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ous. The moft fatal fymptoms are, a continual and furious delirium, with watching; thin watery urine and white faces, running off involuntarily, or a total fuppreffion of there excretions; a ready difpofition to become ftupid, or to faint; trembling, rigor, chattering of the teeth, convulfions, hiccough, coldnefs of the extremities, trembling of the tongue, fhrill voice, a fudden ceffation of pain, with apparent tranquillity. The following are favourable: fweat, apparently critical, breaking out; a diarrhoea; a large hemor rhagy from the nofe; fwellings of the glands behind the ears; hæmorrhoids.

511. The Cure entirely depends on obtaining a refolution of the inflammation. The objects chiefly to be aimed at are, 1. The removal of fuch exciting caufes as continue to operate: 2. The diminution of the momentum of the blood in the circulating fyftem: 3. The diminution of impetus at the brain in particular: and, 4. The avoiding circumftances which tend either to accelerate the motion of the blood, or to give determination to the head. With thefe intentions the moft power ful remedies are to be immediately employed. Large, and repeated bleedings are especially neceffary, from veffels as near as poffible to the part affected. The opening the temporal artery has been recommended, but this is attended with inconveniences; the opening of the jugular veins may prove more effectual, along with drawing blood from the temples by cupping and fcarify. ing. Purging may also be of more ufe in this than in fome other inflammatory affections, as it may operate by revulfion. For the fame purpose, warm pediluvia are a remedy, but rather ambiguous. The taking off the force of the blood in the veffels of the head by an erect pofture is generally useful, Bliftering is also useful, but chiefly when applied near the part affected. In fhort, every part of the antiphlogiftic regimen is neceffary, and particularly the admiffion of cold air. Even cold fubftances applied to the head have been found useful; and the application of vinegar is certainly proper. On the whole, however, practitioners are very uncertain with regard to the treatment of this difcafe, as the fymptoms by which the difeafe is judged to be prefent, appear fometimes without any internal inflammation; nd, on the other hand, diffections have shown that the brain has been inflamed, where few of the P culiar fymptoms of inflammation had appeared.

512. GENUS X. CYNANCHE.-Cynanche, Sauv. gen. na o. Lin. 33. Sag. gen. 300.-Angina, Vog. 49. Hoffm. II. 125. Junck. 30.-Angina inflammatoria, Boer 798.

513. Sp. I. CYNAN HE TONSILLARIS. The InAammatory QUINSY.-Lynanche tonfillaris, Sauv. fp. 1.-Angina inflammatoria, fp. 5. Boerh. 805. 514. Defcription. This is an inflammation of

the mucous membrane of
the fauces, affecting
principally that congeries ot
mucous follicles
which forms the tonfiis; and the affect every
ce fpreading a-
long the velum and uvula, fo as often.
part of the mucous membrane. The.
difeafe ap-
pears by fome tumor and redness of the
arts; is
attended with a painful and difficult deglu
ition;
a troublefomeclamminefs of the mouth and thr
at;

a frequent but difficult excretion of mucus; and the whole is accompanied with pyrexia. The inflammation and tumor are commonly at firft moft confiderable in one tonfil; and afterwards abating in that, increafe in the other. This disease is not contagious.

515. Caufes, &c. This difeafe is commonly occafioned by cold externally applied, particularly about the neck. It affects efpecially the young and fanguine; and a difpofition to it is often acquired by habit. It occurs especially in spring and autumn, when viciffitudes of heat and cold are frequent.

516. Prognofs. This fpecies of quinfy terminates frequently by refolution, fometimes by fuppuration, but hardly ever gangrene; though in fome cafes floughy fpots appear on the fauces; the prognofis therefore is generally favourable.

517. Cure. As the principal morbid affection in this difeafe, on which all its characterising fymptoms immediately depend, is the active inflammation in the tonlils and neighbouring parte, the firft and principal object is to obtain a refolution of this inflammation. Sometimes, however, it is neceffary to obviate urgent symptoms before a refolution can be effected; and where a refolution cannot be obtained, to promote a fpeedy and favourable fuppuration, After this has taken place, the proper means of promoting a discharge of the purulent matter will conclude the cure. Some bleeding may be neceflary, but large evacu ations are feldom beneficial. The opening of the ranular veins is recommended by Sir John Prin gle: but more benefit may be derived from leeches to the external fauces. The inflammation may be often relieved by moderate aftringents, and particularly by acids applied to the parts affected. In many cafes, nothing has been found to give more relief than the vapour of warm water received into the fauces. Blistering, and especi ally rubefacient medicines, are applied with fuc cefs, as well as purgatives; and every part of the antiphlogistic regimen is to be obferved, except the application of cold. Sir John Pringle recommends a thick piece of flannel moistened with two parts of common fweet oil, and one of spirit of hartfhorn, to be applied to the throat, and renewed once every 4 or 5 hours. By thefe means the neck, and fometimes the whole body, is put into a fweat, after which bleeding either carries off or leffens the inflammation. When the dif eafe tends to fuppuration, nothing is more useful than taking into the fauces the fteams of war water. Poultices may also be applied to the ex ternal fauces. When the abfcefs is attended with much fwelling, if it break not fpontaneously, it ought to be opened by a lancet ; and this does not require much caution, as even the inflammatory ftate may be relieved by fome scarification of the tonfils. When this disease runs very rapidly to fuch a height as to threaten fuffocation, it is fometimes neceffary to have recourse to bronchotomy But this operation is fo feldom requifite, that Dr as the only mean of faving the life of the patient. Cullen never faw any cafe requiring it.

518. Sp. II. CYNANCHE MALIGNA. The male nant, putrid, or ulcerous SORE THROAT-Cynanche maligna, Sauv. fp. 3.-C. ulcerofa, Sauv. var, i Jour

Journ. de Med. 1758.-C. gangrænofa, Sauv. var. b. Journ. de Med. 1756.-Ulcera faucium et gutturis anginofa et lethalia, Hifpanis Garrotillo, Lud. Mercat. confult. 24.-Angina ulcerofa, Fothergill's Account of the ulcerous fore throat, edit. 1751. Haxham on the malignant ulcerous fore throat, from 1751 to 1753-Febris epidemica cum angina ulcufculofa, Douglas's Practical Hiftory, Bofton, 1736.-Angina epidemica, Ruffel, Oecon. Natur. p. 105-A. gangrænofa, Withering's Differt. Inaug. Edinb. 1766.-A. fuffocativa, Bard's Inquiry, New York, 1771.-A. maligna, Johnstone on the malignant Angina, Worcester, 1770.

feizure, and fometimes cotemporary with it, a fwelling and foreness of the throat was perceived, and the tonfils became very tumid and inflamed, and often the parotid and maxillary glands fwelled very much, and suddenly, even at the beginning; fometimes fo much as even to threaten ftrangulation. The fauces alfo appeared of a high florid red, or bright crimson colour, very fhining and gloffy; and most commonly on the uvula, tonfils, velum palati, and back part of the pharynx, feveral whitish or afh-coloured fpots appeared, which often increased faft, and foon covered the tonfils, uvula, &c. Those in the event 519. Defcription and Hiftory. This diftemper is proved floughs of fuperficial ulcers, which fomenot particularly described by the ancient phyfici- times, however, eat very deep into the parts. ans; though perhaps the Syrian and Egyptian ul- The tongue at this time, though white and moist cers mentioned by Aretæus, and the peftilent ul- at the top, was very foul at the root, and covercerated tonfils by Aetius, were of this nature. ed with a thick yellowish or brown coat. The Some of the scarlet fevers mentioned by Morton breath also now began to be very offenfive; and feem alfo to have approached near to it. In the in some became at length intolerable, even to the beginning of the 17th century, a disease exactly fi- patients themselves. The 2d or 3d day every milar to this is described by the phyficians, as raging symptom became much more aggravated, and the with great violence and mortality in Spain and fever much more confiderable; the reft leffness fome parts of Italy; but no account of it was and anxiety greatly increased, as well as the diffipublished in this country till 1748, when a very culty in fwallowing, The head was very giddy, accurate one was drawn up by Dr FORTHERGILL, pained, and loaded; there was generally a deliriand in 1752 by Dr HUXHAM. The latter fays, um; sometimes a pervigilium and perpetual phrenthat this difeafe was preceded by long, cold, and zy, though others lay very ftupid, but often startwet feafons; by which the bodies of people were ing and muttering. The skin was very hot, dry, debilitated, and more apt to receive contagion, and rough; there was rarely any difpofition to which alfo might be produced by the ftagnant and fweat. The urine was pale, thin, crude; often putrid waters. The attacks were very different yellowish and turbid. Sometimes a vomiting in different perfons. Sometimes a rigor, with ful- was urgent, and fometimes a very great loofenefs. nefs and foreness of the throat, and painful ftiff. The floughs were now much enlarged, and of a nefs of the neck, were the firft fymptoms. Some darker colour, and the furrounding parts of a litimes alternate chills and heats, with fome giddi- vid hue. The breathing became much more difBefs, drowsiness, or headach, ushered in the difficult; with a kind of a rattling ftertor, as if the temper. It feized others with great pain of the head, back, and limbs; a vaft oppreffion of the præcordia, and continual fighing. Some grown perfons went about for fome days in a drooping date, with much uneafiness and anxiety, till at laft they were obliged to take to their beds. Thus various was the difeafe, fays Dr Huxham, at the onfet. But it commonly began with chills and beats, load and pain of the head, forenefs of throat, and hoarfenefs; fome cough, fick nefs at Romach, frequent vomiting and purging, in children efpecially, fometimes very fevere. There was in all a very great dejection of fpirits, very fudden weaknefs, great heavinefs on the breaft, and faint ela, from the beginning. The pulfe in general was quick, small, and fluttering, though fometimes heavy and undulating. The urine was commonly pale, thin, and crude; however, in many grown perfons, it was paffed in fmall quantities and high-coloured, or like turbid whey. The eyes were heavy, reddish, and as it were weeping; the countenance was often full, flufhed, and bloated, though fometimes pale and funk. How flight foever the diforder appeared ia the day-time, at night the fymptoms were greatly aggravated, and the feverish habit much increased; fometimes a delirium occurred on the first night; and conftantly returned through the whole courfe of the difeafe. Our author was often much furpried to find his patient had paffed the whole aight in a phrenzy, whom he had left tolerably cool and fedate in the day. Some hours the

patient was ftrangling, the voice being exceeding hoarfe, refembling that from venereal ulcers in the fauces: this noife in fpeaking and breathing was fo peculiar, that the Spanish phyficians gave it the name of garrotillo, as expreffive of the noife made by those who are ftrangled with a rope. Many about the 4th or 5th day spit off a vaft quantity of ftinking purulent mucus tinged fometimes with blood; and fometimes the nat ter was quite livid, and of an abominable smell. The noftrils were greatly inflamed and excoriated, continually dripping down a most sharp ichor or fanious matter, fo exceffively acrid, that it not only corroded the lips, cheeks, and hands of the children that laboured under the disease, but even the fingers and arms of the nurfes. It was furprifing what quantities of matter fome children difcharged this way, which they would often rub on their face, hands, and arms, and blifter them all over. A fudden ftoppage of this rheum from the mouth and noftrils actually choked several children; and fome swallowed fuch quantities of it, as occafioned excoriations of the inteftines, violent gripings, dyfentery, &c. nay, even excoriations of the anus and buttocks. Not only the noftrils, fauces, &c. were greatly affected by this extremely fharp matter, but the wind-pipe itfelf was fometimes much corroded by it, and pieces of its internal membrane were fpit up, with much blood and corruption; and the patients lingered on for a confiderable time, and at length dica

bid; though there were more frequent inftances of its falling fuddenly and violently on the lungs, and killing in a peripneumonic manner. Dr HUXHAM was aftonished sometimes to fee several fwallow with tolerable ease, though the tumor of the tonfils and throat, the quantity of thick mucus, and the rattling noise in breathing, were very terrible. Moft commonly the angina came on before the exanthemata; but often the cuticular eruption appeared before the fore throat, and was fometimes very confiderable, though there was little or no pain in the fauces: on the contrary, a very fevere angina feized fome patients that had no eruption; and yet, even in thefe cafes, a very great itching and defquamation of the fkin fometimes enfued; but this was chiefly in grown perfons. In general, however, a confiderable efflorefcence broke out on the furface, particularly in children; and that moftly on the 2d, 3d, or 4th day: fometimes it was partial: fometimes it covered almost the whole body, though very feldom the face: fometimes it was of an eryfipelatous kind; fometimes more puftular: the puttu'es frequently eminent, and of a deep fiery red, particularly on the breaft and arms; but often they were very fmail, and might be better felt than feen, and gave a very odd kind of roughness to the skin. The colour of the efflorefcence was commonly of a crimfon hue, or as if the fkin had been smeared over with juice of rafp-berries; the skin appeared inflamed and fwoln; the arms, hands, and fingers, were often evidently fo, very ftiff, and fomewhat painful. This crimson colour feemed indeed peculiar to this difeafe. Though the eruption feldom failed of giving manifeft relief to the patient, as to anxiety, fickness at ftomach, vomiting, purging, &c. yet there was an universal fiery eruption on fome persons, without the least abatement of the symptoms; nay, almost every symptom feemed aggravated, and more than one or two patients died in the moft raging phrenzy, covered with an universal fiery rafh. He had under his care a young gentleman, about 12 years of age, whofe tongue, fauces, and tonfils, were as black as ink, and he fwallowed with extreme difficulty; be continually spit off immenfe quantities of a black, fanious, and very fetid matter, for at least 8 or 10 days: about the 7th day, his fever being fomewhat abated, he fell into a bloody dyfentery, though the bloody, fanious, fetid expectoration ftill continued, with a moft violent cough. He at length got over it, to the very great furprise of all who faw him. In this patient, an univerfal rafh broke out upon the 2d and 3d day; and the itching of his fkin was fo intolerable, that he tore it all over his body in a moft fhocking manner. An early and kindly eruption was commonly a good omen, and, when fucceeded by a very copious defquamation of the cuticle, one of the moft favourable fymptoms that occurred; but when the eruption turned of a dufky or livid colour, or fuddenly receded, every fymptom grew worfe, efpecially if purple or black spots appear ed; the urine grew.iimpid, and convulfions came on, or a fatal fuffocation foon clofed the tragedy. The difeafe was generally at the height about the 5th or 6th day in young perfons; in the elder the crifis was often not till the 11th or 12th: fome

adults, however, were carried off in 2 or 3 days; the diftemper either falling on the lungs, and kill. ing in a peripneumonic manner; or on the brain, and the patient either died raving or comatose. In fome, the disease brought on a very troublefome cough, purulent expectoration, hæmoptoë, and hectic; in which they lingered on for fevral weeks, and then died tabid. If a gentle eafy sweat came on the 3d or 4th day; if the pulfe became more flow, firm, and equal; if the floughs of the fauces caft off in a kindly manner, and appeared at the bottom tolerably clean and florid; if the breathing was more foft and free, and fome degree of vigour and quickness returned in the eyes; a falutary crifis followed foon by a continuance of the fweat, and a turbid, fubfiding, farinaceous urine, a plentiful expectoration, and a very large defquamation of the cuticle. But if a rigor came on, and the exanthemata fuddenly dif appeared or turned livid; if the pulfe grew very small and quick, and the skin remained hot and parched, the breathing more difficult, the eyes dead and glaffy, the urine pale and limpid, a phrenzy or coma fucceeded, with a coldifh clammy fweat on the face or extremities; life was defpaired of; especially if a fingultus and choking in the throat attended, with fudden, liquid, involuntary, livid ftools, intolerably fetid. Medical writers are still much divided in opinion, whether the cynanche maligna is the fame difeafe with the Scarlatina anginofa, or not. (See § 664-671.) Here we may only obferve, that although ulcerous fore throats of a malignant nature often appear fporadically, yet that the difeafe above defcribed only is an epidemic, and is always the confequence of contagion.

520. Prognofis. This may be eafily gathered from the above description. The malignant and putrid tendency of the disease is evident, and an increase of the fymptoms which arife' from that putrefcent difpofition of the body must give an unfavourable prognoftic; as, on the contrary, a decrease of these, and an apparent increase of the vis vita, are favourable: in general, what is obferved to be favourable in nervous and putrid malignant fevers, is alfo favourable in this, and vice verfa.

521. Caufes. Since the accurate accounts given by Drs Fothergill and Huxham of the epidemics which prevailed about 70 years ago, this difeafe has been obferved at times epidemic in almoft every different part of Britain. It feems in every cafe to be the effect of a peculiar and specific contagion. It has been obferved to prevail in every fituation, and at every season, and on exposure to the contagion, no age, fex, or condition, is exempted from it. But the having once had the difeafe, affords the fame fecurity againft future contagion as in the small-pox.

522. Cure. Like other febrile contagions, the malignant ulcerous fore throat is terminated only by a natural course; and the chief bufinefs of the practitioner is to combat unfavourable occur rences. In this the feptic tendency of the difcale is chiefly to be kept in view. The debility with which it is attended renders all evacuations by bleeding and purging improper, except in a few inftances where the debility is lefs, and the inflammatory

flammatory fymptoms confiderable. The fauces are to be preferved from the effects of the acrid matter poured out upon them, and are therefore to be frequently washed out by antifeptic gargles or injections: and the putrefcent ftate of the whole fyftem fhould be guarded against and corrected by internal antifeptics, efpecially by the Peruvian bark given early, and continued through the course of the disease. Great benefit is alfo often derived from the liberal use of the mineral acids. Both the vitriolic and muriatic, in a ftate of proper dilution, are productive of the beft effects, when introduced to a fufficient extent. Emetics, both by vomiting and naufeating, prove ufeful. When any confiderable tumor occurs, blifters applied externally will be of fervice, and in any cafe are proper to moderate the inflammation. The internal ufe of the capficum annuum, or Cayenne pepper, as it is commonly called, has been of late highly celebrated in this affection; and is faid to have been employed with fingular fuccefs in the Weft Indies.

523, Sp. III. CYNANCHE TRACHEALIS. The CROUP.-Cynanche trachealis, Sauv. fp. 5.-C. laryngea auctorum, Eller de cogn. et curand. morb. fect. 7.-Anginæ inflammatoriæ, fp. 1. Barb. 801.-Angina latens et difficilis, Dodon. obf. 18.-A. interna, Tulp. 1. 1. obf. 51. A. perniciofa, Greg. Horf. Obf. l. iii. obf. 1.-Suffocatio tridula, Home on the Croup.-Afthma infantum, Millar on the Afthma and Chincough.-Afthma infantum fpafmodicum, Rush, Differt. Lond. 1770. -Cynanche ftridula, Crawford, Differt. Inaug. Edin. 1771.-Angina epidemica anno 1743. Mollay apud Rutt's Hiftory of the weather.-Morbus ftrangulatorius, Starr, Phil. Trans. no 495.—Morbus truculentus infantum, Francof. ad Viadrum et in vicinia graffans ann. 1758. C. a Bergen. A. nova. N. C. tom. ii. p. 157.—Catarrhus fuffocativus Barbadenfis ann. 1758. Hillary's Difeafes of Barbadoes.-Angina inflammatoria infantum, Ruffel, Oecon. nat. p. 70.-Angina polypofa five membranacea Michaelis.-Argentorati 1778, et auctores ab eo allegati.

524. Defcription. Dr Cullen thus defcribes this difeafe. It confifts in an inflammmation of the glottis, larynx, or upper part of the trachea, whether it affect the membranes of thefe parts or the muscles adjoining. It may arife firft in thefe parts, and continue to fubfift in them alone; or it may affect thefe parts, from the cynanche tonfillaris or maligna fpreading into them. In either way it has been a rare occurrence, and few intances of it have been marked and recorded by phyficians. It is to be known by a peculiar croaking found of the voice, by difficult refpiration, with a fenfe of ftraitening about the larynx, and by a pyrexia attending it. From the nature of thefe fymptoms, and from the diffection of the bodies of perfons who died of this disease, there is no doubt of its being of an inflammatory kind. It does not, however, always run the course of inflammatory affections; but frequently produces fach an obftruction of the paffage of the air, as fuffocates, and thereby proves fuddenly fatal. It particularly proves fatal, in confequence of the trachea being obftructed by a membranous fubtance lining the infide of it, and very nearly ap

proaching in appearance to the inflammatory exudation often difcovered on the inteftinal canal in thofe dying of entiritis. The moft powerful remedies of inflammation ought to be employed upon the very firft appearance of the fymptoms. When a fuffocation is threatened, whether any remedies can be employed to prevent it, is not yet. determined by fufficient experience; but it is evident, that the life of the patient can be preserved only by the removal of that matter which obftructs the paffage of air through the trachea. The accounts which books have hitherto given us of inflammations of the larynx, and the parts connected with it, amount to what we have now said; and many instances are recorded of the difeafe happening in adult perfons; but there is a peculiar affection of this kind happening to infants, which has been little taken notice of till lately. Dr HOME is the firft who has given any diftinct account of this difeafe; but feveral other authors have fince noticed it, and have given different opinions concerning it. This disease feldom attacks infants till after they have been weaned. After this period, the vounger they are the more they are liable to the difeafe. The frequency of it becomes lefs as children advance; and there are few inftances of children above 12 years of age being affected with it. It attacks children of the midland countries, as well as those who live near the fea; but it occurs much more frequently at certain places than at others. It does not appear to be contagious; and its attacks are frequently repeated in the fame child. It is often manifeftly the effect of cold applied to the body; and therefore appears most frequently in winter and spring. It commonly comes on with the ordinary symptoms of a catarrh; but fometimes the peculiar fymptoms of the disease show themselves at the very first. These are the following: A hoarfenefs, with fome fhrillness and ringing found, both in fpeaking and coughing, as if the noife came from a brazen tube. At the fame time, there is a fenfe of pain about the larynx, fome difficulty of refpiration, a whizzing found in infpiration, as if the paffage of the air were straitened. The cough which attends it is commonly dry; and if any thing be spit up, it is a matter of a purulent appearance, and fometimes films refembling portions of a membrane. With all thefe fymptoms, there is a frequency of pulfe, a reftleffness, and an uneafy fenfe of heat. When the internal fauces are viewed, they are fometimes without any appearance of inflammation; but frequently a rednefs, and even fwelling, appears; and fometimes there is an appearance of matter like that rejected by coughing, with great difficulty of breathing, and a fenfe of ftrangling in the fauces, by which the patient is fometimes fuddenly taken off. Many diffections have been made of infants who had died of this disease, and almoft conftantly there has appeared a preternatural fubftance, apparently membranous, lining the whole internal furface of the upper part of the trachea, and extending in the fame manner downwards into fome of its ramifications. This preternatural membrane may be eafily separated, and fometimes has been found feparated in part, from the fubjacent proper membrane of the tra

chea.

chea. This laft is commonly found entire, that is, without any appearance of erofion or ulceration; but it frequently fhows the veftiges of inflammation, and is covered by a matter refembling pus, like that rejected by coughing; and very often a matter of the fame kind is found in the bronchiæ, fometimes in confiderable quantity. From the remote causes of this difeafe; from the catarrhal fymptoms commonly attending it; from the pyrexia conftantly prefent with it; from the fame kind of preternatural membrane being found in the trachea when the cynanche maligna is communicated to it; and from the veftiges of inflammation on the trachea difcovered upon diffection; we muft conclude, that this disease confifts in an inflammatory affection of the mucous membrane of the larynx and trachea, producing an exuda tion analogous to that found on the furface of inflamed vifcera, and appearing partly in a membranous cruft, and partly in a fluid form refembling pus. Though this difeafe confists in an inflammatory affection, it does not commonly end either in fuppuration or gangrene. The troublefome circumftance of it confifts in a fpafm of the mufcles of the glottis, threatening fuffocation. When this difeafe terminates in health, it is by refolution of the inflammation, by ceafing of the fpafm of the glottis, by an expectoration of the matter exuding from the trachea, and of the crufts formed there, and frequently it ends without any expectoration, or at leaft with fuch only as attends an ordinary catarrh. But, in fome inftances, a falutary termination has very speedily taken place, in confequence of the difcharge of the membranous substance from the trachea, even under its proper tubular form. When the difeafe ends fatally, it is by a fuffocation feemingly depending upon a fpafm affecting the glottis; but fometimes probably depending upon a quantity of matter filling the bronchiæ, or obftructing the trachea.

525. Cure. The cure is by the ufual remedies of inflammation. Bleeding, both general and topical, has often given immediate relief, and, by being repeated, has entirely cured the disease. Bliftering alfo, near the part affected, has been found ufeful. Upon the first attack of the disease, vomiting, immediately after bleeding, feems to be of confiderable ufe, and fometimes fuddenly removes the disease. But emetics are still more ufeful in advanced periods. By the employment of thefe, the matter obftructing the trachea, and inducing fpafmodic affections, has often been fuccessfully removed, when the fituation of the patient seemed to be almost desperate. And as, in the progrefs of the difeafe, fresh effufions of this matter are very apt to take place, the frequent repetition of emetics becomes neceffary. It is often neceffary to have recourfe to thofe operating the most expeditiously, fuch as vitriolated zinc, even in large dofes. In every ftage of the difeafe, the antiphlogiftic regimen is neceffary, and particularly the frequent ufe of laxative glyfters. Some have ftrongly recommended the ufe of afafoetida under the form of injection; others place great confidence in oil, or oily mixtures, taken by the mouth; but more immediate benefit is derived from tepid bathing, and the employment of vitriolic ether, both externally and internally.

526. Such is the account given of this dangerous, and moft commonly fatal difeafe, by Dr CULLEN. But, however "few inftances of it" may "have been marked and recorded by phyficians," it is far from being " a rare occurrence." We are credibly informed, that it occurs very frequently in the Weft Indies, both among children and adults; and in this country, to our certain knowledge, it has for fome years back occurred often, and carried off great numbers of children, when not properly treated. It almost always appears as a primary difeafe, totally unconnected with either the cynanche tonfil. laris, or the maligna. We are affured by the ingenious Dr WILLIAM WRIGHT of Edinburgh, that it occurs very frequently in Jamaica, particularly among the negroes; and that the only certain remedy is early, frequent, and copious bleeding. Dr JOHNSTON, of this town, from long ex. perience, recommends the fame method of cure. Mr PETER MARTIN, however, furgeon at Dunning, in this county, affures us, that he has found no method of cure fo uniformly fuccessful, as giving large dofes every 2d hour of the hydrargy rus muriatus mitis. Perhaps no diftri&t in Scotland (he fays) has afforded more numerous examples of this disease than that in which he practises; and he adds, that before he tried this medicine, his patients uniformly fell victims to it, though he treated them according to the most established practice recommended by Dr Cullen. But ever fince he gave his patients the hydrargyrus, as above mentioned, he has never failed in accom plishing a complete cure. The disease often comes on fuddenly, without any previous symptom, but Mr Martin has often obferved it preceded by a profufe difcharge of a peculiarly vitiated and fetid tough faliva, which, after continuing several days, has ceafed, and been fucceeded by the croup with in 24 hours after. The mercury, he adds, effects a cure either by occafioning a discharge of bilious ftools, or by acting on the falivary glands; and very often by producing both thefe effects. When a fufficient quantity of the hydrargyrus has been given, the child generally coughs up a mouthful or more of a very tough, thickish, but tranfparent fubftance, refembling the white of an egg; often blended with a few whitish films or fkinny-like fubftances, fometimes very fpongy and thick. After this the difeafe goes off very quickly, fometimes immediately. But if the pulfe continues frequent for any time, a relapfe may be dreaded, to prevent which Mr Martin repeats the hydrar gyrus in dofes of one or two grains twice or thrice a-day, till all danger be over; after which he puts the patient upon the moft nourishing_regimen. He was alfo fuccefsful in fome cafes, by givin: the Saturated tincture of Digitalis in large dofe every fecond hour; and fays, that two parts of the digitalis must be given with one part of fpirita atheris nitrofi, as the digitalis given alone is apt to excite very fevere vomiting before any other effect can be produced. No exact ftatement can b given of the dofes, either of the hydrargyrus or digitalis, as fome cafes, even where the age is th fame, will require triple the quantity that others require.

527. Sp. IV. CYNANCHE PHARYNGIA.-C

panche

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