TO TREAT A COUGH.

By EDWIN GEER, M.D., Physician-in-Charge City Hospital Dispensary, also Physician-in-Chief Out-door Department, Maryland Maternity Hospital, Baltimore, Md.

Unfortunately it has not been demonstrated that we have anything like a specific for the more severe diseases of the chest, as phthisis or pneumonia. There are some good reasons for believing, however, that we may be soon as successful in treating these diseases as we are now successful with diphtheria under its new treatment.

The knowledge of the cause of phthisis enables us to detect that disease in its very earliest stages; while the physical signs of pneumonia are sufficiently distinct to tell us of its presence. With two such formidable diseases to treat, the question of controlling the cough may be an altogether minor one, at least for a time. But we have to remember that for every one of these cases we have a score or more of the lighter affections of the chest. We We may have superior ability in directing a case of phthisis, yet we signally fail in the eyes of the laity if we cannot speedily master a hacking cough.

The object of this brief paper is not to try and teach my colleagues how to treat a cough, but simply to state how I do it, and to call their attention to those lighter affections of the throat and chest, the principal symptom of which is an annoying cough, for which alone we are often consulted. The patient may fear an approaching pneumonia or be anxious because of a bad family history, or the cough may cause loss of sleep and detention from business. What shall we do for these coughs? It has been my custom for some time to treat each of the following conditions after this general plan: If constipation be present, which is generally the case, I administer small doses of calomel and soda which opens the bowels freely, and if they do not I follow with a saline purgative, then I give the following prescription:

gr.

B Antikamnia and Codeine Tablets, No. xxx. Sig. One tablet once every four hours. The above tablet contains 4 gr. antikamnia and sulph codeine and is given for the following reasons: The antikamnia has a marked influence over any febrile action; restores natural activity to the skin, and effectually controls any nervous element which may be in the case. The action of the codeine is equally beneficial, and, in some respects, enforces the action of its associate. The physiological action of codeine is known to be peculiar in that it does not arrest secretion in the respiratory or intestinal tract; while it has marked power to control inflammation and irritation. It is not to be compared to morphine which increases the dryness of the throat, thus often aggravating the condition, while its constipating effect is specially undesirable.

Irritable cough. The patient complains that he has a constant tickling in the larynx, which makes an equally constant desire to cough. Nothing else appears to be the

matter, and if this cough were only removed, our patient

would be satisfied. He also complains that the more he coughs, so much the more irresistible does it become.

Hacking cough. This occurs both in children and adults and appears to be due to an irritated condition of

the mucous membrane of the upper air passages. The desire to cough is not so strong as in the above; neither is the cough itself so severe. Besides ordering the above tablets in these irritable and hacking coughs, I usually direct the patient to use a demulcent drink of flaxseed tea, flavored with a little lemon juice. This drink is especially agreeable to children and is certainly an aid in controlling this annoying difficulty.

Harassing irritative cough. This is one of the most stubborn coughs to relieve. The patient complains only of a harsh, hard, dry cough, which begins the moment he lies down to rest and continues through the greater part of the night. During the day there is but little trouble, and his hopes are raised, only to find them all disappear when he again seeks rest. In these cases the above tablets are given more frequently; while slight counter-irritation over the upper chest, perhaps a hot foot-bath before retiring, and some hot drink may be added.

Winter cough. Then again, we have the chronic cough of winter which comes with persistent regularity with the beginning of each cold season. This is especially the case with elderly people who often have a chronic bronchitis. Here again, we have the two drugs indicated, as mentioned above.

Nervous cough. This is a cough which does not appear to have any physical cause whatever. It is aggravated by those conditions which irritate or excite the nervous system, as well as by those which weaken or debilitate it. The above tablets will control this irritability at once.

Excessive coughing. In cases of bronchitis or phthisis, the cough is often far in excess of an amount sufficient to free the lungs from mucus. The object here should be to reduce the force and frequency of the cough to only the necessary amount. This is easily accomplished with the above tablets, without causing any disturbance of the digestive organs.

Acute coughs. Lastly, we have the acute coughs, more or less severe, which accompany the acute inflammations of the upper air passages as in acute colds. In these cases we almost invariably find an increase in the pulse, elevation of temperature, dry skin, and a dry throat. The antikamnia has a marked influence over these conditions,

insuring their prompt relief; while the codeine effectually controls the inflammation and irritation, exerting an action of its own and enforcing the action of its associate. I might also mention the cough which accompanies measles. This is brought under prompt control by the tablets, while the antikamnia exerts a marked influence for good over the disease itself.

In thus briefly describing the treatment of a cough, we are fully aware we are usually treating a symptom. But experience has demonstrated that in a great majority of these cases when remedies are administered which show difficulties as well. In conclusion, I wish to say that whentheir effect by controlling the cough, they remove the other normal functions of the respiratory and digestive tract, I ever we desire to control a cough without affecting the have found, in both dispensary and private practice, nothing better than the combination above referred to.

NEW YORK MEDICAL JOURNAL, Dec. 7, 1895.

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