28 AFFECTIONS OF THE LARYXX. 



recur. If there snould be no remission, should no croup membrane be 

 expelled, or if the expiratory act be free from impediment, the repe- 

 tition of the emetic is contraindicated. This rule is often broken. How 

 often do we see cliildren incessantly dosed with different salts of copper, 

 even when they have ceased to vomit, and they can do no more service ! 

 They lie bathed to the armpits in the bluish fluid which, mixed with 

 curdled milk, flows from their bowels, and in vain turn away then* head 

 and push away the spoon containing the repulsive medicine which gives 

 them so much griping and distress. 



The application of cold deserves a full trial, in the shape of cold 

 compresses, quickly changed, laid upon the throat of the child, as soon 

 as the signs of croupous laryngitis appear. In families where they are 

 not afraid to use this treatment, we shall have a far more happy result 

 than in houses in which the prejudice against it is not to be overcome. 

 The employment of cold to the skin in inflammation of internal organs, 

 as first recommended by UTiwisch in puerperal peritonitis, seems indeed 

 to act as a direct antiphlogistic ; and difficult as it may be to compre- 

 hend what effect it can have upon an organ separated from it by skin 

 and muscle, experience has here more right to respect than physiological 

 abstract reasoning. (See treatment of pneumonia.) The fanaticism of 

 the hydropaths in this matter, who, while applying cold to an inflamed 

 part, are loath to refrain from other hydropathic measures, has done more 

 harm than good. 



We have already recommended touching of the pharyngeal mucous 

 membrane with nitrate of silver as a direct antiphlogistic, and now, 

 after personal experience, cannot sufficiently urge the application of a 

 solution of the lunar caustic to the inflamed mucous membrane of the 

 larynx, as has been much practised in France, and but too little resorted 

 to among ourselves. JBretonneau, with whom this local treatment of 

 croup originated, uses a curved rod of whalebone, with a small sponge 

 made fast to its lower end. This is dipped in a concentrated solution 

 of nitrate of silver ( 3 ss to 3 ij). We press down the tongue of the 

 child, and endeavor to reach the entrance of the glottis with the sponge. 

 There the sponge is immediately compressed by the muscular contrac- 

 tion which takes place, whereby certainly a portion of the liquid, if 

 only a small one, arrives in the larynx. 



It is doubtful if calomel have indeed an antiphlogistic, or even a 

 specific effect upon croup, although I cannot deny that very high 

 authority is inclined to credit the beneficial effect of this agent in its 

 treatment ; nor that I myself make use of from a quarter to half a gram 

 of calomel every two hours, in most cases of this disease, while my ex- 

 perience leads me to shun the too customary employment of small 

 doses of tartar-emetic and sulphate of copper (tart. stib. gr. i ; aqua? 



