HICCOUGH Occurring in the course of serious diseases, as renal or organic stomach affections, may prove fatal by inducing exhaustion, and it must be met promptly by agents directed against the primary cause. Thus the hiccough arising in the uraTnic state should be treated by eliminatory measures, as brisk saline purgatives, hot-air baths or hot packs and Pilo carpine hypodermically. When occurring during the progress of stomach affections the most rational treatment will be to evacuate the contents of the organ by an emetic or by a skilful lavage with the soft rubber tube.
In most instances, however, this symptom must be met by empiric methods, the remedy which acts instantaneously in one case proving valueless in the next, so that the physician is compelled to resort to one agent after another till he discovers the remedy suitable for the case under treatment.
The simplest manoeuvre is to cause the patient to hold his breath for the longest possible period, and if this fails, to close the mouth firmly and pinch the nostrils to arrest totally the respiration till some degree of cyanosis is produced. Compression of the eyeballs may stop it speedily.
Hiccough in children is often dissipated by their companions who have learned the trick for themselves by inducing a sudden degree of fright, but usually it is not desirable for the physician to resort to this as a therapeutic agent; a cold shower-bath is often efficacious in hysterical patients. Compelling the patient to raise his arms vertically above his head and keeping them there till they fall by reason of muscular exhaus tion acts in a similar manner by strong arrest of the attention, which modifies the respiratory action.
Firm and continuous pressure for a couple of minutes over the phrenic nerve in the neck, over the supra-orbital at the brow, and ice to the auditory meatus often act promptly. A large sinapism or a hot poultice to the pit of the stomach may be tried, or a Cantharides blister may be applied over the phrenic or upper cervical nerves. Often intractable cases yield to forcible continuous traction on the tongue for a couple of minutes. Sneezing induced by the insulllation of strong snuff or the inhalation of Ammonia may be tried. The continuous current applied
with one pole over the phrenie and the other on the epigastric region sometimes stops the spasmodic contraction of the diaphragm.
Internal remedies must also be employed in empiric fashion. The simplest consists in the administration of any warm carminative as Sal Volatile diluted by water, a small dose of undiluted Alcohol, Oil of Peppermint. Turpentine, Capsicum, 'Fr. Card. Co., &c. When these fail inhalation of Nitrite of Amyl or Nitroglycerin by the mouth may be tried; Chloroform Narcosis is usually very efficacious, especially in hysterical cases, and where deep anaesthesia is necessary Ether is preferable.
Cannabis Indica holds a place next to Opium amongst narcotics em ployed for the relief of the spasm. Bromides in large doses, Chloral, Hyoscine, Valerian, Camphor, Musk, Prussic Acid and Antipyrine are but a few of the host of agents recommended. A good routine in in tractable cases is a powder consisting of 4 gr. Cocaine, gr. Morphine and 5 grs. Bismuth Carbonate placed upon the tongue and washed down with a little water every two hours, a capsule of i min. Creosote being given also every z hours alternating.
A full hypodermic of Morphia seldom fails to give temporary relief, and often the spasm does not return.
A serious responsibility rests upon the physician who is called to give relief to the agonising discomfort caused by the hiccough appearing as a terminal event in advanced renal disease or gastric cancer in patients dying from the effect of the primary lesion. With the view of soothing the last hours of life the question of affording euthanasia becomes urgent, and too often the attendant feels compelled to withhold the narcotic in case the sufferer might not regain consciousness before death and his friends might consider that the injection had hastened his end. The wisest and most humane course under these circumstances is after a consultation with another physician to take the patient and his friends into his confidence, and assure them that the hypodermic injection of morphia will relieve suffering without hastening death, though the patient may pass away in his sleep.