[Presented before I.H.A., Bureau of Materia Medica, September, 1944].
ELIZABETH WRIGHT HUBBARD, M.D.
This has been a year for coughs in New York. I dont know what it has been in Akron, but there is always an epidemic, some years it is croups and some years pneumonia; but this year New York City has coughed its head off. That suggested to me I might briefly give you a few ideas about cough as it seemed to me this year.
I was educated by Pierre Schmidt, over in Europe. I have to mention it so as to have the spirit, and he said, “When you do the Kent Repertory, study mind first, generals second, and cough third.” I was a young thing that was many years ago and I thought, “Why cough third?” but this winter I know why.
The most handy thing, aside from the repertories and your own knowledge of the materia medica, is that little gem, Lee & Clarkes little repertory on Cough. It is what Bells Diarrhoea is to diarrhoea. Also, if you are a user of Dr. Bogers Card Repertory I play with it since Dr. Hayes says it does so well for him you will find one-third of the cards in his box are pertinent to cough. That is simply amazing. So, you see, cough is quite a subject.
Every remedy in the materia medica, practically, has cough, so how are you going to know what kind of cough? What symptoms do you need to guide you?.
I have a British husband and he came to me the other day and said, “Woman, I have a cough. Give me something for it or I shall go to the allopath”.
I said, “What kind of cough have you, dear?”.
He said, “Begging your pardon, a hell of a cough”.
Well, you cant find that in the repertory, and yet there are certain remedies which have a hell of a cough, and I dont ever want to go out on an acute house visit without those few remedies. It is really beginning at the end instead of at the beginning to tell you what I consider those few remedies to be, but certainly one of them is Belladonna.
I have had two cases this winter in which the coughing was so dreadful I really thought one old lady, who has a little aneurism, would burst something if we didnt stop it. She had been coughing for hours before she called for me, and she lived way up in the sticks, and when I got there she was in such a continuous spasm of coughing I think an allopath would have given her chloroform. I didnt even look at her. I went into the bag I could tell by the sound and got Belladonna 50M., and in two minutes she said, “Oh, well, that is the first time I havent coughed like that in six hours”.
So you want always to carry Belladonna for some of these perfectly frightful coughs.
Then I had a small boy whose family telephoned me one morning. Literally he had coughed every sixty seconds all night, and the whole house had been up just “Bing, bing, bing, bing, bing, bing!” You know what that is the minute they begin to cough, and there were practically no symptoms of consequence except the second of that sharp repeating. He had no cold or fever, felt perfectly well, couldnt get his breath, and coughing, coughing, coughing, dry, unproductive.
I looked at him and said, “What did you want to eat today?”. His mother laughed and said, “He has been impossible. He wont eat anything. He went out in the pantry and grabbed a jar of anchovies, which we dont let him eat, and he ate them, and went and got a box of salt crackers and ate them in between his “Bing, bing, bing”.
You all know how Corallium rubrum, “craves salty things,” and the poor child had one other symptom I got out of him, felt every little bit of air that went by went all through him, and that is in the book, “sensation as though a draft of air goes through your head and chills your air passages when you breathe.” That child, again inside of ten minutes after a 10 M. dose of Corallium rubrum, stopped that dreadful “Bing, bing, bing !”.
There is another one to carry around with you.
Then some of the worst coughs I have even seen, curiously enough, needed Ignatia. You never would think of it, but i had a very charming French lady, of most uncertain age, who was so daintily dressed and so delightful, and I found her children had spoiled her, and she came and told me that she coughed every night, chiefly, but pretty much also all the day, and that it had such a spasm.
She never coughed when she came to my office, and I couldnt make her cough. I said, “Please, madam, will you cough?”.
She said, “But I cant”.
“Do you really cough as badly as you think you do?”.
The daughter-in-law said, “It is just terrible how she coughs”.
I tried to get out of her something about her, and I said, “why dont you cough when you come to my office?”.
She said, “I dont know. I dont want you to see me at a disadvantage”.
And I thought, “My goodness, she doesnt have to cough. She can stop coughing,” and so I thought, “I was foolish. I should have given it right away, but I didnt for she said, “The cough simply strangles me and I almost vomit,” and I was in a hurry Dr. Plumb Brown where is he? and I did a little “rapid-firing,” and gave a dose of Cuprum. That has “lovely spoiled ladies and spasmodic coughs,” and I sent her home feeling very proud of myself, and the next day the family said, “Mama is terrible! She coughed all night again”.
I thought, “That wont do.” Then I remembered she didnt cough when she came to see me because she didnt want to make a bad impression, and I sent up to her Ignatia 50M., one dose. She had been coughing like this nearly two weeks, but she never coughed again.
It is very interesting what those remedies will do when they really are badly needed.
Then of course, you all know of coughs that are quite desperate, that bark and that choke, and that want to have three or four pillows, and crave hot drinks, and that sound like sawing through a board if you ever do, and I do, even though I am a doctor and often Spongia will bring peace in the household with those. That is another of my “hell of a remedies”.
But my good man didnt need any of those, and as he wouldnt tell me any symptoms, I stuck around and listened to him, and he sounded like somebody ringing a bronze gong when he coughed, a most terrific metallic noise. How a human chest can make it, I dont know. He has a big one, and I suppose that is why. It is really like a metal thing. He said he had no other symptoms whatsoever. He loves beer, and I said, “For you, Kali bichromicum,” and he took it and his cough went away. He didnt have to go to the allopath!.
Now, to stop being frivolous for a moment, and come back from these terrific remedies, what is it really we want to know about coughs in order to be able to prescribe for them?.
I, unfortunately, have a “mail order” practice. It sounds most illegal, but it isnt. I have lots of suburban patients and they write in and telephone in and expect me to do a little miracle out of the little case they have at home. I say, “Get the patient to the phone. Let me hear her cough.” The one thing I want with a cough is to hear it, and often over the phone you can get an instant reaction to something from the sound of that cough.
I should like to remind you of the sound of certain coughs that I know. I wish I could imitate them. Do you know the people that go “H-h-h-e-ah-he-he-ah” so feeble they havent got pep enough to cough; you say, “For goodness sake, come across and cough,” and they do it and do it, and do it, and you worry about them. I worry about them much more than the people, these terrible people, who need not Cuprum and Spongia, those mean little “Aheh- heh” coughs they just vanish often with a dose of Tuberculinum or Bacillinum. Those little coughs are very nasty and I dont know any so-called acute remedies which will reach them as those nosodes will.
Then there are the terrible barks to whom you give Aconite, croupy barks, a different sound, again, from Spongia; sound almost animal Aconite, Belladonna, Aconite, and the croupy sounds, sounds metallic. Spongia, sounds woody, like a woodywind, instead of like an animal to me, that is I suppose everybody hears things differently, but you get a perfectly definite sense as you do in the realm of smell some doctors come in a house and can smell diphtheria. They dont have to see the patient; they know what it smells like, and certain diseases do smell like that.
I was called another day to a tonsillitis and got that smell, and took a throat culture, but the Board of Health said it was negative, but it got a remedy which is great for diphtheria, which has that kind of thing.
Have you heard Ipecac patients cough? They cough with a wheeze mixed in, a kind of tension, tightness, and, on the contrary, Antimony coughs with a cough so rattley and feeble and cant do anything about it. One cough I like to hear is the Iodine cough. It is as hard as Phosphorus and as violent sometimes. All the Iodine things are violent as violent almost as Corallium and yet it has a roughness like somebody playing badly. Take Bromium that is a curious combination of hardness of Phosphorus and roughness of the Halogens. It is a very distinctive cough. “Concussed” is the word should use for it.
Well, you will think my prescribing is very funny, but sometimes if you get those things into your soul, it saves you a lot of time and you dont have to repertorize. You know what they need on those. So, I like to hear them cough, if I can, but very often I cant. Then what do I want to know?.
Usually patients will just hand it to you, if you just say, “Tell me about your cough.” They come out in the most charmingly naive way and tell you just the symptoms you need to repertorize, or what you need to know if you are blessed with good homoeopathic patients. When you get an allopathically-trained patient, you have to work for it.
They tell you everything you dont want to know and nothing you do want to know, and you have to help them, and with them I say, “What is queer and strange about your cough?” and they sit and look at me as though I were crazy, and begin to think what is queer about it and tell me some little funny trifle. One said, “I cough chiefly when I laugh. It is perfectly silly. I cant go in company, I cant go anywhere socially. I laugh and go into one of these awful coughs.” That helped me. It was interesting and the patient had not realized it.
Then we want to know what the modalities of anything are. Dr. Carr said that a strong general is a great thing and in wartime we all know it is and a strong modality is a great comfort, and very often you can get quite a few very distinct modalities from patients once you have taught them what it is and what it is you want to have.
Then one thing that helps me in prescribing for coughs particularly is the concomitants of a cough. Now I sound like Boenninghausen. Dr. Roberts should be here! But very often patients should have some little thing they dont connect with the nature of their cough and often they dont know they do it. A child will get a fit of coughing in your office and not cry but tear while they cough, or get red in the face while they cough, and a woman will tell you that she spurts a little urine when she coughs, and those concomitants are priceless rubrics for picking a really exact remedy.
Then there are some coughs very troublesome, which I call terminal coughs, which come after something else; after you have cleared up some sort of illness, they come, and those I find usually dont need a specific remedy. They need the patients constitutional, if you know what it is or if you can determine it, or one of the nosodes, Tuberculinum, Bacillinum, Medorrhinum, or even sometimes, if you know the cause, Influenzinum, to clear a cough, terminal, long after an influenza.
I could go into a much longer list of the remedies for coughs, but we have a big afternoon ahead of us. I should like to tell you what remedies I would put in my cough kit if I carried one. I have often wished I could have a little trailer to go behind me with a kit especially made up for everything; it would be so easy.
I would put in the cough kit: Antimonium tart. You all know why. Curiously enough, Alumina for the horrid little dry hacks, where they have a wad of phlegm down here and have uvulas that are too long. Belladonna, and, of course, Bryonia, everybody thinks of first for coughs, yet Bryonia doesnt get cough alone, only those going in pneumonia, but for just a plain cough, Bryonia is not much good to me. Bromium if it has hoarseness and feeling of fumes in the throat.
Have you ever smelled hydrocyanic acid? It hits you in the back that is the nasal pharynx, and Bromium does that, burns and hurts. Of course, Carbo veg. and Causticum. Speaking of sounds, you can hear the Causticum. You hear it scrape the trachea, the way you hear something scrape along a pipe. Cina how I love Cina in the naughty children. Rub the end of their nose and they fly in a tantrum and wont let you examine them, and cough their heads off, and throw up about it.
Coccus cacti I never have very good luck with it, but once in a while you do. I should like to hear some of your experience with it. I have borrowed potencies and bought potencies and restudied and restudied it, and rarely have any luck with it. Corallium, of course; Chromium beautiful cases of Chromium. Cuprum you couldnt do without that; Drosera, Hepar, Hyoscyamus, Ignatia, Iodum, Ipecac, Kali carb. my cough wouldnt have Kali carb. in it; for pneumonia, yes, cough with asthma, yes, but not plain cough, just cough. Kreosotum, sometimes. I should like to hear your experiences with Kreosotum. From the allopathic point of view, of course; it is very popular, and I have had a couple of cases in men of a syphilitic background with a great deal of catarrh, in whom Kreosotum was brilliant, but I personally dont see it often.
Strangely enough, Lachesis has cured many a tough cough for me and so has Arsenicum, although one doesnt connect either of them particularly with that; Mercurius, sometimes, though I think I see it less than some people do; Phosphorus, very often; Pulsatilla, universally the number, of course, that yield to that, nobody would believe if one didnt know. Rumex and Sanguinaria are among the big polychrests and constitutionals.
I would say I had cured more coughs with Lycopodium and Sepia than with any of the other big constitutional remedies; and finally Spongia, Stannum, Squilla, not often, but when you want it, how beautiful it is! Dr. Roberts says he never goes out without Cantharides and Squilla. Why, I wouldnt know. He told me that, He looked at my case and said, “Whats the matter? Never go anywhere without Cantharides and Squilla”.
Finally, Sulphur, the old standby, which has cured many an old, stubborn cough after I have tried to prescribe for it and have not succeeded.
This is just a humorous sketch of what the cough remedies can do but it may give you some ideas and I hope you will give me some ideas on ones I have omitted. I should like to know whether anybody uses Arabia racemosa. One of our old members, Dr. John Hutchinson, used to tell me that was his favorite cough remedy. I never see it indicated and never have any luck with it. Perhaps some of you have and can enlighten me.
DR. SUTHERLAND: I should like to make a comment and ask a question. Coughs are my bugbear. I hate coughs. I cant do a damn thing with coughs, and I am glad to hear this paper. I think I have some useful information now.
There is a group of remedies you dont have a chance to read very often, and you have to remember Spongia, Medorrhinum, and Zinc, all aggravated, particularly Zinc and Medorrhinum, by candy. I had a patient over whom I sweat blood for a week and a half until I found that she invariably coughed worse when she ate a piece of candy. I looked it up and Zinc was the remedy, and it disappeared in twenty-four hours. So those three I will never forget, but I dont have a chance to use them because you dont have those modalities very often. Rumex cough is aggravated by cold air. If he holds his hands in front of his face, he wants Rumex, and if they cough harder when you touch the throat, you know it is Allium cepa, which is similar to that.
I had a patient who needed Rumex, who kept still, and that was exactly the same kind of cough he had, always had, I suppose, and Rumex didnt touch it, but I found after further questioning he had Allium cepa symptoms. I looked it up and found this: “Cough aggravated by the least cold air.” He had to walk around the street this way (demonstrating) to keep the cold air away, and when the door opened and the air changed in my office, he held his hand up in front of his face to keep it at an even temperature. That is Allium cepa. Incidentally, he had an Allium cepa nasal discharge. I had that to serve as a differentiation.
The question I wish to ask is this: What remedy would be suggested by a cough that occurs in three, not three paroxysms of cough, but three short coughs, “Hack, hack, hack,” and then intervals and “Hack, hack, hack,” and another interval? I once saw that in a child who was coming down with measles and I looked it up and the nearest thing I could find was Cuprum and it didnt do a thing, so what would you do? Nature got her well, as in most measles cases. What is the remedy? She continued to cough until the eruption was well out and began to subside. Cuprum was the only remedy I could find that suited that, but it didnt suit that patient. Maybe I didnt give it high enough. I only gave her 200.
DR. WILSON: Doesnt Mercury help that?.
DR. SUTHERLAND: This wasnt a paroxysm; like a whooping cough paroxysm, where they have an actual paroxysm, and another repeated and another on top. This was three coughs, three single coughs.
DR. GRIGGS: Next time you get that symptom, you give nosode Marrubium in 10M. or CM. I have seen it work.
I am going to try to answer something about Kreosotum that Dr. Wright Hubbard mentioned simple, straight cough, but what was diagnosed as bronchitis, a little child, three and a half years old, with a recent hard, hacking type of cough, and admitted to the hospital for it after she got it. After she was there about twenty-four hours, the children complained, so that we had to isolate her because with the fetid bronchitis she smelled so bad. She coughed up a greenish-gray mucopurulent expectoration.
This expectoration became so offensive that even the nurse demurred to go and attend her, and we put a screen up around her. She was a dirty-looking, poor little mortal. I gave her Psorinum for three or four days. It did not do anything, but this time it had a grayish-green, pungent offensive expectoration. Coming along, the child had a zigzag temperature, and was very ill, and so offensive that I didnt bother listening to the chest effect. I couldnt stand it, so I gave Kreosotum to the child in the 200th potency and inside of a week I had the children all back in the ward. The offensiveness was all cleared and in two weeks I had the cough cured, which had existed for sometime before, several months before, so Kreosotum does cure a very pungent, offensive expectoration, accompanied by a hard, racking cough.
DR. MOORE: One dose?.
DR. GRIGGS: No. I gave it every three hours for one day. I always repeat the dose until there is improvement. My interpretation of Hahnemanns idea is to repeat the remedy until improvement is established, and then withhold it so long as improvement continues.
I think the worst cough I have ever heard in all my practice with children, the loudest cough, is produced by the nosode Pertussin. I have seen them cough and gag and retch, so you would think they were going to pass out the loudest kind of cough. It is called Coqueluchin now. It was first proved by John Clarke, of London, and I took his hints and I used it in some of the intractable coughs of children, with very prompt results. I sent over to Nelson and got his potency, the 1 and 10, and they are both very efficient, and I have cleared up some coughs that have gone the rounds and had all sorts of prescriptions loud, hard, retching coughs.
DR. AMES: I want to mention a remedy used in our own family. My daughter, when she was two years old, was desperately ill with whooping cough. I had prescribed everything I ever heard and got no results. We had consultations with a better prescriber than I was, and the remedy was Arnica, and the symptom was the child woke up and cried before the cough because it was going to hurt her.
DR. JACKSON: That old saw about the man who follows his nose wherever he goes, is not a bad things at all, particularly when you get accustomed to following your nose. Dr. Hubbard spoke of it in that case, and more than likely her nose was correct. The Health Departments laboratory test was probably wrong. You more than likely had a laryngeal diphtheria which didnt come up high enough for you to get a positive culture.
DR. FARRINGTON: This is such a large subject that we could talk all night on it. I havent heard anyone mention the old-fashioned garden herb, Thyme. I have found that when you get a cough with gagging, hard, racking give that medicine. It is the principal ingredient of a proprietary substance called Pertussin. This is one reason the name of the nosode was changed from Pertussin to Coqueluchin.
DR. VAN NORDEN: Dr. Hubbards cough remedies repertory is much larger than mine, but I still want to mention, though Dr. Sutherland took the wind out of my sails, Rumex. Dr. Hubbard did mention Rumex. I hadnt found any indication as far as I knew, for Rumex, either in Illinois or in Philadelphia, nor part of New Jersey, until I got down in Maryland, in Chesapeake City, and I suppose I have had two or three hundred cases of cough which Rumex has cleared up. The indication I get is complaint of a tickling here in the throat pit, and cough and cough. Once doesnt satisfy, and they cough half a dozen times or so and get a speck of mucus loose, and that is the end of it for a little while, and it starts up again.
Then I ask, “How is the cough at night?”.
“Well, it is worse from ten to thirty minutes when I lie down”.
And they dont cough again all night, and they have this of course, oftentimes, the cold air aggravation, also want to put the bed clothes over their head. I have cured many, many cases of it after Arsenicum and Ferrum phos., and many of these active epidemic cases of croupy cough I find Rumex comes in to clear that up.
Then I had a case down there of a lady who couldnt talk and couldnt have company because as soon as they talked a little while, she would have this tickling cough. Somebody told her to come to my office, but she didnt do it. Finally she got a bad cough, and couldnt seem to get rid of it. I cleared up the tickling cough and she didnt have it for a long time.
They went out to California a year or two after wars and she sent from California to Chesapeake City to get some Rumex.
DR. WILLIAMS: I think Dr. Roberts cant do anything more for homoeopathy than to emphasize the importance of modalities. Dr. Hubbard and I had the privilege of studying with Dr. Roberts for the summers at Boston when the American Foundation was there, and I have been so impressed in the years since we heard that work regarding the modalities of cough remedies.
You know Florida is a hotbed for respiratory troubles, with so many tourists coming in, with all sorts of upper respiratory tract infections, and we are busy treating such cases.
We seem to have fairly good luck with many of the coughs, and I have found the coughs which are worse in Miami need Pulsatilla. Pulsatilla has a dry evening cough and moist in the morning, and the cough that is worse lying down, and relieved the minute the patient sits up is quite frequently relieved with Pulsatilla. Nightly cough, Hyoscyamus, worse lying, doesnt have loose expectoration in the morning, Pulsatilla, but many time I have seen Hyoscyamus has relieved stubborn coughs of influenza or virus infection, as they call it now; and three years ago we had at one time over fifty thousand Army trainees and they brought us a new disease.
Many of the young trainees were ill with the virus infection that has spread over the country. These cases have not been the type of the old influenzal infections we have seen all the years (and I have finished my twenty-nine winters practicing among tourists, and we have had influenzal infections and various upper respiratory tract infections) but this thing we have had since the trainees came to Florida is different.
They do not have aching and headache and backache. These people run not very high temperatures, but they are sick quite a good many weeks. We are not able to control it with the indicated remedy. Many of them drag along inspite of all you can do, and I know in quite a few instances I heard the Army physician say that many of the boys they had to keep at bed rest for twelve weeks in the Army hospital at twelve weeks they were still running temperatures of 99.5 and 100 and no matter what you do, many of the cases, if x-rayed, will show spots in the lung tissue that look like cotton spots, and those cotton spots are pneumonia, pneumonitis, or a virus pneumonia, and, I am sorry to say, with a stethoscope you dont hear at thing.
The only way you can make a diagnosis is by use of the x-ray and in the Army hospitals all the boys with the temperatures were x- rayed. That was routine, and generally they would find evidence of a virus pneumonia.
A peculiar thing about those virus pneumonias they are like the good old-fashioned bronchopneumonias we used to see around New York. A person would have a little focus, a pneumonic patch, bronchopneumonia, and the temperature would come down, and things look better, and within a few days the temperature would go up another focus of infection and little consolidation; but in those case you saw then, they had physical signs you could detect with a stethoscope, and rales, heard very distinctly. Unfortunately, in these cases, going over the chest with a stethoscope, you cant hear a thing, and the only way to diagnose is by x-ray. But they are persistent.
They dont want to use sulfa drugs any more for pure and simple virus infections. They do not respond to sulfa drugs; in fact, I think they do harm. The only cases given sulfa drugs is when the Army physician thinks the cases seem to have mixed infection. They make a rule that if a pneumonia patient or a person running a temperature, with a high leukocyte count, of 15,000 to 20,000, they will try a sulfa drug, believing that leukocyte count is due to the mixed infection or entrance of streptococci in the virus infection, but with a normal or subnormal leukocyte count, if they have leukopenia, they withhold the sulfa drugs entirely and never think of giving a sulfa drug now for the pure and simple virus pneumonia.
I am quite proud of the way homoeopathy acts in these cases. They seem to do well, if you get the right remedy.
DR. MOORE: Tuberculinum has given a very fine account of itself in the spotty cases.
DR. WILLIAMS: I should have mentioned that.
DR. HUBBARD: I want to thank Dr. Sutherland for speaking of the shift of remedies. I find often that in a case where the patient is typically helped, if you dont go deeper and give a chronic in between attacks, they are likely to shift from that remedy and go waltzing down the line of remedies. Repeated attacks each time have different things. We ought to bear that in mind and make our acutes, when they are better, come back and be chronic patients.