Belladonna. The German writers praise belladonna beyond measure, and would almost consider it as a specific in hooping cough; they recommend it even at the commencement. But it is principally during the second stage that it is of service, it being always a condition ella. that there is neither acute bronchitis, nor phenomena of cerebral

congestion, nor any pulmonary congestion; it would be then more injurious than useful. Laennec employed belladonna in the form of extract, in the dose of 15 to 37 grain, and he admitted that it class ind calmed the spasm of the bronchi and diminished the difficulty of th= pls, breathing. MM. Guersant, Blache, and Baron also prescribed belladonna in gradually increasing doses, even until the symptoms of narcotism were produced. M. Trousseau associates opium and valerian with belladonna, and thus avoids the insomnia which this substance most frequently causes. The tincture and the syrup of belladonna are convenient preparations to give to children at the breast, and they should be preferred to the other methods of administration.

This remedy has also been employed by means of frictions on the chest, but it then appears to possess very slight efficacy.

Conium. Conium is far from deserving the repute it has acquired; like other sedatives, it possesses the inconvenience of diminishing the expectoration. Nevertheless, M. Guersant appeared to place great confidence in the following mixture:

Belladonna, conium, oxide of zinc-of each equal parts.

Commence by the .15 of a grain, repeated three times a day, and progressively increase it according to the state of the little patieut. But should the good effects which are obtained be attributed to the conium? A great portion of the success may be referred, at least so it appears to me, to the belladonna and oxide of zinc. Let us profit by this occasion to remark that the combination of various narcotics possesses a more powerful action than that of the component parts given separately.

Hyoscyamus, lactuca, cherry laurel water, repeatedly distilled and unfiltered, hydrocyanic acid, have been also recommended in the second stage of hooping cough, and have produced a more or less decided effect. Distilled cherry laurel water and hydrocyanic acid are remedies which we can scarcely make use of for little children.

If we would obtain the real effects from narcotics, their employment should be suspended for some days, and then resumed; for without this precaution, the economy soon becomes accustomed to them, and all the benefit of the medication is soon lost.

Antispasmodics. Every one of the remedies of this class has been employed against hooping cough. The only ones which are in much repute are musk, castoreum, syrup of ether, assafoetida, oxide of zinc, the subnitrate of bismuth. Musk has especially succeeded in

those subjects endowed with a nervous constitution; artificial musk (a mixture of concentrated nitric acid and oil of amber) would appear preferable to musk itself.

M. Guersant has observed the oxide of zinc succeed, especially in very young subjects, in the dose of one or two grains every two or three The Ox hours, without exceeding the extreme limit of fifteen to twenty grains

a day. I have often employed it thus, in fractional doses, either alone or combined with a small quantity of powder of valerian or of belladonna, and I have always found benefit from its use.

It

Under the title of an antispasmodic, cochineal has been administered in all stages of the disease, and it is said, always with success. should be be administered in the following manner:

Make a mixture, of which a teaspoonful should be given three or four times

a day.

Tannin has been given in the following dose and manner:

Mix and divide into twelve doses, one of which should be taken every two hours in water.

Alum is often made use of in the hospitals for children at London, in the dose of one and a half to seven and a half grains every four or six hours to children from one to ten years of age.

The following is the formula which is generally used:

Sulphate of alumina and potash

Extract of conium

Syrup of corn-poppy

Fennel water

11 grains.

9 grains.

3 iij.

3 iij.

Mix. A dessert spoonful every six hours.

We have seen M. Trousseau try, without much success, the subnitrate of bismuth and the syrup of strychnine in a case of hooping cough which had resisted all the means extolled against this disease.

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The treatment which sometimes succeed in suffocative catarrh has also been tried; I refer to the respiration of etherized vapours. Bell* speaks very highly of the results obtained by sprinkling a little ether on the clothes of the patient at the onset of the paroxysm. Use has also been made of fumigations composed of a mixture of olibanum, benzoin, and styrax, of each eight ounces; of lavender and rose flowers, of each five pounds. But we should only have recourse to these remedies after all the usual resources have been exhausted.

[The following are the results of Dr. Churchill's experience of ether and chloroform in the treatment of this disease: "Soon after the discovery of the anaesthetic effects of sulphuric ether, it struck me that it would be likely to modify or suspend the spasm in hooping cough; and having a case under my care, I directed that a little (I suppose about half a drachm) should be spilled upon the nurse's hand, and held before the child's nose and mouth at the commencement of a fit of coughing. I preferred this simple mode of administration, and do so still, because of the impossibility of thereby giving an overdose. The effect surpassed my expectation;

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most generally the paroxysm was shortened one half-often stopped immediately-ilies

and the duration of the disease unquestionably considerably diminished. Since then I have tried the ether in twelve or fourteen cases, and chloroform in six. In one or two cases no benefit accrued, in others great mitigation of the spasm, and in three or four almost complete relief when the ether was applied at the beginning of a fit of coughing. Decidedly also in two thirds of the cases the course of the disease was much shortened, so that I look upon this as a valuable addition to our remedies. In no instance was insensibility or the least inconvenience occasioned."(On Diseases of Childhood; p. 223.)

In the cases of very young children it is difficult to cause the inhalations to be performed at the right time and in the proper manner, but in older children (twelve or fourteen) Dr. Churchill directs the inhalation to be used at the moment when tickling in the larynx is felt, the chloroform removes the spasm and the cough is for the time prevented. By persisting with the chloroform in this way the threatenings of attacks becomes less frequent and at last cease.-P.H.B.]

It may be of advantage to administer internally a few spoonfuls of a julep of iss to 3 ij, to which four or five drops of liquor ammoniæ have been added. Although I have not employed this remedy, it may be imagined that it would possess, in hooping cough, the same result as in other nervous diseases attended with suffocation, such as hysterical spasms, the dyspnoea of pulmonary emphysema, &c.

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Here would also be an opportunity of employing cauterization of the palate or of the pharynx with ammonia. This operation rapidly applied, with all the necessary precautions, by means of a brush composed of # cotton or of wool slightly moistened, undoubtedly puts a stop to the nervous symptoms of hooping cough, in the same manner as it causes the disappearance of the asthma, consequent upon pulmonary emphysema. It is a means of which we cannot judge à priori, and is one which is well worth the trial.

Tepid baths once or twice a day, especially when the nervous symptoms predominate, have appeared to diminish the attacks, and procure sleep. To guard against determination of blood to the brain, the head and forehead should be bathed with a sponge dipped in cold water. But in the case of inflammatory complication of the thoracic organs, we should abstain from this remedy, or at least employ it with the greatest caution (Blache, Guersant).

Revulsives. No importance is to be attached to cutaneous revulsives applied to young children, they only produce very extensive irritation, cause insomnia, and sometimes bring on a more or less intense febrile

state. Thus blisters, the pomade of Autenrieth, and spirits of turpentine should, in our opinion, be proscribed in the treatment of hooping cough in children at the breast. These means are only useful in those cases in which an intense bronchial inflammation exists at the same time as the hooping cough.

Other internal revulsive means may be employed with more advantage.

Putere 2 Thus, the daily cauterization of the pharynx and of the epiglottis

Fallon of horfur days. We may even employ, as I have previously observed, slight cauterization with weak liquor ammoniæ, applied by means of a brush not too full of liquid.

with a solution of nitrate of silver, fifteen grains to one ounce of distilled water, effected the cure of a hooping cough in eight or ten

[Dr. Watson (Assoc. Med. Journ., August) speaks of the great utility of topical applications to the larynx in hooping cough; he uses the sponge and whalebone employed by Dr. Green, with a solution of nitrate of silver of variable strength from gr. xv toij to 3j according to the stage of the disease; it should be applied every second day or more frequently if the hoops are violent. Watson (Glasgow Med. Journ., April) combining his cases and those mentioned by Soubert (Bulletin de Therapeutic. Dec. 52), finds that by this means in 125 cases, 62.4 per cent. were cured within a fortnight, 31.2 per cent. within three or four weeks, and 6.4 per cent. resisted the treatment.

When the disease is complicated with convulsions, the treatment will be of no avail without the frequency and violence of the cough can be lessened. Hydrocyanie and belladonna are likely to be of service in these cases.-P.H.B.]

3rd Stage. When the hooping cough has arrived at the stage of decline, the fits of cough, although less frequent, still preserve their convulsive character, and sometimes the termination of the disease is delayed a long time. The emollient ptisans should be discontinued, and replaced by tonics and bitters.

Light decoctions, lichen, gentian, polygala, centaury, quinquina, infusions of wild thyme, or of hyssop, may be given; and, according to the age, sulphurous mineral waters, those of Bonnes, of Cauterets, or of Enghien, either alone or mixed with milk or corn-poppy water.

Lastly, when the disease prolongs itself, and when a chronic catarrh succeeds hooping cough, a blister may be applied over the chest, then it may be reapplied over the arm, or may be replaced by an issue.

[As the disease manifestly does not consist in an inflammatory condition of any part, the antiphlogistic plan of treatment should be avoided, as its tendency 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.

The occurrence of bronchitis and pneumonia, as complications of the disease, should be carefully guarded against, by keeping the patient in a well-ventilated apartment, of uniform temperature; at the same time the general nutrition should be attended to by a nourishing and easily digested alimentation, meat in regulated quantities, and properly masticated.

Dr. Todd ́speaks of sponging the chest with cold water, once or twice a day, as a practice which exercises a most favourable influence on the nervous system. This Cof sponging of the back and front of the chest, night and morning, exercises a bracing and tonic influence on the nerves, and in this way often acts very beneficially in this disease. Sedative and antispasmodic remedies, in virtue of the power which they possess of allaying irritability of the nervous system generally, such as the various

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preparations of opium, henbane, conium, belladonna, an, hydrocyanic acid, Cities ling

beneficially employed; the non-nauseating expectorants, such as chloric ether, ammonia, and senega, may be used; and when the bronchial secretion is excessive, alum, sulphate of zinc, tannic and gallic acids, are often of service.-P.H.B.]

APHORISMS.

207. Hooping cough is a special and specific disease, the result of the influence of a specific, indiscernible, and incontestable agent, the effects of which, on the organism, always astonish the common herd of anatomo-pathologists.

208. Fits of coughing, the successive attacks of which are interrupted by a long, sonorous, and noisy inspiratory hoop, characterize hooping cough.

209. Hooping cough is evidently a contagious disease. 210. Hooping cough is often epidemic.

211. Hooping cough, originating in a place, dies and disappears a little distance off, by the sole fact of removal, and of the modifications occasioned in the hæmatosis by the change of air and of locality. 212. Hooping cough is sometimes observed in children at the breast and in adult age, but it especially attacks subjects of second childhood. 213. Hooping cough is a nervous disease grafted on a bronchitis; it commences by a catarrh, and terminates by spasms peculiar to itself. 214. Hooping cough is unfavourable at certain times, according to the epidemic constitution of the situation, or of the year.

215. It is a singular fact, that hooping cough only appears to possess importance from its indirect consequences; for instance, the vomitings which result from the fits of cough, and which bring on inanition; and also, the fibro-plastic deposits of the lungs which sooner later engender granular pneumonia, &c.

or

216. Hooping cough is the only disease of early childhood in which the cough is accompanied by a real expectoration.

217. An acute disease, coming on during hooping cough, diminishes its intensity, and causes its disappearance, either for a short time, or in a definite manner (Trousseau).

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