At the end of the spasmodic stage and during the period of decline alum is very beneficial. This remedy, first recommended by Dr. Golding Bird in 1845, has a marked influence in checking too copious secretion and bringing the disease to a favourable termination. Two or three grains of alum may be substituted for the sulphate of zinc in the atropia mixture, and given three times in the day. It is at this time, viz., the end of the spasmodic stage and during the period of decline, that I have found the quinine treatment especially useful. I have little experience of the drug at the beginning of an attack. According to Binz, Jansen, and others, who, following the suggestion of Letzerich, direct their attacks against the organism which has been supposed to cause whooping-cough, quinine given at the beginning of the illness suppresses altogether the spasmodic element, and converts the disease into a severe but manageable bron chitis. They recommend the comparatively tasteless tannate of quinine, given twice a day in doses of a grain and a half for every year of the child's life.
There is no doubt that to be efficient in pertussis quinine should be given in full doses. I have given three times a day two grains of the sulphate of quinine to children between twelve months and two years old towards the end of the spasmodic stage, and have thought that the disease was cut short by this means. Another combination which acts sometimes at this period of the illness with wonderful promptitude is formed by adding two drops of the tincture of cantharides to five drops each of the tincture of cinchona and paregoric, and giving this dose three times a day. Tonics generally are useful during the stage of decline. The preparations of iron are especially valuable. Thirty drops each of the compound decoction of aloes and iron wine make a good combination ; iodide of iron is of service, and the citrate of iron with an alkali may be resorted to. It is a matter of great practical importance in all these cases to avoid the use of syrups in sweetening the mixture for the infant's palate. Glycerine, being non fermentable, is far safer ; or we may use a few drops of chloric ether for this purpose.
Many other drugs are used in the treatment of whooping-cough. The old treatment by dilute hydrocyanic acid and that by dilute nitric acid, each of which has had its day, has now, probably, fallen into complete dis use. Opium, however, in some form has not been completely superseded by belladonna. The preparations of morphia are still relied upon by some practitioners, and the remedy is no doubt a useful one. It should be
given in sufficient doses to produce slight drowsiness, and this effect should be maintained for several days. For a child of twelve months a drop of the morphia solution (P. B.) can be given every four hours. There is no doubt that the spasm can be reduced by this means ; but the treat ment is, in my opinion, inferior to that by atropine, and necessitates very careful watching of the patient lest the narcotic effect of the remedy be carried further than is desired. Chloral may be also employed to reduce spasm in doses of gr. ij. every four,or six hours. It is sometimes used in combination with bromide of potassium, and the effect of both drugs ap pears to be heightened by the association. Croton chloral is a remedy greatly relied upon by some practitioners. The close is one grain for a child of twelve months, given every four, six, or eight hours in water sweetened with glycerine.
Besides the above methods of treatment the topical action of drugs is largely used in the management of whooping-cough. It is now nearly thirty years since Dr. Eben Watson advocated swabbing the larynx with a solution of nitrate of silver, twenty grains to the ounce. The application was repeated every second day, and the spasm is said to have subsided at the end of the week. This heroic remedy is not now in Instead, milder applications sprayed into the throat are made use of. A two per cent. solution of salicylic acid used regularly in this manner is said to diminish rapidly the number of paroxysms. Dr. R. J. Lee is a warm advocate of carbolic acid inhalations, and claims for them that they induce a daily decrease in the violence of the cough, and promote the disappearance of the symptoms within a period varying from a fortnight to three weeks. Dr. Lee prefers long-continued inhalations of a diluted vapour, and recommends that the air of the room should be kept saturated with a weak solution of carbolic acid. As this acid does not evaporate when exposed to the air, special means have to be used for con verting it into vapour. Dr. Lee's " steam draft inhaler," which moistens the air as well as medicates it, is a useful and simple apparatus. A solu tion of one part of the acid to thirty of water is to be used for vaporisa tion, and by this means the child may pass a large part of his time in air kept saturated with a dilute medicated vapour. If carbolic acid be in haled in the ordinary way from a mouth-piece, the solution should not be stronger than one part in eighty parts of water.