34

REMARKS ON HOOPING COUGH.

BY DR. BLACK.

According to the London bills of mortality hooping cough is a very frequent cause of death; only six diseases produce a greater mortality, viz., phthisis, pneumonia, bronchitis, typhus, convulsions. This circumstance, coupled with the frequency of the disease, and the injurious effects it sometimes entails, suggests the importance of an examination, first, as to whether improvement in the medical art is likely to diminish the duration, the intensity, and the mortality; secondly, what assistance homœopathy brings to effect this desirable consummation.

The first question may be limited to the ordinary modes of healing.

Few diseases have afforded more scope than hooping cough for theories as to its nature, and seat, but comparing later with earlier writers, there is now much less leaning to conjectural pathology as a basis of treatment. The error is still too prevalent of regarding the nature of the disease as the guide to treatment, and however pleasing such a plan may be to the mental powers, a system of pathological therapeutics based on imaginary and apparent explanations of their internal causes, must be ever changing and unsteady. It is adherence to this plan which has led and still leads to much of the mortality arising from hooping cough; this will be apparent in the following extracts, which are taken from an admirable clinical lecture lately delivered by Dr. Todd,* and from the last edition of the well known work of Barthez and Rilliet.+

Dr. Todd writes: "I am sure that the more hooping cough is treated as a spasmodic, rather than an inflammatory affection, the greater will be the success of our practice, and the less the mortality from that disease."

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"That plan, [the antiphlogistic] indeed has had a fair trial; and if it had any real power over the disease, we should have, long ere this, accumulated abundant evidence to prove its supe

* Medical Times and Gazette, March 4, 1854.

Traité clinique et pratique des Maladies des Enfants. Tom. ii. Art. Coqueluche. 1854.

riority. The tendency of all the usual antiphlogistic measures is to weaken the nutrition of the lungs and the nervous system, and to impoverish the blood; to reduce the quantity of its colouring matter, to favour the accession of convulsions, and, by the watery parts of the blood filtering through the walls of the blood-vessels, to promote the tendency to hydrocephalus." -p. 206.

"But you must bear in mind, that such remedies should be used with caution, especially opiates, which in infancy and childhood are at all times to be given with great care, and more particularly if the lungs have become congested. The drugs which I would recommend you to avoid are those which have a depressing and lowering tendency, such as Tartar emetic and Ipecacuanha. Many children, I am quite satisfied, while suffering from hooping cough, have died from the too free and slovenly exhibition of these emetics.”—(p. 206.)

"Assuming hooping cough to be a disease depending on the presence of a morbid poison in the blood, [why the blood?] (which is the most reasonable view of its pathology,) to cure the affection perfectly, we ought to find an antidote for the poison, which produces it. If we could find some material which, when introduced into the system, after it had received the poison, would neutralise that poison, then we should have the same power over this malady, as we now possess over intermittent fever, which, as you know, is also a paroxysmal disease, depending on the presence of some morbid poison in the system, and for which an antidote has been found in Bark. But since, unfortunately, no antidote for hooping cough has as yet been discovered, it should not be our practice to look on in silence, and let the patient cough it out; but our aim should be to find the means of guarding him against the bad consequences of the cough, and to protect him from all those complications to which I referred in the commencement of the lecture."

The treatment recommended by Dr. Todd in uncomplicated hooping cough may justly be called expectant, it is one rather of prevention than of cure. He believes, that "in a large number of cases, one can get on very well without having

recourse to drugs," and when drugs are used he recommends that they be administered with caution. There is one remedy which he feels inclined to recommend, in very severe cases, when the lungs are free from congestion, Chloroform, not so much from his personal experience of its efficacy, as from the recommendation of other physicians, and its utility in other convulsive diseases.

One other extract may be given where Dr. Todd very clearly explains the nature of the changes that take place in severe hooping cough. When the character of these changes are more generally recognized, it is to be hoped that they will favourably modify the practice which too often becomes most active where it is most destructive.

"Let me direct your attention to these secondary changes, which occur in the lungs and vascular system, after the disease has lasted for some time. At first the lungs are not at all affected so that hooping cough can no more be considered a disease of these organs, than can an aneurismal or other tumour pressing upon the vagus nerve, and in this manner, exciting cough, be so regarded. After the cough has continued a long while, changes take place, as I just now stated, affecting the lungs, and the general appearance of the patient. The countenance becomes dull and bloated, and the capillaries distended, especially those of the conjunctivæ, which look watery and swollen; and some of these minute vessels often burst, giving rise to some chemosis. From this state of countenance, a practical eye can generally at once recognise the nature of the malady under which the patient labours.

"All these changes result from the circulation in the capillaries being retarded, in consequence of the violence of the cough. At the same time, and for a like reason, the pulmonary circulation becomes similarly affected; the secretion of the bronchial tubes becomes altered; these tubes pour forth more freely than natural a watery mucus; the lungs become congested and œdematous; more or less crepitation is heard in different parts of these organs, according to the amount of fluid in the tubes or oedema present, and this crepitation is usually most audible towards the lower part, being sometimes more distinct in one lung than in the other. Both the patients in the hospital exhibit these changes to a considerable extent. The sound on