50 



PRACTICE OF MEDICINE. 



made much progress, it would seem preferable rather to omit bleed- 

 ing than to destroy, by injudicious depletion, the powers requisite 

 for the separation and excretion of the false membrane. In weak 

 children, leeches to the throat may supersede the necessity for vene- 

 section. Although this is the general practice, it would be advisable 

 to adopt the suggestion of Dr. Farre, which is, not to apply leeches 

 over the larynx, but rather along the line of the clavicles, as they 

 often induce an oedematous state of the skin or ecchymoses, which 

 occasion a stiffness of the parts, and add to the suffocating feeling 

 of the patient. 



Two methods of treatment are strongly advocated in this disease, 

 the one being the mercurial^ the other the antimonial; some emi- 

 nent practitioners recommend the former, others, and, those who 

 have paid most attention to this disease, the latter. Dr. Copland 

 recommends, immediately after depletion, calomel ^ndi James' pow- 

 der ; from three to five grains of the former, and two to three of the 

 latter. This powder may be repeated every second, third, or fourth 

 hour, until two or three doses have been taken. After the first dose, 

 the child should be put into a tepid bath, and be allowed as much 

 tepid diluents as the stomach will bear, in which carbonate of soda 

 may be dissolved, and which may be rendered agreeable with syrup. 

 If the powders, given to the extent now mentioned, have not acted 

 upon the bowels, castor oil, or some other purgative, should be 

 administered. 



The treatment of croup by means of tartarized antimony is as 

 follows : The exhibition of this medicine should commence from 

 the very first period of the treatment: and Dr. Stokes advises, " that 

 the medicine should be so exhibited as to produce free vomiting at 

 least once in every three quarters of an hour." This treatment 

 should be persisted in for several hours, when, according to circum- 

 stances, the quantity of the antimony may be diminished. The 

 solution employed by Dr. Stokes contains one grain of the salt to the 

 ounce of distilled water, and of this a dessert-spoonful is given every 

 quarter or half an hour, according to its action. Dr. Cheyne, who 

 first introduced this powerful remedy in croup, observes — " In very 

 few cases have I known the child survive the second stage of croup ; 

 and in all these the children recovered while using a solution of tar- 

 tarized antimony. Emetics I had repeatedly given in the second 

 stage of croup, but in these cases the patients were kept sick for two 

 or three clays^ ivith scarce any interval.'''* 



In the advanced stage, where there is feeble respiration, a weak 

 and sinking pulse, pallor of the countenance, &c., stimulants and 

 derivatives must be employed. It has also been recommended to give 

 such medicines as will act on the mucous follicles of the affected 

 part, causing them to throw out a fluid between the mucous and 

 adventitious membrane, and thus promote the separation of the latter. 



