Dr.Bernoville will speak to-day on the semeiology and treatment of cough, considered from the point of view of drainage, canalisation and re-equilibrium of the subject.
We know that cough should be considered as a reflex symptom on the bulbous centre of which the starting point may lie in the attack of stratum of the respiratory tree but which involves necessarily the territory of the nerve of the upper part of the larynx. Mackenzy of England in his so interesting book “The value of the symptom Cough” shows that the cough is exclusively laryngial.
On the other hand let us recall here that in the therapeutics of the respiratory affections, very often we will effect a derivation than effecting an elimination through the mucous membranes. We should try to re-equilibriate the patient. The term drainage does not mean only to purify by the help of material elimination, but also derivation and re-equilibrium to cause and direct the metastasis. Whence it appears that one should not neglect clinic and etiology. In a case of cough we must try to know what is the cause of the cough, if it is caused really by an inflammation of the respiratory mucosa or if it is not caused by worms or in children if it is not caused by dentition, etc… We know that in some cases of tuberculous patients, who coughs incessantly and when they are not disciplined, have in reality a cough which is more psychological than pulmonary.
The important remedies of temperament in the treatment of cough
Let us make at first a review of the most important remedies of morbid temperament that are required in the treatment of cough. In the next lecture we will study the functional remedies in two groups: Remedies of Dry cough and the remedies of Moist cough, i.e, remedies of cough without expectation and remedies of cough with expectoration. Let us insist in this chapter on the importance of the remedies of temperament. These are the remedies that often help derivation and to re-equilibriate the patient. In the drainage of the respiratory system the functional remedies cause to disappear the symptoms and the ground remedies are of capital value. It results thus that in the treatment of the diseases of the respiratory system one should act much more deeply than in the case of the diseases of the other organs.
To pass in review the polychrests of cough means to take into account a great number of medicines that are of equal importance. We study these remedies of the respiratory apparatus on the one hand and their action on the other hand, on the other important apparatuses of the organism.
Carbo vegetabilis-It is, as we know, the remedy which is suitable to grave or even pre-agonic states with loss of vital heat coldness of the body which is cold to touch: knees, nose, even the tongue and breath is cold in the extreme condition. carbo vegetabilis is the “burnt” subject or who has come to the end of an acute state. The patient of Carbo veg. has a paradoxal symptom, defense-symptom against the loss of vital force. He has the need of fresh air, likes to be fanned, has burning sensation which is a contrast to his objective cold state.
Carbo vegetabilis is often indicated in grave pulmonary states with cyanosis, specially in old persons suffering from bronchitis. Old persons having cough, who die slowly of a pneumonia. Sometimes in tuberculous patient who has reached the terminal stage. In less grave state Carbo veg. is a capital remedy of aphonia, either due to laryngial catarrh or to grave lesions of the larynx. It is also a remedy of laryngitis which has resisted to all medicines when there is weakness of the voice or persistent aphonia and when the patient complains of burning in the larynx, with incessant cough with tingling of the larynx. In summary, what characterise Carbo vegetabilis from the point of view of the larynx are:
-Tendency to chronicity.
-Sensation of burning in the larynx descending towards trachea.
-Husky, subdued voice, even aphonia.
Arsenicum album may be compared with Carbo vegetabilis in grave states. Sometimes the patient is prostrated and some times he is agitated. Sometimes prostrated and agitated at the same time, in such a way that the prostration and agitation alternate rapidly. One important fact is that Arsenic acts on all parts of the respiratory tree. Besides its acts on all the organs, all the tissues and on all the glands of the organism, thus it is one of the greatest polychrests of the Materia Medica. In acute and chronic cases of respiratory diseases it is of the first importance. Diseases of the rhino-pharynx, of the lungs, of the pleura. It has an elective action on the right lung, perhaps in the middle portion of the lung (Chelidonium and Lycopodium act specially on the lower part of the right, hemithorax and Bryonia on the right apex). This question of local elective action is important to consider in the case of drainage and derivation. Arsenic is also an important remedy of the catarrh of the of the cavum: Acute of chronic coryza, burning and corrosive, affecting specially the right nostriL and ameliorated by heat.
From laryngial point of view there is the sensation of burning with amelioration by the application of heat or by hot drinks, but its action on the larynx is not of the first importance.
The time of Arsenicum is very important: Aggravation at night from midnight to 3 a.m. and specially at 1 a.m. The patient begins to feel bad at 11 p.m., his condition aggravates towards 1 o’clock. From this time he may remain in a static condition up to 3 a.m. Then his condition begins to ameliorate. Sometimes there is sudden aggravation at 1 to 2 a.m. with phase of agitation which is followed by prostration after 3 a.m. Arsenic is a curious remedy and a difficult to manipulate. It is the question of the dose and the time of application. Chavanon has rendered us a great service indicating that this remedy should be applied at 6 or 7 p.m. because by doing so one can check the midnight or after midnight aggravation of the remedy. One should avoid the application of this remedy when the patient is agitated, because it may then cause momentary aggravation.
Arsenic is used in all possible respiratory affections from simple bronchitis to asthma, emphysema and pneumonia. It has a deep action on the general condition. It is a remedy far more important to bring back equilibrium than to cause derivation.
Nitric acid. It is less important than the preceding two but it should be thought of in ulceration of the laryngial mucous membrane. The patient complains of an acute pain as if from multiple needles pierced on the diseased portion. He may have nasal voice or loss of voice. Rhagades on the lips. It is neither a remedy of parenchyma of the lungs like phosphorus, nor it is a remedy of conjunctive tissues like Silicea but it has an elective action on the larynx or on the pharynx which makes it interesting to specialists.
Iodine is more related to Arsenicum but it is less important. It is an important remedy of pneumonia and even of tuberculosis with great emaciation. The patient emaciates though he eats well. It acts on cavum and on the nasal mucosa. Iodium causes corrosive discharge like that of Arsenicum. On the larynx it causes some pains, burning sensation and a great sensation of ulcer in the chest and in the larynx. On the lungs hepatisation of pneumonia (like phosphorus). Finally, it is a remedy of conjunctive tissues like Silicea. It has elective action on the pleura like Sulphur and Arsenicum.
Sulphur iodatum is a compound of Sulphur and Iodine and the compound of Arsenicum and Iodine is Arsenicum iodatum. In these two remedies the action of Iodium dominates: These are two important remedies of pleurisy and tuberculosis of the lungs. Sulphur iodum is used as a basic remedy and Arsenicum iodium in lower or medium dilutions. Sulphur iodatum acts much better in Cortico Pleuritis in opposition to phosphorous triodatus which is indicated in central lesions.
Phosphorous forms with Sulphur and Arsenic the trio of burning sensation of Nash. In our study it is a very important remedy. It is a remedy of parenchymas and the congestive states. It acts electively on larynx, trachea and lungs. Its important laryngial symptoms are: -Cough aggravated in cold air, while speaking. Tendency to nasal voice towards the evening accompanied by a sensation of heaviness in the chest with the feeling of heat (like boiling water).
We know that phosphorous is out heroic remedy in all stages of pneumonia, of broncho-pneumonia, of acute and developed pulmonary congestion. In acute or chronic laryngitis it should be used in the 30 th (one dose without repetition). In chronic laryngitis it will yield its place to Carbo vegetabilis. Phosphorous is also a good remedy of trachitis and of cough of tracheal origin.
Here are the counter indications of Phosphorous: in pulmonary and laryngeal tuberculosis where it should be substituted by Phosphorous iodide or triodide which is without danger (Here this is somewhat domesticated by Iodum).
Causticum. It is opposite of phosphorous. It has a paretic action on larynx and on the trachea and not a congestive action like that of phosphorus. The subject of Causticum will scrape his throat and will have nasal voice and cough in the morning. Paresis aggravates during rest at night. Whereas phosphorous will have nasal voice and cough in the evening after having congested his vocal chord during the day. After drinking of small quantity of water the cough stops (which excites this laryngeal contractility). Cuprum has also similar cough ameliorated by drinking water but his cough is related to a spasm and not to paresis (two contrary states producing a common symptom). Other valuable symptoms of Causticum: Cough causes pain irradiating to the right hip.
Drosera. Another important remedy of laryngitis and trachitis. It is always indicated in marked tuberculinism. It is used either in the 6th or in 200th one dose in chronic or tubercular laryngitis. When it is used in high dilution it really acts like a tuberculin. It is for this reason it should not be repeated in these cases.
Some complementaries of Drosera: Cuprum, already studied Spongia, Rumex, Sambucus, Hyoscyamus, Belladonna which we will study in our next lecture. These remedies in association or in alternation with Drosera will soon stop the cough of rebellious tracheitis. When remedies like Bryonia, Antimonium tartaricum will fail Drosera 200 followed by Rumex 6, Sambucus 6 and Spongia 6 may rid the patient of his cough.
Sulphur. It is a centrifugal remedy, a remedy of derivation towards emonctories or towards the skin. We use Sulphur when we want to effect a derivation of the respiratory system towards the skin, specially in asthmatic patient and in persons having hay fever and thus we may transform them into patients of urticaria and eczema. Such an eruption on the skin heals the respiratory mucosa (same phenomena with Psorinum). Besides the alternating manifestations (respiratory apparatus and the skin, digestive apparatus and the skin), Sulphur has a characteristic periodicity. Sulphur, Psorinum and Arsenicum have periodicity. In Sulphur the period is long the subject is ill every month or every year). In Arsenic on the contrary the periodicity is very short (a few hours), Sulphur, Psorinum and Arsenicum are remedies of psoric constitution having periodicity as opposed to Calcarea carbonica and Graphites that have no periodicity though they are antipsorics. The prognosis of Sulphur patient is generally good. The patient has sudden disturbing symptoms. Sulphur in high dilution is risky in these case (best dilution is the 30th), but the patient bears well the aggravation.
The patient of Sulphur has cough with aggravation by heat, he is very hot, wants to open the windows, his lips are red, hacks up large quantity of mucous which relieves him of his dyspnoea Graphites is also an antipsoric remedy and specially indicated in women who have congestion of larynx during menses.
Psorinum is old Sulphur, the old asthmatic who has become lean and chilly. There exists also a young Psorinum, child or adult suffering from ganglions. Psorinum has a dry cough, specially in asthma patients with the sensation of ulceration of the larynx. Psorinum, with Lachesis is a good remedy of hay fever. As regards the frilosity, the important characteristic of the remedy the lecturer cities a very curious fact: Psorinum act favourably on the general condition of the patient but does not ameliorate his sensitiveness to cold. In order to ameliorate his sensitiveness to cold. Tuberculinum should be used or the skin should be rubbed in order that the skin functions well.
Petroleum is nearer to Psorinum and like it has aggravation in the winter. It is an important antipsoric remedy and a remedy of derivation. In the winter the patient has chapped skin, some digestive troubles, specially diarrhoea aggravated by cabbage. Petroleum is related to Nitric acid. Like the latter it is to be used in rhagades of the lips which is a precancerous stage (Condurango). Let us always remember the quarto in old persons suffering from cough: Petroleum Psorinum, Arsenicum and Carbo vegetabilis.
Lycopodium acts on all parts of the respiratory tract, on the nose, cavum, pharynx, bronchus, lungs. It acts less on larynx and Pleura. It has an elective action on the lower part of the right hemithorax.
From the point of view of the respiratory system its indications are: Pneumonia of the right base, asthma, chronic bronchitis always with hepatic insufficiency. In acute stage there is the fanning of the alae nasi specially in children.
Lycopodium should be given with precaution (30 ) in acute stages and should not be repeated. In influenza if there is dragging digestive phenomena Lycopodium 30 will act favourably.
Hepar sulphur. It is also related to Psorinum by its frilosity. The subject is very much afraid of air current. He keeps himself closed in a room but still feels the air. He coughs by the least wind or while uncovers a part of the body. It is an important remedy of larynx. Thick and short-necked child is a symptom mentioned in the Materia medica. It seems that the child’s head is placed deep between the shoulders. These children generally suffer from the spasm of the glottis and very often suffers from asthma.
Calcarea carbonica. An important remedy like Hepar, having suffocation with tendency to the spasms of the glottis. The most important symptom of this remedy is the great sensitiveness of the chest by pressure, by palpitation and by percussion. The patient is big, fat, soft, chilly, indolent and anxious. The child easily weeps. The adult is melancholic and thinks he will become mad. It is a great remineraliser.
Silicea. Another important remedy of remineralisation. From the point of view of the respiratory system it acts on the lungs and bronchus. It is a remedy of tuberculosis, of chronic bronchitis and of old persons suffering from emphysema. In pulmonary tuberculosis one should not go beyond the medium dilution. The high dilutions are dangerous in these patients. Silicea 200 or M may be given advantageously in chronic patients of emphysema before R.T (Residual tuberculine).
Thuya and Natrum sulphuricum. These two are important hydrogenoid remedies specially in patient suffering from asthma and chronic bronchitis. They do not act only on the bronchus and lungs. Thuya acts specially on the nose and cavum and larynx. It is an important remedy of papilies and polyp of nose and larynx. Thuya, Natrum sulphuricum, Lycopodium and Sulphur are all remedies of arthritic coryza and of elimination in renal or peptic subjects who make their derivation by chronic nasal discharge.
There remains four more remedies to study rapidly:
Lachesis. It is such an important polychrest that it is necessary to place it here. It has an elective action on the neck. It acts specially on pulmonary vago-sympathetic nerve and is a remedy of hyposphyxia that we have studied in our preceding lecture.
Ignatia is the remedy of nervous cough according to a vicious circle such a cough is seen in tuberculous patients or in women of 60 years old having laryngo-tracheal cough for which Sambucus, Drosera, Hyoscyamus, Cuprum, etc. fail and Ignatia M acts immediately.
Cimicifuga is related to Lachesis and Ignatia. It acts specially on the vago-sympathetic nerve. It is an important anti-spasmodic remedy. It is a good remedy of mediastinal cough with Silicea (Silicea M alternated every 10 to 15 days with Cimicifuga followed by Bryonia, Arnica 30, etc.)
Sepia is not well known, neither it is used in respiratory troubles. It is an important remedy of oxygenoid tuberculinics and tubercular patients.
In high dilutions it is a good remedy of pulmonary decongestion. The lecturer has often found that after the failure of Natrum muriaticum and Sulphur iodium, Sepia helps the patient to take up weight, causes a diminution of the fever and important ausculatory and radiographic diminution. Sepia should be thought of in vicarious hemoptysis of hypomenorrhic women who have menstruation of black blood with venous congestion not only portal but also of lungs.
Pulsatilla is related to Sepia. Pulsatilla is not a ground remedy. It is a remedy of drainage of the circulatory system and is to be given in chronic tuberculous patients suffering from respiratory troubles.