External applications have not been neglected in the treatment of -whooping-cough. Many patent remedies, such as Roche's embrocation, -which is composed of the oils of cloves and amber with double their quan tity of olive-oil, belong to this class. Stimulating liniments are often useful if the catarrh of the chest is severe, and if applied along the sides of the neck, and to the spine as well as to the chest, may help to reduce the spasm. Mustard poultices to the back are favourite remedies with some practi tioners, and it is said that if applied along the whole length of the spine for six or eight minutes every night before the child is put to bed a speedy im provement is noticed in the symptoms.
When complications arise in the course of whooping-cough, special measures must be adopted for their relief. If the vomiting of food become excessive, so as to interfere seriously with the child's nutrition, it may be often relieved by emetics of sulphate of copper (half a grain to the tea spoonful) given every day or on alternate days, so as to clear away tena cious mucus from the stomach. Chloral is useful in these cases by its power of diminishing reflex action. Excessive vomiting is usually found in cases where the laryngeal spasm is extreme, and the remedies which are useful in alleviating this symptom have also a beneficial action in checking too forcible contraction of the diaphragm. Looseness of the bowels is usually easily controlled by a dose of castor-oil. In this coun try dial-I-lima seldom becomes troublesome, but in warm climates during the hot season choleraic diarrhoea may supervene. This must be treated according to the rules laid down for the management of that serious con dition.
If laryngismus stridulus complicate the paroxysm, bromide of am monium or potassium (gr. iij.) may be given with atropia two or three times a day ; and the same treatment is useful if unwonted nervous excite ment, or signs of cerebral disturbance, indicate the imminence of a convul sive fit. If the spasm be prolonged and seem to threaten suffocation, slip ping the child's hands into cold water will often relax the glottis at once.
Convulsions must be treated according to the special condition from which they appear to have arisen. In the more serious form of eclamptic attack, such as that induced by collapse of lung, catarrhal pneumonia, or thrombosis of intracranial sinuses and veins, the treatment must be directed against the complication by which the nervous seizure has been excited.
Convulsions set up by pure nervous agitation, or by partial asphyxia from violence of laryngeal spasm, are usually to be controlled by the administra tion of chloral in the quantities already indicated. If the seizures occur in a rickety child, and appear to be the consequence of digestive disturbance and acidity (a not uncommon case), a dose of ipecacuanha wine, followed by an antacid and aromatic mixture, will usually put an end to them at once.
If the pulmonary catarrh become severe and threaten collapse of the lung, prompt steps must be taken to ward off this dangerous complication. Stimulating applications should be applied to the chest and back ; occa sional emetics should be given to aid in the expulsion of mucus ; and the child's strength must be supported by a suitable supply of alcoholic stim ulant. In these cases alcohol should be given boldly. A young child in a weakly state from mute disease will respond well to such treatment, and a few timely doses of brandy-and-egg, or other powerful stimulant, will quickly give him renewed strength to struggle against his disease. It may be necessary to give a teaspoonful every hour, or even half hour, until the difficulty is overcome. • If catarrhal pneumonia supervene, the complication must be treated upon the principles laid down in the chapter relating to that subject.
When the disease is at an end, change of air to a dry, bracing spot or to the sea-side is of importance. Remembering the frequency of glandular enlargements and the danger of tuberculosis, we should recommend such measures as are required for restoring impaired nutrition and replacing lost strength. Cod-liver oil is very valuable, alcohol is of service, and iron is usually indicated.
The symptoms described as "mucous disease," which are often seen in children of three or four years of age or upwards after an attack of whoop ing-cough, are quickly removed by careful regulation of the diet. The child should be fed upon meat, eggs, fish, poultry, and milk ; and potatoes, farinaceous puddings, fruit, cakes, sweets—all articles, in fact, capable of affording material for fermentation must be strictly forbidden. A mild aperient, such as the compound liquorice powder, should be given twice a week to ensure the expulsion of excess of mucus from the bowels ; and iron with alkalies, or iron wine with compound decoction of aloes Oa 3 ij. for a child of five years of age), should be given two or three times a day, two hours after meals.