The respiration becomes short and difficult, in paroxysms; with loud and wheezing, hissing and sawing inspirations. As the disease advances the paroxysms become more severe, the dyspnoea more terrible; the little patient raise themselves up, want to leave their beds, grasp at the larynx; in order to remove the obstacle from the throat, they put out their tongues, throw their tongues, throw their heads back and breathe in this way with the windpipe pushed forward; there is an evident endeavor to elongate the neck, and to stretch it upwards and backwards. According to Heim, this is a sign of membranous exudation having taken place”. Hartmann. After these violent paroxysms of orthopnoea, the sufferers fall back exhausted and sometimes sleep.
The later stages of the disease are marked by the blue or livid color of the skin, the result of deficient oxygenation of the blood; swelling of the face and neck, from obstructed circulation; and drowsiness, &c. The fever, which from the first is strongly marked, becomes still more intense as the disease advances; there is great thirst, and little or no difficulty of swallowing; while the pulse becomes irregular and rapid in the paroxysms; and more and more faint with the rapidly increasing debility.
There are numerous other symptoms either common to croup, or peculiar to individual cases, which it is impossible and indeed unnecessary to enumerate here or among the indications for the various remedies. But the most remarkable and characteristic have been mentioned, in either case; so that the practitioner, however inexperienced, need be at no loss to know on the one hand what he has to content with or to determine the appropriate remedy, on the other. It should be remembered, that croup is one of the few diseases in which it may be necessary to awaken the patient in order to give the medicine regularly. For if allowed to sleep too long at a time, the disease makes very great progress. This is however principally to be observed by those who use the lower Homoeopathic preparations. In badly-treated cases there may be noticed sometimes a strong disposition to the development of bronchitis or even of pneumonia, as the successor of croup; but this will very seldom occur under the Homoeopathic regime.
Aconite. This remedy should always be given at the first; it will often prove to be the only one needed, if given right; unless some other remedy is strongly, in fact I might say, perfectly indicated. Aconite will be especially called for, if there is a high fever, skin dry, much restlessness and distress. Cough and loud breathing during expiration, but not during inspiration. Every expiration ends with a hoarse cough. Dr. W.E. Payne, U. S. Journal of Homoeopathy, Vol. II., p. 521.
Belladonna. If the cough is hoarse, causing the face to flush, and the eyes to become red.
Bromine. Spasm of the larynx; suffocative cough; hoarse, whistling, croupy sound with great effort; rattling wheezing; gasping, impeded respiration; heat of the face; formation of false membrane in the larynx and trachea; much rattling in the larynx when coughing.
Chamomilla. With this unusual remedy, I once cured a very bad case of croup, when all other medicines had failed to afford relief; and I despaired of the child’s life; from observing very strongly marked in this case that characteristic symptoms of Chamomilla, the child must be carried up and down the room for relief, I was led to give this remedy, which, must to my delight, was followed by speedy recovery.
Hepar. If there is a rattling, choking cough, becoming worse particularly in the morning part of the night.
Iodine. Always indicated when there is pain in the chest and larynx. If the child is too young to express its feelings, it will grasp these parts with the hand. The child is pale. Coldness of the face in very fleshy children. The voice has a deep, hoarse, rough, sound.
Kali bichromicum Croup with expectoration of tough, stringy mucus.
Lachesis. This remedy has cured very far advanced and apparently hopeless cases of croup, indicated particularly by very distressing aggravation after sleeping, as if the child were dying.
Phosphorus. When a hoarseness remains after croup; and when there is a tendency to relapse.
Spongia. The cough is dry and sibilant; or it sounds like a saw driven through a pine board, each cough corresponding to a thirst of the saw.
Tartar e. When there is a sound as if a large quantity of mucus were in the bronchial tubes, while none is expectorated. And there is apparent danger of suffocation.
WHOOPING COUGH– PERTUSSIS.
Whooping cough is an epidemic or contagious affection, which, at its first onset, appears as catarrhal; then becomes nervous and paroxysmal; and finally convulsive and again catarrhal. It particularly attacks little children; and seldom occurs twice in the same individual. Adults are not always except when exposed to its influence for the first time; and it constitutes one of the most dangerous forms of disease to which young infants are liable. At its first appearance, this affection is scarcely to be distinguished from a common cold; but when fully developed, it is characterized by a convulsive cough in which the attacks, occurring at longer or shorter intervals, are composed to sudden, jerking and noisy expiration, and followed by inspirations, anxious, protracted, and still more sonorous.
When left to itself and uncomplicated, whooping cough runs a regular and progressive course, occupying about six weeks in each of its successive stages of development, persistence and decline. But the disorder, in each case, proves more or less severe in intensity and various in manifestation, according to the nature of the individual constitution in which it is implanted; in some instances it takes no very severe hold upon the system, in others it seems to develop organic, pulmonary, or bronchial disease. In others again it more powerfully affects the cerebro-spinal system, and terminates in convulsions, which, arising in consequence of nervous exhaustion, soon destroy what little strength remains.
Like the asthma of adults, and the laryngismus stridulus of children, whooping cough appears to be, primarily, a nervous affection, which consists in an irritation of certain of those motor filaments of the pneumogastric which supply the organs of voice and respiration. And the profuse, catarrhal secretion, which appears in its more advanced stage, forms a similar crisis in this disorder and in asthma. That this affection is an irritation of the motor filaments, corresponding to neuralgia of the sensitive filaments, and not an actual inflammation of the nerve, may be seen from the severe functional disorders of the parts supplied by this nerve, on the one hand; and, on the other, from the almost constant absence of organic lesion, as proved by numerous post-mortem examinations. And, as will appear in the following description of the phenomena of whooping cough, the nervous affection may at the same time produce, by spasmodic contraction, a temporary occlusion of the smaller bronchial ramifications; Lank, Diseases of the Chest, p. 101, and a still more severe contraction of the rima glottidis.
In spasmodic cough, spasm of the glottis forms a constituent art of the affection. At the onset of the attack,”there is a feeling of contraction and oppression of the chest, during which the patient generally seizes hold of some firm object; at times there is nausea, and then attacks of cough supervene, the expiration occurring in jerks, and in a more or less rapid succession, introduced or interrupted by a sudden inspiration with a lengthened sound. The respiratory muscles act tumultuously, the abdominal muscles are drawn in rigid, the trunk is bent of forward. At times there are convulsive movements of the extremities and starting of the whole body. Suffocating attacks are more violent and threatening the less the patient exhales. The impeded transmission of the air shows itself in the absence of the vesicular murmur, as well as in the phenomena attending a disturbed state of the circulation viz., lividity of the tumid face, congestion of the eyes, and ecchymosis between the conjunctiva and the sclerotic, hemorrhage from the nose, the cavity of the mouth and the bronchia. The cough is dry, and a little viscid mucus in expectorated with difficulty. After a duration of from two to five minutes, the paroxysm, which often consists of two fits, divided by an interval ceases; it generally torments with vomiting of bronchial mucus and of the contents of the stomach, and at times with syncopic exhaustion. After this comes a period of great repose. Romberg.
As the disease advance, the paroxysms become more protracted, severe and exhausting; the infant becomes black in the face; and seems to lose its breath entirely. And the characteristic whooping sound with which the attack commences, which appears so frightful to strangers, seems to call the attention of the mother or nurse, if the child is for the moment out of her arms. In the decline of the disease, the symptoms may become less violently spasmodic, and more prominently catarrhal, the catarrh becoming in some cases so profuse as to threaten suffocation. In other cases, from hereditary disposition to such disease, the whooping cough seems to become complicated with, or to run into pneumonia. In these cases, instead of intervals of perfect rest and natural respiration between the paroxysms, we find a permanent acceleration of breathing, shortness of breath and dyspnoea, the characteristic symptoms presented by auscultation or percussion; a livid hue of the lips and cheeks; incapacity for exercises or exertion; and loss of strength.
