PATHOLOGY AND PRACTICE OF MEDICINE.
On Nervous or Convulsive Cough. By M. Sandras.—There are
several varieties of this:—1. The patient can receive no physical or
moral impression, without suffering from a cough almost convulsive in
its character. In examining the chest of such a person, the physician
may be led into grievous error, and the unnecessary fear of incipient
phthisis, unless he examines it on various occasions and under different
circumstances. Patients with incipient phthisis also cough from the
slightest cause ; but it will be generally found that in those cases the
impression is physical, while in those we are alluding to it is oftener
moral.
2.	Another form of cough, having some analogy to this, is observed
whenever certain functions are brought into play, or when they are more
actively exerted than usual. Thus, it is found in some whose meals
have been too long delayed, in others as soon as they have eaten,
especially if rather fully. Other persons cannot take a little extra mus-
cular exertion without bringing on a tormenting cough of this kind. In
both this and the preceding form the cough is dry and capricious,
exhibiting very inconstant physical signs ; but this latter form is some-
what more fixed in character than the first, inasmuch as in the same
person it is always when the same function is fulfilled that it is produced ;
and it seems, too, to be more dependent upon disorder of the organs in
connexion with the exercise of whose functions it appears; and this
should be our chief guide for its treatment.
3.	Another cough is observed upon the slightest irritation of the
bronchi being produced ; so that the least cold brings on a convulsive
cough nearly as bad as that of pertussis. Sometimes, and especially in
children and in very young adults, it takes on this form from the very
commencement of the cold, and retains it until coction is produced.
Each paroxysm is accompanied by a dry, raucous sound, and attempts
at vomiting. Sometimes it is periodical, the disease only gradually
assuming the characters of an ordinary ripening catarrh. In other cases
the spasmodic character is only observed as the cough is drawing to-
wards an end. Instead, however, of coction taking place, the expec-
toration continues frothy and transparent, and is only ejected by con-
vulsive efforts and vomiting—the paroxysm being brought on by the
slightest cause, and a. state of spasmodic suffocation being almost
induced, until a little transparent and frothy matter is expectorated,
when all becomes quiet and normal until a new paroxysm. In some
cases the cough suddenly ceases, without the expectoration having un-
dergone any change; but this is rare. The causes of this pertussoid
cough are not of easy appreciation. At the commencement, all is like
a common cold; and' it is the reiterated catching cold in an eminently
neuropathic subject that seems to induce the aggravation. The prog-
nosis, as regards immediate danger, is favorable ; but is more serious in
respect to future consequences, owing to the various evil consequences
which may ensue upon the congestions the paroxysms give rise to.
The destruction of sleep and disturbance of digestion which it causes
are other important circumstances. Among the more serious results,
is the production of hernias and of emphysema pulmonum. The irri-
tation of the glottis and larynx should be relieved by tepid aqueous or
narcotic vapours, and by the use of demulcent emulsions with laurel-
water. When the expectoration is difficult, syrup of poppies, with
small doses of tartar emetic, should be given, the antimony, whether it
causes vomiting or not, affording great relief. So, too, small doses of
extract of belladonna every night, or night and morning, should be given
when the expectoration is somewhat modified, and in a few days the
convulsive character of the cough usually abates. When this drug dis-
agrees with the patient, it should be used endermically.
4.	This variety may be called hysterical, from its occurring in hys-
terical patients. In a subject whose respiratory organs are habitually
in a good condition, all at once an irregularly paroxysmal cough comes
on, occurring at frequent intervals, and sometimes almost without inter-
mission. It does not terminate with the expulsion of mucosities, but is
either dry and objectless, or is accompanied by a true phlegmorrhagia.
Hysterical phenomena sometimes precede or accompany the cough ;
while at others it ceases instantly that these appear. The cough is
found to get worse and worse, in proportion to the developement of the
hysteria; and this without any physical explanation of its intensity.
The pulse is not febrile, but may be irregular, and such a one as is found
in nervous subjects. The prognosis is favorable, unless the cough is
mistaken for a phlegmasia, and aggravated by maltreatment. The
treatment is, in fact, that which is proper for hysteria ; but two means
are especially indicated—the use of belladonna, and the employment of
baths. Belladonma, given in doses of one seventh of a grain every
half-hour, is highly efficacious ; and it is rare for five or six doses to be
given before improvement is visible. Baths at from 84° to 89° act as
if by enchantment; but sometimes it is useful to give them at 75° to
82° ; and this is the temperature which will in most cases prove the
best, after the patient has already employed the higher.—British and
Foreign .Med. Rev. from Bulletin de Therapeutique.