Queries and Minor Notes

1918 Journal of the American Medical Association (JAMA)  
To the Editor:\p=m-\Forthe past month I have been on epidemic duty with the United States Public Health Service. Most of the cases that I have seen that have developed pneumonia have been complicated with a most rebellious cough. This has been so common in my own experience and with those with whom I have discussed this epidemic that it has occurred to me that this cough might be one of the causative factors of the pneumonia, either by producing trauma in some part of the respiratory mechanism
more » ... hich acts as an infection atrium, or by so lessening the resistance of the patient through loss of sleep, pain and exertion that he readily picks up the pulmonary infection. The cough at first seems to be only irritative, for the patient expectorates but little; usually, however, after coughing almost incessantly for two or three days, he begins to spit up fresh blood; in another twenty-four or forty-eight hours this has changed to a typical "prune juice" sputum, with a fever of from 103 to 104 and the physical findings of bronchopneumonia. In all my cases the cough was controlled completely with diacetylmorphin, from^to % grain, as circumstances may require. I am sure that a cough that is causing a patient great pain or interfering with sleep should certainly be controlled. This may be regarded as quite commonplace, but I have seen so many cases in which the cough had not been con¬ trolled that perhaps a reminder of a commonplace might prove a decided benefit to the patient. In this connection let me add that I see many physicians using heavy cough syrups with but little effect on the cough and usually producing nausea and gastric irritation, thereby making proper feeding impossible. Diacetylmorphin in tablet triturate form produces no such side-effects and is always most effective in the control of the cough.
doi:10.1001/jama.1918.02600470064031 fatcat:4y36bcxuxrbcrioqsfwks652wi