CKOUP. 567 



carbonate of an monia, may be employed, along with mild 

 aromatics and to.nics, such as ginger or gentian. 



"Blisters may be applied early in the disease ; they should 

 be confined to the throat, unless there is attendant pneumonia. 

 It is advisable to avoid the application of such agents to the 

 trachea, as it may be requisite at a later stage to have re- 

 course to tracheotomy, and the vascularity of the dermis 

 which a blister induces, is calculated to interfere with this 

 operation. 



" The employment of tracheotomy in this disease has 

 been condemned as being liable to hasten a fatal result; 

 there can be no doubt, however, that much of the preju- 

 dice against it has been owing to the cases in which it 

 has hitherto been resorted to. It has been chiefly per- 

 formed in extreme and advanced cases, to obviate, pro tern- 

 pore, a fatal result, when that seemed imminent. Can we 

 wonder, then, at the greater relative number of fatal cases 

 after tracheotomy? 



"Local applications to the mucous membrane have likewise 

 been employed. Delafond blew calomel through an artificial 

 opening into the trachea. The same agent might be intro- 

 duced by insufflation, and a traumatic lesion avoided in cases 

 in which it is unnecessary to resort to tracheotomy. Powder 

 of burnt alum may be employed in a similar manner. 

 Perhaps the best application, however, is the nitrate of silver, 

 employed in the form of solution, and introduced into the 

 larynx by means of a sponge attached to a whalebone pro- 

 bang, which may be actually introduced into the glottis. 

 The solution in common use consists of 30 grains of the 

 crystallized salt dissolved in an ounce of distilled water. 

 These local applications at first produce a great amount of 

 irritation, and paroxysms of spasmodic coughing of extreme 

 violence; they nevertheless prove highly useful in many cases, 



