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.