Dr. Bernoville after having studied in his previous lectures the important remedies of temperament that should be considered in the treatment of cough, proposes now to describe the symptomatic remedies of cough that he classifies into two groups: remedies of dry cough and the remedies of moist cough. The medicines of dry cough are generally the remedies of derivation and reequilibrium. They have a calming action and have generally an action of polarity, acting for example on the one hand on the respiratory system and, on the urinary system or on the skin and digestive apparatus. The medicines of humid cough act in a centrifugal or centripetal sense or as a check to expectoration. The same remedy acts in one sense or the other according to the dose. To-day Dr. Bernoville speaks about the remedies of dry cough.
Symptomatic remedies of dry cough
These remedies are useful in the syndrome of the acute stage and in some cases in the chronic stage, for example in the case of laryngitis. But I must say that our classification is very schematic and that some medicines may according to the case be applied in a dry or in a most cough. I insist especially on the local and multiple elective actions of these remedies on the polarity, so as to be able to use them by understanding their action.
Let us consider at first a first group of remedies: remedies of dry cough of the first stage of an acute affection.
1. Remedies of dry cough in the first stage of an acute disease.
They are Aconite, Belladonna, Bryonia, Ferrum Phos, Chamomilla, Veratrum viride, Hepar sulphur, five from vegetable kingdom and two from mineral origin. These remedies oppose Mercurius, Ipeca, Antim crudum, the Kalis, Hydrastis and Pulsatilla, remedies of coction of acute bronchitis or of an acute coryza which we will study later on.
Bryonia is the limit between these two groups of remedies.
Aconite is the remedy of brutal affection in acute stage having a sudden start after taking generally dry cold; the subject is agitated, anxious and has fear of death. The indications of Aconite appear just at the beginning of a respiratory affection: ordinary cold, acute laryngitis, bronchitis, pneumonia. They also appear in certain chronic stages of congestion. Asthma in hypersensitive persons with hypertrophy of the heart and mediastinitis. Aconite acts essentially in all acute or chronic manifestations beginning violently affecting the circulatory system. Aconite is first of all a Remedy of Circulation. It is, we know, acute of Sulphur. If it acts on cough, it is by decongestioning the arterioles (sub-mucous) of the whole respiratory tree and specially of the larynx.
Belladonna-It very often follows Aconite when begins sweat (skin dry in Aconite). Belladonna is either broken down and delirious but there is no anxiety. The remedy acts also on the circulatory system causing the vascular erythism to diminish, though it is less marked than Aconite, but it is before all an antispasmodic. The patient coughs because he has the sensation of tickling by a feather in the larynx. The throat is red. Belladonna is much more interesting than Aconite in pharyngeal cough or bronchial cough (sensation of dry heat in the throat)
Bryonia-It comes after the two preceding remedies. The cough is dry or with very little expectoration but the stage of coction and of catarrh is very near. Bryonia has no special action like Belladonna and Aconite on the circulatory system. Its sphere is much more vast. It acts on the whole economy but specially on the mucous membranes and serouses and on the liver. Let us not forget its action on the pleura, in dry pleuritis, sero-fibrinous pleurisy before the stage of effusion (Apis, Cantharis), on the peritoneum, in chronic tubercular peritonitis (with Silicea, Senecio and Magnesia phosphorica); on the articular serouses, in acute articular rheumatism. The Indication of Bryonia is always dominated by a Fundamental in Modality, every movement causes cough. Either in acute or chronic stage. An important fact is that Bryonia has important polarity while Belladonna and Aconite have not. Bryonia is not only an important remedy of respiratory system but also it is an important remedy of digestive apparatus and specially of the liver. In course of an acute or chronic respiratory troubles, having dry cough aggravated by the least movement some digestive phenomena with yellowish tongue, great thirst, big liver, yellowish face etc…are seen. Bryonia seems to reenforce the defense of the organism acting on the insufficient liver.
Ferrum phosphoricum-It is to be given in the first stage of Acute affections when the organism defends less than in Aconite and Belladonna. The patient is pale, the pulse is soft and small, however it has some phenomena like those of Aconite. We know that Aconite plant contains a sufficiently strong quantity of phosphate of iron, which explains its relation with Ferrum phosphoricum. The acute congestion of Ferrum phosphoricum does not increase as that of Aconite towards a clear effusion but on the contrary proceeds towards suppuration and chronicity (As for example the asthmatic or the bronchitic who has repeated congestion of the lungs : in this case one should give Ferrum phosphoricum 30.) Another characteristic of the remedy is the tendency to hemorrhage (In the case of haemoptysis Ferrum phosphoricum comes before Aconite or Millefolium).
Chamomilla-It is often to be associated with Belladonna in the first stage of acute affection in children. It is related to Calcarea carbonica and Lycopodium as ground remedies. It is essentially a remedy of cough of dental origin. Cough coming at night but that does not wake up the child. The child is capricious very irascible wicked often suffering from worms (Cina). It has also circulatory troubles (one cheek red, the other pale) and may proceed towards Ferrum phosphoricum or Sanguinaria). Chamomilla has like Bryonia respiratory and digestive polarity: hepatic troubles are frequent, particularly diarrhoea having the characteristic of a rotten egg with spinach.
Veratrum viride is related to Ferrum phosphoricum, Aconite and Bryonia in pneumonia. It has an elective action on pneumococcus and it is shown experimentally that it is capable to modify the opsonic index of pneumococcus.
Hepar sulphuricum- A very important remedy at the sametime of acute and chronic stages and is not only a remedy of ground but also a functional remedy. One should know how to use this remedy because its action is variable according to the dose and the stage of the disease. It acts on all the stages of the respiratory tree: Cavum, larynx and trachea, pharynx, lungs and pleura. It is a remedy of suppurative tendency and of suppuration. We know its essential symptoms: extreme frilosity, sensitiveness to the least current of air which causes him to cough, he is a irascible having morbid compulsions. Hepar sulphuricum is important for its mental symptoms when there is balancing of morbid conditions, specially balancing of the mental and physical conditions. Hepar is interesting in the phlegmons of tonsils where given earlier after Pyrogenium in the 30 it may abort the development of the abscess. It acts better in rhinitis, acute and chronic pharyngitis when the discharge is purulent, yellowish, having the smell of old cheese: this last characteristic is fundamental of Hepar sulphuricum. It is also a remedy of laryngitis aggravated by cold air, also of croup where it is a triade with Aconite and Spongia (in Hepar sulphuricum the croup comes after midnight, in Aconite at midnight or a bit earlier). It should also be tried in hepatisation of pneumonia, in the abscess of the lungs, in purulent pleurisy and even in gangrene of the lungs where it yields its place to Balsamum peruvinum, Phellandrinum, Kreosotum, and to isopathy of the expectoration. Dr. Bernoville cities here a case treated in collaboration with Dr. Lancelot. A child suffering from abscess of the lung: Hepar sulphuricum 30 aborted the case. The fever feel rapidly and radiographic signs soon ameliorated. It is besides a very exceptional case. Finally Hepar sulphuricum is often indicated at the moment when dry cough changes into moist cough and specially when a moist cough becomes dry. Similarly when a nasal flow which seemed to develop, suddenly stops. Hepar sulphuricum may reestablish the flow or may save the patient from a sinusitis. After Hepar one should pass to Kali bichromicum, Hydrastis or Pulsatilla.
Thus Hepar is the frontier between remedies of dry and moist cough.
Now we will study another group of remedies related to the preceding: Remedies of Pharyngo-laryngo-trachitis
2. Remedies of Pharyngitis, laryngitis and trachitis
The first important group is Sambucus, Rumex, Spongia, Drosera and Hyoscyamus. The group of second importance is Chlorum, Bromium, and Ammonium bromatum.
Sambucus, Rumex, Spongia, Drosera and Hyoscyamus are the five remedies of trachitis specially of acute stages. They are often indicated in influenza. Really speaking Hepar sulphur and Aconite may be placed in the second group, though laryngitis in them is of less important.
Sambucus-The patient has coryza or rhino-pharyngitis. The mucous of the nose descends to the throat either during sleep or when the patient is awake. The mucous arriving at the glottis causes cough. In children the phenomenon causes a strident cough which is admirably cured by Belladonna 6 and Sambucus 6, used alternately. Sambucus is more useful to children than to adults.
Rumex crispus-A capital remedy of tracheitis and is related to Hepar sulphur. The patient coughs after having inspirated suddenly cold air. He coughs more in the open air than within the house. His trachea is so much sensitive that the very touch near the sternal fork with the finger immediately causes cough. An interesting fact : Like Bryonia, Rumex has digestive and respiratory polarity. The patient of Rumex may have a digestive syndrome with diarrhoea of yellowish stool, coming suddenly towards 5 to 7 a.m. which forces the patient to rise up (Sulphur and Tuberculinum). Let us finally insist on the deep tuberculous condition of the patient who has often the need of Rumex.
Spongia-It is indicated in laryngitis without nasal voice. The cough is dry, incessant, fatiguing and is aggravated towards midnight like that of Aconite. Spongia is also a remedy of recurring cough with Naja in aortitis or mediastinitis.
Hyoscyamus-Dry cough, while lying down, caused by a sensation as if the uvula is tickling the posterior part of the pharynx.
In all stubborn coughs, of influenza of others many remedies may be applied alternately. As for example: Sambucus, Rumex, and Spongia and often one dose of Drosera 200 is indispensable.
Drosera is the most important remedy of this group. At first experimented by Hahnemann, later on studied by curie who experimented Drosera on cat and showed precisely its indications on man. Dr. Leon Renard who was the doctor in the Homoeopathic hospital of London told us about Drosera when he came back in France. In France we usually give Drosera in whooping cough, in the 3rd and the 6th potencies. But in certain cases it is better to use it in the 200th rarely and even not repeated. In this dilution it has an action in all laryngial cough. We know also that Drosera is a remedy of extra-pulmonary tuberculosis. In tuberculosis of lungs it has almost the same counter indications as that of Phosphorous with which it is a vegetable homogeneous. When there is a laryngial cough which does not yield to any medicine even to Sulphur one should think of Drosera 200 which in certain cases gives really extraordinary result. A few words about the three remedies of the second group: Chlorum, Bromium and Ammon bromatum. These are rather remedies of chronic cases. Bromium and Chlorum are really remedies of Asthma. Chlorum is less used but Bromium is important. Bromium-An important remedy of subjects having fair skin, round type, whose asthmatic fits remain better on the sea-side.
Ammonium bromatum-An important remedy having the characteristic weakness, spasmodic cough at night with oppression. It is the only remedy of the Ammonium group which is indicated by dry cough. The other Ammoniums on the contrary have abundant expectoration.