COUGH.
Cough should be treated as a symptom and not as a disease, and the cause should always he carefully sought for first. Even when chest signs and expectoration are absent the diagnosis may usually be easily made. Thus the hacking, short, dry cough of early phthisis may be traced to its cause, should there be a subfebrile temperature, marked loss in body weight, and a bad family history with unfavourable surroundings. In dry catarrh of the bronchial tubes of large size, though the writer has seer many such cases where no real or physical sign existed,, nevertheless the presence of some small quantity of tenacious or inspissated mucus or muco purulent secretion at some time or other will be found to clear up the diagnosis. The treatment in such a case must include more than men sedatives or palliatives. The dry bronchial surface must be stimulated so as to cause the pouring out of a secretion of liquid consistence, after which often the cough practically ceases, as detailed under Bronchitis.
'The routine administration of narcotics in bronchitis is to be condemned, but the physician must not err in the other extreme, especiallyas incessant, violent, or spasmodic attacks of cough without any expectoration may in time lead to serious pulmonary trouble.
When bronchial and laryngeal causes are excluded it may be found that the throat is the seat of the irritation. Acute or chronic granular condi tions of the pharyngeal mucous membrane may produce incessant cough ing. Elongated uvula, enlarged tonsils, polypi, and other growths at the back of the posterior nares may call for appropriate local treatment.
Reflex cough accompanying catarrhal sore throat is hest treated by the following spray, which may also be used as a gargle: A cidi Carbolici 5j.
Glycerini Acidi Borici Sss. *are Rowe ad 5xij. Misce.
Chlorate of Potash, Nitrate of Silver, Alum, or Tannin may be applied, or local sedatives as inhalations of Conium, Friar's Balsam, or Menthol spray may be employed. Cocaine should he avoided.
Ear cough occurs, and unless the diagnosis be correctly made there is little probability of the cough being relieved by drugs. A careful examina tion will reveal some irritation or foreign body in the meatus. In the case 01 children, peas, beads, &c., may be found; and in adults, plugs of dried wax. The wax is more likely to give rise to cough if partially loose in the passage, and sometimes the movements of the jaw in eating or speaking may so disturb the mass that cough results at these times. The removal of the foreign body by syringing is generally followed by instant relief.
The eruption of a tooth in infants is sometimes heralded by a smart spasmodic cough, which stops when the crown is through the gum, and in older patients the removal of a painful or carious stump has been some times followed by the cessation of a cough that has been a source of anxiety for a lung time before.
Liver inflammation and binary calculi have been the cause of cough, and in one case known to the writer a bilious attack, resulting from in discretion in eating, always brought on a severe, spasmodic, barking cough, relieved or removed by a smart purge.
Stomach cough has been long recognised, and yields to remedies which cause evacuation of the gastric contents, or to sedatives like Bismuth, Codeine, or hydrocyanic Acid.
Severe coughing may usher in an attack of gout, which is relieved when the paroxysm localises itself, and the presence of foreign irritants in the intestinal canal—as round-worms, fruit seeds, &c.—may cause cough in children, which yields to a smart purge.
Hysterical cough should be treated by antispasmodics like Asafetida and Valerian.
Reflex or spasmodic cough. arising from almost any cause, is always benefited by large doses of the Bromides, especially by the Bromide of Ammonium. Chloroform, in moderate doses (5 mins.). is a powerful sedative in most cases, and Chloral Hydrate, in small oft-repeated doses, will allay cough when the cause cannot be removed. Gelsemium, Grin delia, Conium, and Sanguinaria may be used, like Morphia and Codeine, to lessen the sensibility of the respiratory centre. Guaiacol in full doses 5 mins. has been much used in spasmodic cough even not depending upon pulmonary phthisis—and Hydrastis has been advocated by several. Phe nacetin and the new analgesics are valuable where morphia is contra indicated, and they can be combined with Bromides. Heroin gr.) and Dionin gr.), being less likely to dry up the expectoration, are pre ferred to morphia and opium. The painful cough of pleural inflammation may be relieved by strapping the chest and administering sedatives like the above.
The barking cough of puberty occurs in over-fed or too-often-fed children, and Sir A. Clarke insisted upon a simple but liberal dietary of three or at most four meals a day, active outdoor exercise. and early hours. Locally. he used Glycerin of Borax with Oxvchloride of Bismuth and Morphia brushed over the whole interior of the throat after each meal and at bed time. Internally, he used the Syrup of Bromide of Iron and Quinine, with small doses of Arsenic. When this failed he gave a pill containing Reduced Iron, Valerianate of Zinc, Belladonna, and Nux Vomica, pushed till the physiological effects of the Belladonna became evident.