In this lecture Dr. Bernovillae describes a general classification of the remedies of cough.
Formerly we have studied some groups of remedies of the beginning of the acute respiratory diseases: Aconite, Belladonna, Ferrum phosphoricum, Bryonia, chamomilla, Veratrum viride, to this group we have added Hepar sulphur which may be a remedy of dry as well as of the most cough.
The second group is that of the remedies of trachitis: Rumex crispus, Sambucus, Drosera, Hyoscyamus and Spongia.
The third group is composed of remedies acting also on trachea and larynx: Iodium, Phosphorous, both are ground remedies studied previously; Chlorum and Bromine, Ammonium bromatum being much less important.
The fourth group is composed of Capsicum and Mentha piperata.
If we now follow our general classification we have: The fifth group: Group of fundamental remedies of larynx: laryngial cough, whooping cough, nasal voice etc…
Laryngial cough: Arnica, Selenium, Carbo vegetabilis (Possibility of nasal voice with aphonia). Dominating aphonia with very little or no cough: Populus candicans, Coca, Arum triphyllum Argentum nitricum.
-Remedies of whooping-cough or cough like whooping cough: Pertussin, Cuprum, Corallium rubrum, Mephitis, Cina.
Sixth group: Cough of cardiac origin: Spongia and Naja.
Seventh group: Pleural cough: Bryonia, Rananculus bulbosus, Asclepias tuberosa, Arsenicum iodum.
Eighth group: Spasmodic cough of Asthma or hay fever: Ipeca, Lobelia inflata, Hydrocyanic acid, Laurocerasus, Justicia Osmium, Naphthalin, Scilla.
Ninth group: Different remedies of cough not clearly defined: Ambra grisea, Lithium carbonicum, Sabal serrulata Conium.
Fourth group Capsicum is specially indicated in pharyngitis with sensation of extreme burning in the throat and irradiation to the ears. Possibility of otitis. In children, dry cough, noisy and explosive.
Mentha piperata-Less important. Cough caused by inspirating air. Feels as if he is always taking cold air. Sometimes sensations of burning in the pharynx or in the trachea (Rumex).
Fifth group (more important)
Arnica-Intense traumatic sensation in the larynx and trachea which may extend to the whole chest. In whooping cough the child is afraid before the attack.
Carbo vegetabilis-Dry cough either humid or dry in old bronchial patients. Sensation of burning in the trachea, the larynx and even in lungs.
Selenium- Dry laryngia cough with nasal voice or aphonia, great weakness, with depression not only physical, but also sexual.
Cuprum-Dry cough with intense spasm, cyanosis. Better by drinking some water (Causticum). A good remedy of Asthma.
Pertussin-It is a remedy which should be given not only in whooping cough but in all sorts of whooping cough like cough ( child suffering from tracheo-bronchitic adenopathy).
Corallium rubrum-It is related to Cuprum; red face, dry cough in all whooping cough like cough, specially at night.
Mephitis, Extremely violent cough frequent and coming at night.
Cina-Reflex cough of verminous origin. Also indicated in whooping cough, when the spasms are violent and the patient has blue circle around the mouth, at the root of the nose and on alae nasi (Ipeca). Also indicated in grave cases of broncho pneumonia when the well indicated remedies fail and helminthiasis is suspected. The cough is dry, incessant. The child is capricious and even wicked. In such a case Dr. Nebel gives Cina 200 or M.
Viola odorata-A small remedy to be given in children and in pregnant women who have dyspnoea with spasmodic cough. Helminthiasis and eczema in children, specially on the face and on the tegument.
Spongia and Naja are very important in recurrent cough, nasal voice or loss of voice. But if the trouble seems to arise from the intracardiac nervous system or from cardiac troubles Naja is better than Spongia. It is a clinical question.
Digitalis-Should be thought of when there is dry cough with weakness of myocardia.
Coccus cacti-It is indicated in humid cough of cardiac patients who cough hopelessly with ropy expectoration, albuminous and abundant, difficult to detach.
Ammoniacum-This remedy may be indicated in intense suffocation due to cardiac weakness like Ammonium carbonicum, Veratrum album and Carbo vegetabilis.
Seventh group. Bryonia is of the first importance with Rananculus bulbosus and Asclepias tuberosa. The last two remedies act rather on the left base, while Bryonia on the right base and on the right apex.
Asclepias tuberosa. The patient is tuberculinic or tuberculous.
Rananculus bulbosus. The patient is arthritic rheumatic or an alcoholic one. It is a remedy of Zona and of interstitial neuralgia. It acts on pleurodynia, on the whole thickness of the intercostal wall, from the pleura to the skin while Bryonia and Asclepias have localised action on the pleura.
Arsenicum iodatum is important: Three important indications are: 1. Dry cough of old pleuretic patients proceeding towards symphisis (Arsenicum iodium precedes Silicea).2. Tuberculinism of oxygenoid subjects. 3. Ulcero-caseous tuberculosis with cavity.
Arsenicum album. Should be placed by the side of the preceding one. It is a ground remedy already studied. It acts on the whole respiratory apparatus. It is very useful in asthma.
Eighth group. This group is dominated by the important remedy Ipeca.
Ipeca. It belongs to the group of remedies of humid cough when it is necessary, to make the patient expectorate in the second stage of bronchitis (used in lower dilutions). As a remedy of dry cough when it is the spasm that dominate (Ipeca 30 or 200 will act better in Asthma). The subject of Ipeca is often a hydrogenoid, aggravated by hot humid conditions. It has also nausea not ameliorated by vomiting.
Squilla maritima. A remedy of Broncho Pneumonia of children where the face becomes red during cough which is spasmodic. Equally a remedy of asthma of hydrogenoid patients, aggravated by cold humidity with cough accompanied by abundant expectoration, sneezing (Senega) and loss of small quantity of urine (Causticum, Pulsatilla).
Lobelia inflata. It is very much related to Ipeca. It reproduces the exact picture of vagotonia: weakness with possibility of nausea, extreme oppression, typical asthmatic fit.
Hydrocyanic acid. The case of hydrocyanic acid is much graver than that of Ipeca or Lobelia. The patient has the impression of being suffocated and to break down completely. It is the remedy of grave asthma or a certain forms of subacute oedema of lungs (In acute oedema we have Ethyl. sulph. dichlorum)
Laurocerasus. This plant contains hydrocyanic acid, and has practically a similar pathogenesis like that of Hydrocyanic acid in a less grave state.
Justicia has many indications. 1. Simple arthritic coryza with cough. 2. Asthma, hay fever. 3. dragging cough of influenza which does not yield to Rumex.
Naphthalin. Dry cough with hay asthma. Asthma of children.
Osmium. Dry, explosive, noisy cough with pain in the larynx and trachea with difficult expectoration of thick mucous.
Magnesia phosphorica. Less important here. Dry spasmodic cough, amelioration by heat.
Cuprum metallicum. Already studied. An important remedy of asthma.
Ninth group. Ambra grisea is the most important. The cough is nervous, spasmodic, aggravation in the presence of a stranger. The patient weeps hearing music (Thuja, Ignatia Cimicifuga).
Conium. Dry larynx with tickling. Dry cough, aggravated while lying down, speaking and smiling. Let us cite also: Allium cepa cough of nasal origin; Sambucus-Mucous of the nose depends to the throat which causes cough; Sticta pulmonalis-A remedy of humid cough.
II Remedies of humid cough
The classification is much simpler than that of the remedies of dry cough.
Remedies of Mineral, Animal and Vegetable kingdom.
1. Remedies of mineral origin. Is represented by the (a) Antimony group; heavy metal group, Calcium group and the Baryum group to which we may add the salts of Gold group, having relation to the Bariums
(b) Remedies of animal origin: Blatta orientalis, Coccus cacti.
(c) Vegetable group: We will deal with this group in the next lesson.
(a) The Antimonies: The Antimonium salts respond to catarrh of the mucous membrane, acute or chronic with expectoration.
The most important is: Antimonium tartaricum. An essentially centrifugal remedy of respiratory system which causes expectoration. It is a very faithful remedy acting very rapidly. It is always indicated in Acute bronchitis. In chronic bronchitis it should be used with care and generally temporarily because it eases the expectoration but does not stop it. In pulmonary tuberculosis even fibrous, it should be avoided, because it may transform fibrosis into caseosis.
The symptoms are well known: Cough with Cyanosis, oppression, somnolence and prostration. The arterial tension is low, there may be weakness of myocardia. The patient may have yawning and cough. There are humid rales in the lungs. In children Antimonium tartaricum acts very well in pneumonia or in Broncho Pneumonia. In old errona it is a remedy of old Bronchitis.
Antimonium crudum. The action on digestion is more important than its action on the respiratory system but the most important fact is that when one wants to prescribe an attenuated Antimonium from the respiratory point of view, as for example in fibrous tubercular patient who has bronchial troubles Antimonium crudum may be used in the place of Antimonium tartaricum. The subject of Antimonium crudum is aggravated by heat, specially by radiating heat of a stove or of a fire which provokes cough. The cough is similar to that of Antimonium tartaricum but accentuated with abundant expectoration. A capital symptom of Antimonium crudum is that the tongue is coated white entirely.
Antimonium sulphuricum aurum. It should be used in case of chronic bronchitis accompanied by nasopharyngeal catarrh or when the bronchitis is localised in the lower part of the left lung (laterality of the radical sulphur). Often abundant expectoration, greenish, yellow, difficult to detach.
Antimonium sul. aur. is more chronic than that of the preceding remedies. It is a remedy of the left base having tendency to chronicity.
Antimonium iodatum. It is a remedy of Chronic Bronchitis and as a result of catarrh of the Upper Respiratory system which has gradually spread to the whole Respiratory System. The patient was at first a subject of catarrh of the rhino-pharynx, but gradually has become a patient suffering from chronic bronchitis with emphysema. The emaciation and weakness are to be noted, which are the characteristics of the radical iodum. This remedy is to be given in lower potencies, for example 3x.
Antimonium arsenicosum. With this ends the series of Antimony. It is a very important remedy and which the lecturer uses frequently in emphysema, in chronic bronchitis and in patients who have deficiency of the right heart with congestion of the bases; in the last case one should give Phosphorous 200 followed by Antimonium tartaricum 6 and Antimonium arsenicosum 6 alternated every hour and at the same time 1x or M.T. Asystole of the right heart is differentiated from that of the left heart and circulation with oedema and is suitable to Phosphorus 200 followed by Kali carbonicum 12, Apis 6 and Digitalis.
Antimonium arsenicosum is useful weak asthmatic patient with extreme dyspnoea. The patient is weak with cough accompanied by abundant expectoration. In some cases this remedy is more active in 3x than in 6.
If there is tendency to uremia we may alternate Antimonium arsenicosum 3x with Ammonium carbonicum 3x.
Here we have no need to study Arsenicum album which we have studied as a ground remedy. It is a remedy of dry cough. However in some cases of humid cough it may be used and will be compared with Antimonium tartaricum, as for example when the attack starts from 1 to 3 a.m.
Finally there remains another salt of Arsenic which is indicated when the cough is accompanied by muco-purulent expectoration and which is very much abundant. It is Arsenicum protoiodatum, indicated by Cartier in muco-purulent expectoration with agitation and prostration.
The Kalis. Kali carbonicum has two types of expectoration.
1. Thick, rare painful, viscous expectoration, difficult to detach. The patient is forced to swallow the catarrh. This remedy is to given in adults of infantile type who does not know how to hack up the sputum.
2. Paroxysms of dry cough to which follow unexpectedly some sputum violently thrown out.
The cough and dyspnoea is better by bending forward.
Kali bichromicum. Thread like expectoration, yellowish green, thick, mucous, viscous. The cough is accompanied by pain in the sternum and is aggravated by uncovering the body.
Kali bichromicum responds to asthma of old persons suffering from bronchitis. Some dyspeptic troubles may be seen (Aggr. by bier and Aloe)
The other salts of Kali are less important.
Kali iodum. Greenish expectoration, like soap suds; chronic watery coryza. Violent cough in the morning. Syphilitic subject.
Kali nitricum. Intense oppression. Cardiac asthma of old bronchitis patients. Dilatation of the right heart.
Kali arsenicosum. It is more interesting. The author uses it successfully in emphysema of old persons (6, 30) specially if there is inveterate psora with skin manifestations (chronic eczema etc.)
Kali muriaticum. Nasopharyngeal catarrh is more important than bronchial catarrh.
Kali chloricum. Chronic nephritis with renal asthma.
Chromico kali sulph. It is a kali bichromicum group compounded with sulphur. It is used in asthma with great oppression with expectoration difficult to detatch.
Kali sulphuricum. Very much related to Pulsatilla. A remedy of yellow non-irritating expectoration.
Kali permanganium. Very foetid expectoration (Charge)
Let us conclude by a short schema: Soap sud expectoration
Viscous, colourless, sometimes greenish expectoration
Salts of Natrum
Difficult to detatch
Salts of potassium
Kali bichr, Hydrastis