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is nothing but commendation to be given his paper. In my own work I have not found it necessary to go into other treatments than homeopathic in order to relieve the patients who have come to me complaining of coughs. There is no question but that the strict adherence to the law of the similars will prove that it is indeed a law and will meet the requirements.
We oftentimes find that a study of the earliest cases of bronchial conditions in the fall will lead us to the prescribing of a certain class of remedies which will be found best indicated throughout the winter. Except in the case of acute bronchitis we do not generally find the patient in the first stage, when Aconite is indicated. I have used Bryonia a great deal in the 3rd or 6th potency in cases where the cough is rather dry and aggravated by any disturbance of respiration; the well-known mental symptoms of Bryonia are present..
Phosphorus also is indicated, but not nearly so frequently as Bryonia. In Phosphorus we have hoarseness, together with dryness extending down deep into the chest, with short breath. Smoke or anything in the atmosphere of an irritating character aggravates the cough.
Sulphur is a remedy to be thought of in many cases of bronchitis, particularly where there is dyspnea preventing the recumbent posture, with a dry cough aggravated after midnight. I give this remedy not lower than the 30th perhaps every hour.
Tartar emetic is another remedy which should not be forgotten. It is used where there is accumulation within the bronchial tubes, which the patient is unable to expel. This is the key-note of this remedy. Loose cough, moist rales in different parts of the chest, and no expectoration. In giving Tartar emetic I usually place 10 grains of the 3rd trituration in four ounces of water and give one or two teaspoonfuls every half hour or hour. Drosera is a remedy which is indicated in cough which is followed by nausea and produced by the shock of coughing.
Dr. W. H. Phillips. - In listening to the paper of Dr. Somers and the discussion by Dr. Jones I couldn't help remarking the different attitudes assumed by the general practitioner and the specialist toward the subject in question. To the one a cold is a simple acute catarrhal inflammation of some portion of the upper respiratory tract
- nothing more and nothing less, and, having thus settled the diagnosis to his own satisfaction, he flies at once to the indicated remedy. In the course of time he cures the attack and then proceeds to dismiss the patient as well, just as he would a case of typhoid or scarlatina.
The specialist takes another view. Here is a patient, the subject
of repeated attacks of obstinate thinitis, pharyngitis, tonsilitis or rhinitis; here is a child who has recurrent attacks of croup, the slighest exposure being sufficient to produce an attack. The question with him is not, What can I do for this acute attack, but what can I do to prevent to the fullest possible extent future attacks ? What are the pathological conditions which render these attacks likely?
In childhood the lymphoid structures--and I am speaking now of the upper respiratory tract only-are the active structures and bear the brunt of the inflammatory attacks. Their situation, guarding as they do the entrance to the pharynx and larynx, is peculiar. Four large aggregations form the principal foci, Luschka's tonsil in the. naso-pharynx, the oral tonsils, one on either side of the pharynx, and the lingual tonsil at the base of the tongue just above the epiglottis; these are all joined together by a chain of glands running down the lateral walls of the pharynx, thus completing the “Lymphoid Ring." Repeated colds or the acute infectious diseases of childhood which have as a prominent symptom, throat involvement, produce in these structures chronic inflammatory hypertrophy, so that they become extremely sensitive and take on the acute inflammatory process at the slightest provocation. The larynx is easily inflamed from dripping discharges or from air not properly warmed and moistened--owing to the mouth breathing so frequently present during the acute enlargement. A child who has repeated colds and especially recurrent croup, has a chronic inflammatory hypertrophy of some portion of this Lymphoid Ring.
In later life the lymphoid structures play a far less important part. With the widening of the air passages, the more perfect development of the intricate respiratory apparatus of the nose, and the greater bodily resistance, these structures tend to disappear if they have not become so hypertrophied as to render absorption impossible. Chronic hypertrophic inflammations of the mucous membranes appear in their places involving alike the turbinate and the septum. of the nose, the naso- and oro-pharynges and occasionally the larynx. The pathology of this condition is a thickening of the membrane in patches due to the formation of new connective tissue, dilated and paretic blood vessels, and partial destruction of the glandular supply. These patches are the sensitive areas, which, like the chronic lymphoid hypertrophies, take on the acute process at the slightest provocation. No sooner is a slight thinitis acquired than pharyngeal roughness and laryngeal hoarseness appear. If the posterior wall or the interarytenoid space of the larynx be involved, or relaxation of the soft palate
with hypertrophy of the uvula be present, cough will be a prominent symptom. If the vocal cords suffer, hoarseness is present.
Now, from a specialist's standpoint, the treatment of these cases was summed up by Dr. Baxter, —“Remove the cause,” if possible. Here it is a matter of judgment whether we shall depend on internal medication, topical application, or surgical measures, or all combined, to accomplish the desired end. In the management of the acute exacerbations I can add little to what Dr. Somers and Dr. Jones have already said. I have found that a 3 per cent. Camphor Menthol vapor given to the patient to use at home is very soothing and grateful during the acute ascending stage. During resolution a mild astringent applied locally hastens recovery. These are not by any means a substitute for the well-chosen remedy, but simply an accessory.
Dr. E. O. Adams.- In considering the causes of “colds” of the respiratory tract, and thus securing hints for their cure, I believe that attention should be given to diet. Now Physiology teaches us that carbonic acid gas is chiefly excreted from the lungs, and thus must pass through the air passages. Carbonic acid gas is formed in the body by the oxidation of carbons contained in the carbo-hydrates. It has therefore been suggested that a diet rich in these compounds, such as sugar, candy, cakes, bread, etc., supply a larger amount of carbonaceous elements than are needed, and at the same time necessitate a larger amount of carbonic acid gas being excreted through these passages than normal. As a result the mucous membranes become irritated and congested the same as though air too heavily impregnated with the above gas were inspired. So far this is theory; but it seems to me I have frequently seen a respiratory cold follow a too free indulgence of candy by children. And I have thought that the reason we have more colds now than in the good old times which our forefathers tell about. is due in part at least to the increased number of confectionery stores and bake shops. If this really does have an effect of this kind, of course it is intensified by living in close rooms, where there is not plenty of free oxygen present to dilute carbonic acid gas as it is given off by the lungs. Believing, partly at least, in the above idea, I am accustomed in treating colds, especially if recurring frequently, by replacing the carbo-hydrate foods partly, by advising more niilk, eggs and lean meat, with, I believe, much benefit.
G. D. Cameron, M. D.— The discussions to which we have listened are no doubt helpful as far as they go. Local and internal medication may do good, but are hardly worthy to be classed as the best curative and preventative measures at the disposal of the physician. Fresh air is the best preservative and reconstructive for the respiratory tract. No other agent will prevent and cure such variety of respiratory lesions. It is the best we have to offer and will be a hundred years hence, because it is the medium in which lungs have been developed. A glance at the death reports of Cleveland shows respiratory diseases at the head of the list. The remedy is to increase the breathing habit and capacity. Ventilate sleeping rooms, improve the vitiated air of the schoolroom, instruct the afflicted cases in breathing an abundance of pure air, and our duty to the patient will be more complete and the patient safer. The fact that seven thousand died from tuberculosis in Ohio last year is a plea for care in diagnosis.
Dr. J. T. Carter. – Mr. President: I can add very little to what has already been said, except to name one or two remedies not before mentioned this evening, which I have used successfully.
But first I agree with Dr. Cameron that fresh air is a great thing in preventing, and I believe also in the curing of colds. A cold in the head, so-called snuffles, as usually taken while seated in a warm room, without apparent cause for the cold, can often be cured by a brisk, out-door walk with feet and body warmly clothed, inhaling through the nostrils the crisp, dry, cold air. This would not be advisable if the air were damp or heavy with moisture. Many of our office-workers, shut up all day in ill-smelling and badly aired places, would gain much by a brisk walk to and from their work, even in cold weather.
Among the remedies spoken of to-night, Belladonna, Bryonia, Phosphorus and Gelsemium, I have used Belladonna perhaps the more often. Sanguinaria Nitric 6x has been a good remedy in my handswhere the irritation is low down behind the sternum, mucous secretion somewhat loose and rattling-a succession of coughs will raise it; the next cough may be stifled somewhat, with dyspnea, but will break forth a few minutes later. It has an irresistible irritation, causing cough every few minutes. Sanguinaria Can. has more of a dry cough and tickling in the throat. Rumex 3x is another remedy I use when the irritation is higher up in the throat. Senega 3x is very useful. It combines some symptoms of Belladonna, Gelsemium and Bryonia, there is hoarseness, dry throat that hurts when talking, chilliness, sneezing, thin coryza, red face, worse in warm room, or from fast walking. A great amount of mucus, albuminous in character, in the bronchial tubes; expectorated with difficulty. Can be used successfully where the patient has not responded readily to Belladonna, Bryonia or other remedies.
Drosera I have used very little. Some of the colds I have treated reach a point which is not quite a perfect cure; here I have used a powder or two of Kali Bich. 3x with good results. In one very obstinate case of a child, whose cough was incessant day and night for several days, refusing to yield to other remedies, I gave Ipecac 30x—and the results were complete relief from the cough in twenty-four hours. I am not usually counted among the high potency men, but my association with Dr. Jewitt and some others, has led me to step higher whenever I find a difficult case which has something back of the acute attack that must be considered in prescribing. Aconite I have used very few times. Only those patients who go to the doctor for every little ailment will come to you in the first stages of the cold—when it is most useful. We generally see the patients after the stage of Aconite has passed-and they have exhausted home remedies without a cure. Then the other remedies are usually called for. I do not mean that I would not give Aconite, at any time were it clearly indicated, but I have generally found other remedies needed.
It is the duty of every one to guard against the repeated attacks of colds-by proper clothing, and fresh air. We can put our finger in the fire and burn it. When it is well, we can repeat the process to the injury of the finger-so with our throats, the repeated attacks of cold bring about a condition of affairs which finally send the patient into the hands of the specialist -as we have heard to-night.
It is possible to cure even these cases with remedies, if the patient will support the treatment with the proper care of himself. I believe heartily in removing the cause of every trouble, if it can be done without injury. Also, in using adjuvant treatment to soothe and allay irritation and relieve pain, providing the adjuvant used be not powerful enough to overcome or antidote a prescribed remedy.
Dr. E. H. Jewitt.— There is no question but that Dr. Cameron is right in what he says. We find the patients subject to cold among those people who are housed up in places where the air is impure. The men and women who live and work out-doors are 'not so. It is the people who pass the most of their time inside who take cold easily. One great source of this condition is the wearing of improper underwear. The fact of the matter is, it would be better for us if we wore no underwear at all. When we were boys we did not wear any and we were very healthy and strong and never suffered from cold at all. As it is, we wear underwear which is altogether too heavy. Woolen underwear should never be worn. It is entirely wrong. The result of wearing it is to cause a perspiration, which clogs up the excretory ducts of the sweat-glands, thus preventing their free action. The skin is a respiratory organ and through it should pass a great many of the impurities which Nature desires to excrete from the system. Linen mesh underwear is the best, and is the one which should be used.