LOCAL TREATMENT.-A very abundant and foetid false membrane is liable to reinfect the system secondarily, and hence such solvents and deodorizes as Ac-Mur., K-Permang., Glycerine, Ac- Acetic and especially dilute Carbolic Acid, are of the greatest value.
Tracheotomy has sometimes to be performed, when the larynx is obstructed with the development of membrane. Any laryngeal case needs most careful watching for obstruction, and the moment that the recession of the inter-costal spaces on inspiration becomes at all marked, this is an indication of real laryngeal obstruction and the operation should not be delayed. Tracheotomy should never be put off till the patient is in extremis.
WARM VAPOUR.- The temperature of the room should be maintained at 68 degree F. It is often recommended to use a steam kettle to keep the air moist near the patient. This is seldom desirable, and should only be done at the direction of the physician in charge.
WARM BATHS.-These are valuable accessories. The skin is hot and dry, the urine is often suppressed, the bowels confined, and thus the poison is retained in the system. Warm baths, and the free use of cold water as a beverage, often restore the functions of the skin, the bowels and the bladder.
ICE.-If vomiting occur, constantly sucking small pieces of ice tends to allay it; it also affords comfort to the patient by checking the secretion of mucus, and, as a diluent, favours the action of the kidneys.
DIET, ETC.-From the very commencement of the disease the strength of the patient must be well sustained by nourishment, and he must be urged to swallow it in spite of the pain which it occasions. Eggs beaten up in milk, or in brandy with water and sugar; beef-tea, slightly thickened with rice or pearl-barley; arrowroot or sago, with port or sherry. Sudden extreme prostration requires wine or brandy.
Children who persistently refuse to swallow must have nutritive injections in bad cases. Dr. Kidd recommends the yolk of an egg beaten up with a tablespoonful of new milk, and two teaspoonfuls of fresh essence of rennet, or an ounce of extract of beef with a scruple of pepsine. Injections (about one ounce at a time) should be commenced, if necessary, immediately the true character of the disease is recognized, and repeated every two to four hours.
CONVALESCENCE.-Much caution and patience are required during convalescence, as relapses are prone to occur. Especially the danger of sudden heart failure must be remembered, and sudden movements prohibited, while a most careful watch is kept on the cardiac condition. Nourishing diet, rest, and change of air are of great utility. Nothing does so much good as a through change of air.
PREVENTIVE MEASURES.-The cesspools should be emptied, and if too small or defective, new ones built. The house, water-closets, and local drainage should be thoroughly examined, and imperfections scrupulously rectified; for the popular association of diphtheria with detective drainage is so far correct that any sewer gas poisoning is apt to cause pharyngitis that may render the throat an easier breeding ground for the bacillus. All dustholes and accumulations of refuse should be cleared away; while a plentiful supply of water should be kept in the house, and every room regularly well cleaned, whitewashed and thoroughly ventilated.
46. Whooping-Cough (Pertussis).
DEFINITION.-A paroxysmal cough of an epidemic and contagious nature, consisting of a series of short, spasmodic, forcible expirations, followed by deep, prolonged inspirations, attended with a peculiar sonorous sound called the hoop, whoop, or kink, the paroxysms terminating in expectoration or vomiting.
It is principally a disease of infancy and childhood, and in delicate constitutions is a distressing malady. One attack generally insures immunity for the rest of life.
SYMPTOMS.-Whooping-cough is generally preceded by a common cold, cough, feverishness, etc. After from seven to ten days of the catarrhal stage, the cough becomes louder, more prolonged, and assumes the characteristic convulsive character. Each paroxysm consists in a number of sudden, violent, and short expiratory efforts or coughs, which expel so large an amount of air from the lungs that the patient appears on the point of suffocation; these forcible efforts are followed by a deep-drawn inspiration, in which a rush of air through the partially-closed glottis gives rise to the distinctive crowing or whooping noise. This whooping is the signal of the patient’s safety, for when suffocation does take place, it is before the crowing inspiration has been made. During the paroxysms the face becomes deeply red or black, and swells; the eyes protrude, and are suffered with tears; and the expression and appearance of the sufferer are such as as apparently indicate imminent suffocation. The paroxysm terminates by the expectoration or vomiting of a considerable quantity of glairy, ropy mucus, almost immediately after which the child returns to his amusements, and appears quite well. The ropy kind of expectoration which follows the cough enables us to distinguish it from common cough even before the whoop has been heard. The attacks recur three or four times a day, or every three or four hours, or oftener; sometimes blood escapes from the nose, mouth, and even from the ears, during the fits.
DIAGNOSIS.-It should be distinguished from Laryngismus Stridulus or Spasmodic Croup. In Whooping-cough the whoop follows the cough; in Spasmodic Croup it precedes it, when present; but cough is not an essential symptom of Laryngismus Stridulus.
CAUSE.- A specific bacillus transmitted by the air and by fomites, ( Whooping-cough was some years ago introduced into St. Helena, where it proved very fatal; the captain of a ship, having some children labouring under the disease on board, allowed their dirty linen to be sent on shore to be wasted, and so introduced the disease among the inhabitants (Aitken)) and spreading by infection. As an infectious disease it is most dangerous to the unaffected when at the height of its development. A frequent source of infection occurs when there has been partial recovery followed by mild relapse, and the disorder is transmitted to others to be developed in its worst form.
COMPLICATIONS.- Whooping-cough may be complicated with Small- pox, Measles, Bronchitis, Pneumonia, Pericarditis, etc. It is therefore desirable that the chest should be examined regularly during the disease by percussion and auscultation, especially in obstinate cases, so that any complications may be early met. Convulsions are liable to occur if teething be in progress at the time. If there exist a predisposition to Tubercle, Whooping-cough may hasten its development.
TREATMENT.- The ordinary course of Whooping-cough six weeks to three months, or much longer may be greatly abridged, and its intensity moderated, by homoeopathic remedies. As it begins with a common cold, medicines for its early treatment may be found in the Section on Cold in the Head, and Cough.
EPITOME OF TREATMENT-
1. Premonitory febrile symptoms-Aconite, Belladonna, K-Hydriod., Ac- Carbol.
2. Developed Whooping-cough- Arnica, Drosera, Coral-Rub., Ammon- Bromium, Cocc-Cactus grandiflorus, Cuprum
3. With gastric symptoms-Ipecac., Pulsatilla, Ant-T., K-Bich.
4. With convulsions-Cuprum, Belladonna, Opi., Ac-Hydrocy.
5. With lung complications-Aconite, Phosphorus, Bryonia, Ant-T., Laurocer.
SPECIAL INDICATIONS- Aconitum-Dry, hard, or wheezing cough, with burning pains or tickling in the windpipe, most severe at night, dry heat of the skin, scanty, high-coloured urine, general febrile symptoms.
Arnica- The child cries before the cough comes on; also during the cough. Streaks of blood in sputum. Rupture of blood-vessels in conjunctival membrane of the eye.
Belladonna- Sudden, violent cough, worse at night, with sore throat, determination to the head, effusion of blood in and around the eyes, Epistaxis, etc. In the usual course of Whooping- cough it may follow Aconitum.
Drosera- Whooping state, with frequent and excessively severe paroxysms of hoarse, loud cough, sometimes with haemorrhage from the mouth and nose; there may be no fever, or it may be intense, with perspiration, vomiting of food, water or slimy mucus. Drosera is generally efficient in epidemic Whooping-cough, except in delicate children, who require careful treatment. A dose after every fit of coughing till improvement takes place.
Ipecacuanha- Vomiting of mucus or food and other gastric symptoms; sneezing; watery or bloody discharges from the eyes and nose; violent cough which threatens suffocation.
Veratrum- The mucus rattle begins low down in the chest, with tickling irritation, constriction of the larynx, fever thirst, extreme weakness, cold perspiration, bluish face, protruding eyes, anxious expression, involuntary escape of urine or faeces during the height of the cough, and vomiting of large quantities of mucus at the end of the paroxysm.
Cuprum- Violent forms of Whooping-cough, causing Convulsions; the body becomes rigid, the cough suffocating, and the breath nearly suspended during the paroxysms, which occur frequently, and are followed by Vomiting, great prostration, and slow restoration.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."