241 
PATHOLOGY. 
a line of practice founded on the name of the difeafe. 
In fadt, as we (hall (how when (peaking of Gangrene in 
general, we mud fometimes ftimulate by bark and wine, 
and fometimes a& thereverfe by bleeding and purgatives, 
when we want to produce the expulfion of (loughs. 
Towards the latter end of the malady, when ftimulation 
is required, we certainly meet with much fuccels by fol¬ 
lowing the pradtice thus detailed by Parr. After laxatives, 
the bark is to be given in adtive dofes, with aromatics. 
Half a dram of the bark, with ten grains of aromatic 
(pices, (hould be exhibited every two hours. If it feems 
to produce ftridtures on the (kin, and rigour, five or fix 
grains of camphor, and three or four of James’s powder, 
combined with a little opium, (hould be added to each 
dofe. Thefe may be waihed down with a ftrong decoc¬ 
tion of bark, (harply acidulated with either of the mine¬ 
ral acids. Dr. Parr how-ever remarks, that in this dif¬ 
eafe the bark feldom difagrees. The adtion of thefe re¬ 
medies is greatly aflifted by diet and gargles. Port-wine 
(hould be given freely ; it (hould indeed enter into every 
part of the food, and be drunk alone, cold. Even deep 
is lefs lieceflary than bark and port-wine; and, (hould it 
continue above three hours, the patient muft be awak¬ 
ened, for the lofs of time cannot be regained. The 
quantity of the medicine and the wine muft be regulated 
by the eftedt. If we gain nothing in the firft thirty-fix 
hours, we may depend on a fatal event: if we lofe ground 
in twenty-four, our hopes will be inconfiderable. We 
have known women unaccuftomed to wine drink two 
bottles within twenty-four hours, for more than a fort¬ 
night. The gargles (hould be of a ftrong decodtion of 
bark, very (harply acidulated with mineral acids or with 
the ftrongeft Cayenne vinegar, or fome Cayenne in fub- 
ftance (hould be added ; and they (hould be frequently 
iifed, or, as the patient is languid, injedted with a fy- 
ringe. Pepper-corns conftantly bitten, and the faliva 
fwallowed, we have often found highly ufeful. 
“ Thefe are the appearances, and fuch the pradtice, in 
the more violent attacks of the complaint; and we have 
never feen an inftance of it, when taken early and treated 
in this manner, in a conftitution moderately ftrong, prov¬ 
ing fatal. The fame plan, lefs adtively purfued, is adap¬ 
ted to the milder kinds. But even the mildeft (hould 
not be treated with indifference.” 
y. P. pharyngea : rednefs florid, and efpecially at the 
lower part of the fauces ; deglutition extremely difficult 
and painful ; fever a cauma. This appears to be the fame 
difeafe as the firft variety, except that it is feated lower 
down in the throat. 
5. Emprefma bronchitis, (Cynanche trachealis, Cull.) 
Croup. Breathing fonorous and fuffocative, voice harlh; 
ringing cough ; fever a cauma. The term bronchitis is by 
Dr. Good confined to that peculiar and violent inflam¬ 
mation which is mod appropriately termed by medical 
men in general laryngitis, as the latter term exprefles 
the feat of the aftedtion much better than bronchitis; 
and, as bronchitis is now properly u(ed to defignate 
thofe complaints which will be detailed under the genus 
Catarrh, we (hall ufe the term laryngitis in the following 
defcription. 
Laryngitis, then, is an inflammation of the fuperior 
part of the trachea or larynx, to which parts, however, 
it is feldom confined, but extends downwards through 
the ramifications of the bronchiee. It affedts perfons of 
all ages, but is moft formidable when it occurs to chil¬ 
dren, in whom it is faid, from thenarrownefs of the aerial 
aperture, the internal thickening of the parietes of the 
tube foon produces fuffocation. It feems however, from 
the firmnefs of the coagulum thrown out, that the in¬ 
flammation in croup is of the moft exceflive kind, fo that 
death might be accounted for independently of the 
fmallnefs of the glottis. 
The complaint fometimes runs its courfe in twenty- 
four, thirty-fix, or forty-eight, hours 5 more commonly 
it continues a few days, Occafionally the peculiar noife 
2 
which is the pathognomonic fign of croup, attends on 
flight inflammations of the bronchise and larynx, but 
the complaint is then of a fomewhat prolonged duration. 
Laryngitis is often a confequence of the fpreading of 
true bronchial inflammation ; and fometimes the one al¬ 
ternates with the other. The croup generally begins 
with a (hort dry cough, wheezing, and other catarrhal 
fymptoms. Soon the wheezing becomes more obferva- 
ble, the cough more troublefome, and marked by a pe¬ 
culiar (hrill found ; the refpiration is performed with a 
wheezing or croaking noife, and at length grows very 
diftrefling and laborious. At the beginning, or in (lighter 
cafes, the found of infpiration refembled the palling of 
air through a piece of muflin ; afterwards it was as if the 
noife came from a brazen tube. The cough was attended 
with a peculiar (hrill found, even at an early period of 
the difeafe, as well as the voice, where there was not 
a perfedt hoarfenefs. Dr. Home defcribes it “ vox inftar 
cantus galli.” It has been compared to the noife which 
a fowl makes when caught in the hand. This peculiar¬ 
ity, however, is not eafily expreffed by words, but a 
knowledge of it is readily acquired by obfervation. 
By the end of the lecond, or on the third day, fome¬ 
times fooner, fymptoms of affedtion of the fyftem take 
place, as white tongue, third, increafed heat, and fre¬ 
quent pulfe: and the difeafe advances rapidly, not 
merely from violent general affection, but from the in¬ 
fluence which it has upon the organs of refpiration; the 
difficulty of breathing becoming now very diftrefling, the 
countenance being often flufhed, and great inquietude 
and a continual inclination to change from place to 
place fupervening. The child at the fame time eagerly 
puts its fingers into its mouth, as if to pull away fome- 
thing which flicks in the paflage. All the fymptoms are 
increafed during the night, throughout the difeafe. 
A change now takes place; and, the inflammation 
terminating in effufion, the paflage of the air becomes 
obftrudted by vifcid matter in the trachea, fome of which 
is occafionally thrown up by coughing or retching. 
Occafionally alfo, portions of a film or membrane, of a 
whitifti colour, are thrown up by the fame painful 
exertions ; and the efforts made to diflodge it are often 
fo diftrefling, that the child appears to be almoft in a 
date of ftrangulation. This is fucceeded by an abate¬ 
ment of all the fymptoms, until a frelh quantity of the 
fame fubftance is formed, when the diftrels recurs as be¬ 
fore. In many cafes, the difficulty of breathing and ap¬ 
pearance of fuffocation are increafed by paroxyfms, fo as 
to occafion extreme anxiety and inquietude. And in 
other cafes the difeafe, after continuing fome time, ap¬ 
pears fuddenly alleviated : the breathing is free ; cheer, 
fulnefs, appetite, and a difpofition to amufement, take 
place. But a change for the worfe comes on as fuddenly, 
and death enfues; the livid and fwelled face, and con- 
vulfive ftruggles, giving the little patient every appear¬ 
ance of one actually ftrangled. When the internal fau¬ 
ces are viewed, as Dr. Cullen has obferved, they are 
fometimes without any appearance of inflammation; but 
frequently a rednefs and fwelling appear. But it i? 
commonly remarked that moft of the cafes which occur 
-in the winter are attended with inflammation and fwell- 
ing of the tonfils, uvula, and velum pendulum palati; 
and frequently large films of a white fubftance are 
formed on the tonfils. 
Croup moft commonly attacks children during the 
three firft years after weaning. It rarely occurs before 
three months, or after ten years. It is often infidious 
in its approach; the child having only a flight cough or 
hoarfenefs, with little fever or ill feeling. 
The treatment of croup is that of inflammation in its 
moft acute and violent form, and in a fituation where its 
continuance threatens fpeedy death. On this account, 
the inflammation muft be fubdued at all ri(ks; and no 
fear of the confequences (hould arreft the vigour of the 
practitioner. A very large general bleeding, followed 
