When the paroxysms become attended by vomiting, the critical period in the dieting arrives. The nurse should be directed to withhold food for a short time in the presence of a threatening attack of coughing, and to aim at having the child feed soon after an attack, so as to permit the food to be as long as possible in the stomach before the next turn of vomiting. By attending to this hint lives may be saved by tiding the patient over the dangerous exhaustion which follows frequent acts of emesis.
Hard, indigestible food in the stomach as nuts, green fruits, bread-crust, &c., will increase the laryngeal spasm, and portions of unchewed beef and potatoes may give serious trouble during the act of vomiting. Hence, upon the whole a liquid or semi-solid farinaceous diet is to be preferred for small children, or the ingredients should he carefully comminuted by using a mincing-machine for the meat foods.
Clothing should be warm, and so arranged as to prevent over-heating at one time and chills at another, an even temperature and the avoidance of draughts being desirable. Light flannel underclothing is essential, except in very warm summer weather. Combinations should be avoided, owing to the frequency with which the urine and sometimes the forces are voided during severe paroxysms of coughing.
During the paroxysms young children should he lifted on to the nurse's knee or lap, and every constriction about the neck or chest should be removed. Naegeli states that the paroxysms may be arrested by simply pulling the lower jaw downwards and forwards, and this is effective also during sleep. Abrams attaches a pleximeter over the lower cervical spine, and has this tapped for 5 minutes at a time thrice daily in order to arrest or diminish the paroxysms. Kilmer recommends that a laced belt with rubber gussets should be worn round the abdomen in order to compress or firmly support the viscera, and thus prevent vomiting and diminish the severity of the paroxysms of coughing. Voelcker applies a Martin's rubber bandage around the abdomen after friction of the chest walls with the view of aiding the thoracic respiration by impeding the abdominal muscles in weak rickety children liable to suffer from undue yielding of the parietes of chest and consequent pulmonary collapse.
Ice to the larynx by compresses or Leiter's tubes and blisters to the nape of the neck or along the course of the vagus have been tried; to moderate the spasmodic coughing, but they are generally useless.
The presence of adenoids should be sought for, and removal of these in the early stage of the disease should be recommended in all cases, and the necessary operation may be safely carried out even in protracted cases.
Drug Treatment.—This resolves itself into the local applications of sedative and antiseptic sprays, vapours, inhalations, gargles and swabs and the internal administration of substances which are believed to inhibit the growth or development of the specific micro-organism which causes the disease, or of agents which influence the respirators' centres and act also on the bronchial mucous membrane.
Inhalations are extensively employed, and provided that the heating appliances necessary for their production are not permitted to vitiate the atmosphere of the room, much benefit may be obtained from their use. The Phenol compounds are the most effective. Cresolin allied to crude carbolic acid, being a mixture of the three isomeric cresols, is the favourite. It is volatilised by the heat of a small lamp, the vapour being permitted to saturate the atmosphere of the sick-room, and it is less poisonous than pure Phenol and less irritating than the vapour of Creosote.
When pure Carbolic Acid is employed, however, it is best used as a hand spray r in roo dissolved in rose-water and sprayed in the immediate vicinity of the patient or at a short distance from his open mouth. Veo, in addition to the volatilisation of the acid by heat, recommends that a 5 per cent. warm spray be also diffused through the air of the room, while a r in 4o spray is played before the face and nose. Godson employs Creosote by the method of continuous inhalation, the drug being sprinkled upon cloths hung up in the sick-room, and he states that it produces an immediate effect upon the paroxysms, which are rendered less frequent. It may also be diffused by the steam of the bronchitis kettle.
Oil of Eucalyptus or Eucalyptol is a most grateful antiseptic, and the following spray may:be diffused through the room several times a day, or it may be sprinkled on cotton-wool and placed in contact with the patient's chest, or poured into boiling water for inhalation: . Olei Eucalypti 5ij, Olei Terebinthince j.