were washed out two or three times with hot water, followed by strong coffee, some of the latter being allowed to remain in the stomach. The younger child rallied first, and began to breath spontaneously after an hour and a half's artificial res piration. The interval was about the same in the case of the older child, but he remained drowsy and stupid for some hours. According to the nurse's account, the children had their doses about S A.M., but these were the last in the bottle. Shortly after this they were put to bed, and beimg awakened about 11 A.M. they were giddy and confused, and staggered in their gait. From this time onward the symptoms gradually developed.
The bromoform must have accumu lated at the bottom of the bottle through its not having been properly shaken up each time; but even on this hypothesis it is hard to see how the children could have had more than 3 or 4 grains each of pure bromoform in a dose of a tea spoonful. C. E. Stokes (Brit. Med. Jour., May 26, 1000).
The pneumogastric nerves are re sponsible for all the various forms of spasmodic cough, including pertussis. Counter-irritants over these nerves in the region of the neck procure signal benefit in this disease. Mustard applied along the area of the pulsating carotid artery from the angle of the lower jaw to the clavicle on both sides, three times a day, or painting the same area with tincture of iodine, twice a day, until irritation of the skin is produced, are very beneficial. In very stubborn cases hypodermic injections of silver nitrate over the vagi can be resorted to after injecting 5 minims of a 2'/,-per-cent. solution of cocaine hydrochloride. The needle is left in after injecting the co caine, the syringe washed out, and 3 to 6 minims of a 2'A-per-cent. solution of silver nitrate are then drawn in and injected. T. J. Mays (X. Y. Med. Jour., Sept. 7, 1901).