Part 139

Coughing is greatly under the control of the will, and children ought to be taught to try to restrain the inclination to cough; very often, by this very effort, the desire to cough will vanish. If it cannot be avoided, they should be taught _how_ to cough. It is not in the least necessary to give way to coughing on every occasion, even though there be really something to expectorate, until the mucus or other irritating matter be within easy reach, and then one good, effective, deliberate cough will do as much, or probably more, for the relief of the individual, than perhaps a dozen repeated, noisy, resultless fits of coughing. The noise which accompanies the act can be greatly modified at the will of the individual. There are some people who make not the slightest effort to lessen this annoyance. In many cases the mouth may be closed, and in all the hand may be held before the mouth during the act, whereby considerable modification of the noise may be attained.

Avoid making use of any nostrum vaunted as a cure for all sorts of coughs and colds: all contain opium in some form, and may prove prejudicial to the complaint which initiates the cough. At the same time, a distressing cough calls for amelioration. There never can be harm in causing the patient to inhale steam from a sponge or basin of boiling water; or infusion of hops may be inhaled. Lozenges of various kinds are often useful, e.g. fruit, gum, glycerine, liquorice, marsh-mallow, tamarind, ipecacuanha, &c. Linseed-tea is a bland, soothing demulcent, useful in sore throat, and in allaying tickling cough.

The common mullein, _Verbascum thapsus_, has long been used in Ireland as a domestic remedy for consumptive cough, and Dr. Quinlan finds that when boiled in milk the patient takes the decoction readily, and experiences a physiological want when it is omitted. Its power of checking phthisical looseness of the bowels and the relief afforded to coughing are very marked, so that patients take hardly any other cough mixture. In early stages it appears to have a distinct power of increasing weight, but in advanced cases Dr. Quinlan remarks that he is not aware of anything that will do this except koumiss. (_Brit. Med. Jour._)

Dr. Square recommends a solution of 1 part ethyl bromide in 200 of water as a remedy for whooping-cough. This is of similar strength to the chloroform water of the British Pharmacopœia, and its dose is the same, namely, ½-2 oz.

A German journal mentions a case of whooping-cough treated with turpentine by Ringk, of Berlin, with astonishing results. The patient was a little girl 3½ years of age, and a fatal issue seemed imminent. The doctor prescribed ol. terebinth., 10 grams; syr. altheæ, 80 grams; a teaspoonful every 3 hours. The next day the child was sitting up in bed, with a great slice of bread and butter in her hand, which she was eating and evidently enjoying. The cough had totally disappeared, and no evil results followed.

Following are a few simple recipes for expectorants, useful for winter coughs. The first is particularly suitable for young children:--(_a_) 1 fl. dr. syrup of squills, ½ fl. dr. gum acacia, powdered, 8 gr. ammonium chloride, enough peppermint water to make 2 fl. oz. Dose for a child, 1 teaspoonful every 2 hours. (_b_) For older children and adults, 2 parts syrup of ipecac., 4 syrup of squills, 1 paregoric. Dose, ½-1 teaspoonful, repeated as often as necessary. (_c_) 1 oz. syrup of ipecac., 1 oz. syrup of tolu, ½ oz. paregoric, 1 oz. syrup wild cherry. (_d_) For hoarseness, Dr. Eichelberger gives the following, which he says is very good:--2 dr. tinct. chloride of iron, 4 dr. glycerine, 4 dr. water. Dose, ½ teaspoonful.

Sore throat is a constant accompaniment of some very serious disorders, such as scarlet fever, measles, smallpox, diphtheria, &c., but is most frequently the result of exposure to cold and damp, when the body is heated. It may be confined to the parts situated at the back of the mouth, i.e. the tonsils, palate, and pharynx, or it may extend a little further into the windpipe. The affection is an inflammation of the mucous membrane of the parts enumerated. Many cases speedily recover without any active treatment, provided the invalid will have patience for a few days, confine himself to the house, better to one apartment, and still better to bed, for a couple of days; avoid all conversation; apply a warm poultice to the throat, or a moist compress round the throat night and day. This last is made by wringing a piece of lint, or a pockethandkerchief, out of water sufficiently so that it does not drip, and it is of small moment whether the water be cold or warm; it is now applied to the throat, and covered with a piece of macintosh, and then a woollen comforter is put over all. Ice may be sucked continuously, if agreeable to the patient. If it be not, then a gargle of warm milk and water should be employed every hour. A smart aperient dose of Epsom salts or castor oil should be taken in the morning before breakfast, 1 tablespoonful salts in a tumblerful of hot water. If, under this treatment, the throat do not improve in 2 days, it has ceased to be a minor ailment, and the physician must be sent for.

A very painful form of sore throat is that called quinsy. It is inflammation of the tonsils, two glands situated at the back of the mouth. This inflammation is principally observed in changeable climates; and seems to attack, by preference, young adults. Children rarely suffer from quinsy. Persons who have once been the subjects of this ailment are very liable to a recurrence of the disorder. The most common exciting cause is exposure to wet and cold, with a chilly east wind.

Those who are liable to this form of sore throat, and know from the premonitory symptoms what is impending, ought at once to adopt preventive measures. These consist in using strong astringent gargles; in the administration of single drop doses of tincture of aconite, every hour, for half a day, and a brisk saline purgative in the morning, such as a dose of Rochelle salts. For gargle, one of the best is the old-fashioned homely mixture, consisting of 3 tablespoonfuls red wine (port or claret), 1 of vinegar, ½ teaspoonful powdered alum, and a little sugar, in a tumbler of cold water. This to be used every hour. If, however, the affection has gone too far for this abortive treatment, then the patient must be confined to bed; hot poultices must be kept constantly applied to the throat; steam from hot water should be inhaled often; a gargle of hot milk and water should be used hourly; and ice, if grateful, may be constantly sucked. A sal prunelle ball may be allowed slowly to dissolve in the mouth. The diet should be in semi-solid form, e.g. arrowroot made with milk, soup thickened with rice-flour, or better still, beef-jelly, if the patient can be persuaded to swallow at all. If the abscess do not speedily rupture, and more particularly if both tonsils be simultaneously affected, then it may be necessary to call in the aid of the surgeon to lance it. The necessity for this will be evident by continued and increasing distress of the sufferer, great difficulty in breathing, and extreme restlessness and feverishness. In a first attack, too great delay ought not to be allowed to take place before getting professional assistance.

Every one has a cure for sore throat, but simple remedies appear to be most effectual. Salt and water is used by many as a gargle, but a little alum and honey dissolved in sage tea is better. An application of cloths wrung out of hot water and applied to the neck, changing as often as they begin to cool, has the most potency for removing inflammation. It should be kept up for a number of hours; during the evening is the usually most convenient time for applying this remedy.

For loss of voice in singers and speakers, Dr. Corson recommends the patient to put a small piece of borax (2-3 gr.) into the mouth and let it dissolve slowly. An abundant secretion of saliva follows. Speakers and singers about to make an unusual effort should the night before take a glass of sugared water containing 2 dr. potassium nitrate (saltpetre) in order to induce free perspiration. In similar circumstances this gargle may also be used:--6 oz. barley water, 1-2 dr. alum, ½ oz. honey. Mix, and use as a gargle. Or an infusion of jaborandi, made by putting 2 scr. of the leaves in a small cup of boiling water, drunk in the morning before getting up. The free sweating is said very quickly to restore the strength of the voice.

_Constipation._--Short of mechanically obstructive disease, there are many states in which constipation is the most marked feature. On the nature of these, apart from the mere symptom, the possibility of permanent relief by treatment must of course largely depend. We may procure comfort with a pill, but often we cannot retain it with many. Habit cannot be reformed or expelled by purges. Accordingly, when we proceed against the fault of habit, now under notice, we must take account of the constitution and circumstances in which it is formed. By so doing we do much to ensure the desired relief, though it may be that even then we fail somewhat of complete success. A bowel long deficient in activity, dilated irregularly, with torpid though thickened walls, does not soon, if ever, renew its original tone and contractility. The difficulty is a pathological one, and arises from structural as well as functional perversion. The natural efforts to obtain relief are hindered and enfeebled by the effects of some cause which may still be operative. If we would undo the past or prevent further mischief, we must seek and treat that cause. Aperients of different kinds, however potent at the time, are but temporary palliatives of discomfort so long as no pains are taken to trace the trouble to its origin. Whether it be a sedentary habit of life, an excess of food overloading and overworking the viscus, purgation draining and depleting it, gout, diabetes, struma, chlorosis, altering either the structure of the intestinal wall or the consistence of its contents, it must be sought for as a chief guide to the means of cure. It is not likely that constipation will ever form the chosen hobby of a specialist. A far too general view of medicine and its adjuvant sciences is necessary for successful treatment to encourage such appropriation. We are not, however, outside the sphere of nostrums. There is in our time, if anything too much reliance on physic-taking for constipation. More might be done by appropriate dieting and by inculcating active habits of life than is customary. It may be noted, with regard to diet in particular, that a free use of simple fluids, as water, or mild mineral waters, is of distinct advantage in assisting both digestion and evacuation. There are also many aperient vegetable foods which, with the same end in view, we should like to see in daily use at the table. Almost any kind of wholesome fruit and green vegetable might thus be made serviceable. When, again, we come to medicines, we must remember that the disorder which we have to combat is a complex one. We cannot in this case, more than in any other morbid state, put a finger on one tissue as alone or invariably at fault. Thus in the costiveness of anæmia we have atony of the intestinal muscle combined with defective secretion, and both but part of a general tissue starvation; in the gouty disorder of elderly people the same conditions appear, though due to a very different dyscrasia; and so on. We may say, therefore, speaking generally, that no single drug can be relied on to meet the intestinal difficulty. An agent which aids secretion either of bowel or liver will not alone suffice. The long-inactive muscular coat likewise requires assistance. A free purge may have its value now and then, but when the object to be attained is the correction of a habit, a milder remedy used regularly is much more effective. To meet these various necessities, perhaps no combination is superior to the time-honoured union of belladonna with the compound rhubarb pill and nux vomica, or the most recent mixture of the fluid extract of cascara with the last-named drug. An agreeable change of remedy is afforded by many aperient mineral waters. The effect of these latter, however, is unfortunately apt to pass off after a time, probably from their causing a too copious intestinal secretion. The action of saline or other enemata is not quite similar. More strictly local, and exerted rather on the fæces than the bowel, it gives relief without so much exhausting the latter by secretion or peristalsis; while the very rest which the colon thus easily obtains is itself a help to the recovery of normal nutrition and muscular tone. The chief points which we would therefore bear in mind, whatever the remedies used in combating the habit of costiveness, are the need for recognition of its primary cause, and the fact that its proximate condition is an atonic bowel. (_Lancet._)

Dr. Mortimer Granville gives 3 prescriptions for habitual constipation. It is indispensable to regard persistent inactivity of the bowels, when not demonstrably due to other causes, as the result of, either defect of peristaltic action; deficient glandular secretion; or interruption of the _habit_ of periodic evacuation.

When there is a lax and torpid condition of the muscular coat of the alimentary canal, we get food retained in the stomach or intestines until it ferments, or sometimes “decomposes,” with the result of distension, pain mechanically induced, and either eructations or incarcerated flatus. In a considerable number of cases this last-mentioned trouble is so great, and at the same time so masked, as to give rise to the impression that grave disease exists; whereas every anomalous symptom has quickly disappeared as soon as the muscular tone has been restored, and the contents of the bowels have commenced to pass naturally on their course. The essential fault is partial, in some instances almost complete, loss of the reflex contractility of the muscular coat, so that the presence of ingesta at any part of the canal does not excite the intestine to contract and propel it onwards. It is worse than useless to employ ordinary aperients in such a condition as this; they only irritate without strengthening the nerves, on the healthy activity of which everything depends. When, therefore, there is the form of “constipation” which requires treatment, use a prescription something like the following; and it is, in the majority of instances, successful:--

Sodæ valerianatis gr. xxxvi.; tincturæ nucis vomicæ ♏ lx.; tincturæ capsici ♏ xlviii.; syrupi aurantii ℥iss.; aquâ ad ℥vj. Misce, fiat mistura, cujus sumatur cochleare magnum ex aquâ ter die, semihorâ ante cibum.

The second form of constipation, in which there is a deficiency of glandular secretions generally throughout the intestine, manifested by a peculiarly dry and earthy character of the dejecta when the bowels _do_ act, may be treated by a mixture such as this:--

Aluminis ʒiij.; tincturæ quassiæ ℥j.; infusi quassiæ ℥vij. Misce, fiat mistura, cujus sumantur cochlearia duo magna ter quotidie, post cibum.

The third form, which depends chiefly on interruption of the natural habit of periodic discharge, often results from repeated failure to move the bowels, in consequence of one or other of the two preceding forms of this trouble. This may generally be relieved by directing a perfectly regular attempt to go to stool, and by the use of the following draught, taken the first thing after _rising_ from bed--not on awakening--in the morning, as nearly as possible at the same hour. It will be observed that it is not an aperient in the ordinary sense of the term. It is, as a rule, neither necessary nor desirable to continue it for longer than a fortnight. In most instances, it will be found to re-establish the normal habit in a week or less.

Ammoniæ carbonatis ʒj., tincturæ valerianæ ℥j.; aquæ camphoræ ℥v. Misce, fiat mistura; capiat partem sextam in modo dicto. (_Brit. Med. Journ._)

The value of castor oil as a family aperient is undoubted. Referring to its use, Dr. Soper enlarges on the great advantages of a combination of castor oil and glycerine in equal proportions to act as a purgative. Glycerine has great therapeutic value, especially in its solvent properties, and this combination renders it especially valuable. In regard to castor oil, a great mistake is often made in the largeness of dose administered; in this mixture, only ½ teaspoonful is required combined with an equal bulk of glycerine. In all cases of chronic constipation, piles, &c., it has proved most useful. Also ½ teaspoonful doses in the early stages of bronchitis seem to promote exudation from the tubes, and is certainly expectorant. The great difficulty is the obstinacy with which the mixture becomes a mixture, as it can only be made by placing the bottle in hot water and violently agitating. By adding the oil to the glycerine gradually, and mixing the two in a mortar, the taste of the oil completely disappears. The following is recommended as a pleasant form for children:--1 dr. castor oil, 1 dr. glycerine, 20 drops tincture orange peel; 5 drops tincture senega; cinnamon water to make up ½ oz. mixture.

_Consumption._--It is highly probable that adult mortality from phthisis might be considerably reduced, if members of phthisical families, and persons of phthisical habit and tendency, could be induced to pursue an intelligent course of life. In wisely-chosen food, suitable exercise, well-adapted clothing, and pure air, are four distinct and potent details of every-day life, well within control, which may be turned to efficient account in the prevention of phthisis. Precautions, if they are to be effectual, must not be put off until signs of lung mischief become manifest. Then the evil can only be mitigated, not avoided. If consumption be apprehended, the daily diet should be rich both in nitrogenous flesh-forming and fatty constituents. The especial nutritive value of milk in such a case is universally recognised. Next to well-arranged daily food, exercise in the open air is of the greatest importance. On this point the late Dr. Parkes laid down the rule that “the best climates for phthisis are perhaps not necessarily the equable ones, but those which permit the greatest number of hours to be passed out of the house.” By well-adapted clothing, many of the chills, catarrhs, and pulmonary congestions which often lead up to consumption, might be prevented. The rules in this respect are well established. The feet should always be dry and warm; the covered parts of the body, excepting the head, should be clothed in suitable woollen fabrics; the underclothing should be kept of the same thickness all the year round, and variations of apparel to suit the changes of season be made only in the outer garments; and no constrictions or compressions should be allowed to hamper the respiratory play of the chest and abdomen, or to impede the circulation of blood through the lungs and heart. With regard to the respiration of pure air, it may be said generally that it is within doors that the breathing of vitiated air is most likely to become dangerous, and is such a powerful excitant of consumption. (_Brit. Med. Journ._)

No person, particularly if young, should be allowed to sleep in the same bed, or even in the same room, with a consumptive. No person should be allowed to remain for too long a time in too close or too constant attendance on a consumptive. Ventilation as perfect as possible should be secured. The expectoration of phthisical patients should be carefully disinfected. Those phthisical patients who are in the habit of mixing freely with other persons should wear one of those antiseptic respirators which are now to be obtained for a few pence.

_Corns._--(_a_) Salicylic plaster has recently been put upon the market as a cure for corns, bunions, and thickened skins generally. The price is reasonable enough, but some may prefer to make it for themselves. Dissolve 2 dr. each of salicylic acid and common yellow resin in 6 dr. sulphuric ether, and paint the solution over belladonna or opium plaster spread on swan’s-down. The mixture dries almost instantaneously, and the plaster is then ready for cutting up into suitable sizes for corns. Considering that the whole does not cost more than 3-4_s._ per yd., and that several thousand plasters may be made out of that quantity, it is cheap.

(_b_) Some corns are so painful that neither paint nor plaster can be endured, something of the nature of a shield alone giving relief. For such cases as these, the following wrinkle may be appreciated: Take a corn-shield, enlarge the diameter of the hole to a small extent by means of a knife or scissors, and apply in the usual way. Then place in the hollow thus formed over the corn, a small quantity of any of the following solutions: Salicylic acid and extract cannabis indica dissolved in ether; or ½ dr. extract cannabis indica dissolved in 2 dr. liquor potassæ; or a saturated solution of iodine, or iodide of potash, in strong alcohol. The shield does the double service of taking the pressure of the boot off the corn, and at the same time preventing the liquid being rubbed off by the sock; while all these solutions penetrate the skin with more rapidity than the usual collodion preparation, and are consequently much more effective in their operation. The saturated solution of iodine often succeeds in removing corns and indurated epidermis when other remedies have failed, and the well-known solvent action of liquor potassæ is a sufficient credential to induce for it at least a trial.

(_c_) Many corns may be removed by a persevering application of the ordinary shield, which, relieving the pressure of the boot, enables nature to throw off the old skin. Acetic acid, too, is an excellent remedy for corroding the indurated epidermis; but it is necessary to protect the surrounding parts by means of a paper shield.

(_d_) Mix 16 fl. oz. collodion with 2 oz. (avoir.) salicylic acid, and, when this is dissolved, add 1 oz. (avoir.) zinc chloride. Keep it tightly stoppered and away from lights or fire.

(_e_) Three dr. euphorbium, 6 dr. powdered cantharides, 4 dr. Venice turpentine, 4 oz. alcohol. Macerate the euphorbium and cantharides with the alcohol for 48 hours, strain, and add the Venice turpentine; spread on French tissue-paper with a soft brush--size of each sheet about 18 by 24 in. This article is in much repute for the cure of corns and bunions, and the relief of gout.

(_f_) Dissolve 1 part salicylic acid in 40 of collodion: apply several times a week. The corn dissolves with little trouble.

(_g_) For hard corns apply at night a mixture of 1 part carbolic acid, and 10 of distilled water, glycerine, and soap liniment. Envelop with guttapercha tissue, and the corn may generally be removed the next morning.

(_h_) Gezou’s remedy for corns and warts is prepared as follows:--30 gr. salicylic acid, 10 gr. ext. cannabis indica, ½ oz. collodion.

(_i_) Fasten a piece of lemon on the corn, and renew night and morning. Simple but very effective.