30 AFFECTIONS OF THE LARYNX. 



in giving Schwefelleber, or the " liver of sulphur," so long prized as a 

 specific, carbonate of soda, chlorate of potash, or senega, or other ex- 

 pectorant ; but proceed at once to tracheotomy. The earlier we under- 

 take this, the more hope may we have that pulmonary hypersemia, 

 oedema, and bronchial catarrh, will not injure our prognosis. However 

 bad the results, it should never be neglected when other means have 

 failed. Even death itself, after this operation, is far less painful, 

 for even when the operation has been long delayed we rarely fail to 

 obtain a transient but marked improvement ; and often, indeed, there 

 is a complete relief, upon which, however, slender hope should be based. 



Besides treating the dyspnoea upon the principles given above, we 

 have also to relieve the paralytic symptoms due to blood-poisoning by 

 carbonic acid. For this purpose, the powerful stimulus obtained by 

 pouring cold water upon the child, while in a warm bath, is of great 

 service. This is also a favorite remedy in treatment of asphyxia by 

 charcoal vapor. Lose no time in making use of it, the moment the child 

 begins to grow drowsy, the skin to cool, the sensorium to be benumbed, 

 or as soon as emetics fail to act ; for, at this period, their operation is often 

 of the utmost importance. A few gallons of cold water, poured from 

 a moderate height, over the head, nape, and back of the child, almost 

 always cause it to revive for a while, and to cough vigorously. Thus, 

 sometimes after the bath, masses of exudation are expelled. Other 

 stimulants, such as camphor or musk, are much less effective, and ought 

 not to be employed save when insuperable objections are opposed to the 

 cold effusion. They should be given in large doses, immediately prior 

 to the emetic. ($. camphor gr. x. Ether acet. 3iij. m. S. gtt. x 

 xv. every quarter of an hour. $ nioschi. gr. iv. Sacch. alb. 3 i. m. 

 div. in. ch. vi. s., a powder, every hour or half hour.) 



The application of sinapisms to the calves of the legs and soles of 

 feet, repeated bathing of the hands and forearms in water as hot as the 

 child can bear, the use of "flying blisters" to the neck and chest, ar^ 

 recommended, partly to corroborate the action of the stimulants ad- 

 ministered internally, and partly as a derivative from the larynx to the 

 skin. Although we do not rate cutaneous irritants very high among 

 the remedies against croup, yet, for want of better or more promising 

 means, we make use of them where the disease is protracted, sometimes 

 improving, and again growing worse ; and where we are dissatisfied 

 with the effects of the treatment already described, and yet hesitate to 

 proceed to tracheotomy. In order to accelerate the action of the flying 

 blister, Bretonneau advises that the plaster be smeared with a solution 

 of cantharidin in oil, and covered with blotting-paper before appli 

 cation. 



