Occurring in Bronchitis, Pneumonia, Consumption or Tuberculosis, Asthma, and Influenza or Grippe. Cough is a symptom of many disorders. It may be caused by irritation of any part of the breathing apparatus, as the nose, throat, windpipe, bronchial tubes, and (in pleurisy and pneumonia) covering membrane of the lung. The irritation which produces cough is commonly due either to congestion of the mucous membrane lining the air passages (in early stage of inflammation of these tissues), or to secretion of mucus or pus blocking them, which occurs in the later stages.
Cough is caused by a sudden, violent expulsion of air from the chest following the drawing in of a deep breath. A loose cough is to be encouraged, as by its means mucus and other discharge is expelled from the air passages.
A dry cough is seen in the early stages of various respiratory diseases, as bronchitis, pneumonia, pleurisy, consumption, whooping cough, and with irritation from enlarged tonsils and adenoids occurring in children.
Irritation produced by inhaling dust, or any irritation existing in the nose, ear, or throat may lead to this variety of cough. The dry cough accomplishes no good, and if continuous and excessive may do harm, and demands medicinal relief.
Bronchitis. Cough following or accompanying cold in the head and sore throat generally means bronchitis.
The larynx or lower part of the throat ends just below the “Adam’s apple” in the windpipe. The windpipe is about four and a half inches long and three quarters to an inch in diameter, and terminates by dividing into the two bronchial tubes in the upper part of the chest. Each bronchial tube divides and subdivides in turn like the branches of a tree, the branches growing more numerous and smaller and smaller until they finally end in the microscopic air sacs or air cells of the lungs. The bronchial tubes convey air to the air cells, and in the latter the oxygen is absorbed into the blood, and carbonic acid is given up. Bronchitis is an inflammation of the mucous membrane lining these tubes. In cough of an ordinary cold only the mucous membrane of the windpipe and, perhaps, of the larger tubes is inflamed. This is a very mild disorder compared to inflammation of the smaller and more numerous tubes.
In bronchitis, besides the ordinary symptoms of a severe cold in the head, as sneezing, running of mucus from the nose, sore throat and some hoarseness perhaps, and languor and soreness in the muscles, there is at first a feeling of tightness, pressure, and rawness in the region of the breastbone, with a harsh, dry cough. The coughing causes a strain of the diaphragm (the muscle which forms the floor of the chest), so that there are often pain and soreness along the lower borders of the chest where the diaphragm is attached to the inside of the ribs. After a few days the cough becomes looser, greatly to the patient’s comfort, and a mixture of mucus and pus is expectorated. In a healthy adult such a cough is usually not in itself a serious affair, and apart from the discomfort of the first day or two, there is not sufficient disturbance of the general health to interfere with the ordinary pursuits. The temperature is the best guide in such cases; if it is above normal (98 3/5° F.) the patient should stay indoors. In infants, young children, enfeebled or elderly people, bronchitis may be a serious matter, and may be followed by pneumonia by extension of the inflammation from the small bronchial tubes into the air sacs of the lungs, and infection with the pneumonia germ. The principal signs of severe attacks of bronchitis are rapid breathing, fever, and rapid pulse.
The normal rate of breathing in adults is seventeen a minute, that is, seventeen inbreaths and seventeen outbreaths. In children of one to five years the normal rate is about twenty six breathing movements a minute. In serious cases of bronchitis the rate may be twenty five to forty in adults, or forty to sixty in children, per minute.
Of course the only exact way of learning the nature of a chest trouble is thorough, careful examination by a physician, for cough, fever, rapid breathing and rapid pulse occur in many other diseases besides bronchitis, particularly pneumonia.
Pneumonia begins suddenly, often with a severe chill, headache, and general pains like grippe . In a few hours cough begins, short and dry, with violent, stabbing pain in one side of the chest, generally near the nipple. The breathing is rapid, with expanding nostrils, the face is anxious and often flushed. The matter coughed up at first is often streaked with blood, and is thick and like jelly. The temperature is often 104° 105° F.
If the disease proceeds favorably, at the end of five, seven, or ten days the temperature, breathing, and pulse become normal suddenly, and the patient rapidly emerges from a state of danger and distress to one of comfort and safety. The sudden onset of pneumonia with chill, agonizing pain in side, rapid breathing, and often delirium with later bloody or rusty colored, gelatinous expectoration, will then usually serve to distinguish it from bronchitis, but not always.
Whenever, with cough, rapid and difficult breathing occur with rise of temperature (as shown by the thermometer) and rapid pulse, the case is serious, and medical advice is urgently demanded.
Treatment of Acute Cough and Bronchitis. In the case of healthy adults with a cough accompanying an ordinary cold, the treatment is very simple, when there is little fever or disturbance of the general health. The remedies recommended for cold in the head (p. 55) should be taken at first. It is also particularly desirable for the patient to stay in the house, or better in bed, for the first day or two, or until the temperature is normal.
The feeling of tightness and distress in the chest may be relieved by applying a mild mustard paper over the breastbone, or a poultice containing mustard, one part, and flour, three parts, mixed with warm water into a paste and spread between two single thicknesses of cotton cloth about eight inches square. The tincture of iodine painted twice over a similar area forms another convenient application instead of the mustard. If the cough is excessive and troublesome at night the tablets of “ammonium chloride compound with codeine” are convenient. One may be taken every hour or two by an adult, till relieved.
Children suffering from a recent cough and fever should be kept in bed while the temperature is above normal. It is well to give infants at the start a grain of calomel or half a teaspoonful of castor oil, and to children of five to eight years double the dose.
The chest should be rubbed with a liniment composed of one part of turpentine and two parts of camphorated oil. It is well also to apply a jacket made of sheet cotton over the whole chest. It is essential to keep the room at a temperature of about 70° F. and well ventilated, not permitting babies to crawl on the floor when able to be up, or to pass from a warm to a cold room. Sweet spirit of niter is a serviceable remedy to use at the beginning: five to fifteen drops every two hours in water for a child from one to ten years of age, for the first day or two.
If the cough is harsh, hard, or croupy, give syrup of ipecac every two hours: ten drops to an infant of one year or under, thirty drops to a child of ten years, unless it causes nausea or vomiting, when the dose may be reduced one half. If children become “stuffed up” with secretion so that the breathing is difficult and noisy, give a teaspoonful of the syrup of ipecac to make them vomit, for until they are six or seven years old children cannot expectorate, and mucus which is coughed up into the mouth is swallowed by them. Vomiting not only gets rid of that secretion which has been swallowed, but expels it from the bronchial tubes. This treatment may be repeated if the condition recurs.
In infants under a year of age medicine is to be avoided as much as possible. A teaspoonful of sweet oil and molasses, equal parts, may be given occasionally to loosen the cough in mild cases. A paste consisting of mustard, one part, and flour, twenty parts, is very useful when spread on a cloth and applied all about the chest, front and back. The diet should be only milk for young children during the first day or two, and older patients should not have much more than this, except toast and soups. In feeble babies with bronchitis it is wise to give five or ten drops of brandy or whisky in water every two hours, to relieve difficulty in breathing.
Children who are subject to frequent colds, or those in whom cough is persistent, should receive Peter Möller’s cod liver oil, one half to one teaspoonful, according to age, three times daily after eating. One of the emulsions may be used instead if the pure oil is unpalatable. Adenoids and enlarged tonsils are a fruitful source of constant colds and sore throat, and their removal is advisable. Hardening of the skin by daily sponge baths with cold salt water, while the child stands or sits in warm water, is effective as a preventive of colds, as is also an out of door life with proper attention to clothing and foot gear.
Treatment of Pneumonia. Patients developing the symptoms described as suggestive of pneumonia need the immediate attention of a physician. If a person is unfortunate enough to have the care of such a case, when it is impossible to secure a physician, it may afford some comfort to know that good nursing is really the prime requisite in aiding recovery, while skillful treatment is of most value if complications arise.
One in every ten cases of pneumonia in ordinarily healthy people proves fatal. In specially selected young men, as soldiers, the death rate from pneumonia is only one in twenty five cases. On the other hand, pneumonia is the common cause of death in old age; about seventy out of every hundred patients who die from pneumonia are between sixty and eighty years of age. Infants under a year old, and persons enfeebled with disease or suffering from excesses, particularly alcoholism, are also likely to die if stricken with the disease.
The patient should go to bed in a large, well ventilated, and sunny room. The temperature of the room should be about 70° F., and the patient must not be covered so warmly with clothing as to cause perspiration. A flannel jacket may be made to surround the chest, and should open down the whole front. The nightshirt is worn over this; nothing more. Daily sponging of the patient with tepid water (85° to 90° F.) should be practiced. The body is not to be all exposed at once, but each limb and the trunk are to be separately sponged and dried. If the fever is high (104° F.) the water should be cold (77° to 72° F.), and the sponging done every three hours in the case of a strong patient. Visitors must be absolutely forbidden. No more than one or two persons are to be allowed in the sick room at once.
The diet should consist chiefly of milk, a glass every two hours, varied with milk mixed with thin cooked cereal or eggnog. It is wise to give at the beginning of the disease a cathartic, such as five grains of calomel followed in twelve hours by a Seidlitz powder, if the bowels do not act freely before that time. To relieve the pain in the side, if excruciating, give one quarter grain morphine sulphate, and repeat once, if necessary, in two hours. The application of an ice bag to the painful side frequently stops the pain, and, moreover, is excellent treatment throughout the course of the disease. The seat of pain usually indicates that the lung on that side is the inflamed one, so that the ice bag should be allowed to rest against that portion of the chest. Water should be freely supplied, and should be given as well as milk even if the patient is delirious.
The bowels are to be moved daily by glycerin suppositories or injection of warm water. Dover’s powder in doses of five grains is useful to assuage cough. It may be repeated once, after two hours’ interval if desirable, but must not be employed at the same time as morphine. After the first two or three days are passed, or sooner in weak subjects, give strychnine sulphate, one thirtieth grain, every six hours in pill or tablet form. The strychnine is to be continued until the temperature becomes normal, and then reduced about one half in amount for a week or ten days while the patient remains in bed, as he must for some time after the temperature, pulse, and breathing have become normal.