SPEC. VI. " E. Bronch acuta. Common or and blisters. Vapour of warm-water. a little flaky mucus is excreted. Very copious bleeding* GEN. VII. at the commencement of the attack, by breaking down abruptly the inflammatory action, has sometimes carried lemmitis off the disease at once. This M. Fieliz recommends from the jugular veins †, and M. Ghisi by topical scarifica- acute croup. tions; but leeches will usually be found to answer best in infancy. Emetics have afterwards been tried, but with Emetics › § doubtful success: sinapisms and blisters with as little. doubtful: sinapisms The inhalation of warm vapour, recommended by Dr. Home, can rarely be practised from the extreme restlessness of the little patient; and the remedy principally relied upon in the present day, and which certainly seems in many instances to have operated like a charm, is large Calomel. and repeated doses of calomel; of this, not less than five or six grains are commonly given to very young children, and continued every two or three hours till there is a discharge of a green bilious matter, which seems to be the criterion of its having taken effect, and not only excites a salutary revulsion or counter-action, but breaks down the thicker part of the blood, from which the membranous secretion is principally furnished. Relaxants, as Relaxants. antimony and ipecacuan, should be employed during the action of the calomel: and as soon as this has answered, sedatives, as opium or hyoscyamus may be united with Narcotics. the relaxants: but above all the hydro-cyanic acid, as Prussic acid. halready recommended in hooping-cough, and to the same extent. If this plan should not succeed, Dr. Michaelis Tracheotorecommends tracheotomy, and has so little apprehension of its being attended with danger, that he advises it to be had recourse to soon after the attack, as affording a convenient opportunity of bringing away the preternatural membrane which serves as a lining to the trachea ||. But this advice is given with more courage than judgment. Whenever performed it should be after every other remedy has failed, and not before any other has been Michaëlis. Richter's Chir. Bibl. v. B. p. 739. Fieliz, 1. c. my. SPEC. VI. GEN. VII. attempted. As the exudation extends through the ramiE. Bronch-fications of the trachea, and probably through the lungs, there is but little hope after all of any benefit from such an operation*. lemmitis acuta. Common or acute croup. Cold affusion. Distinguished from laryngismus. Dr. Harden of St. Petersburg has of late, after every other remedy had failed, ventured upon cold affusion. He first tried it in a fit of despair upon a child of his own, eighteen months old. The child was placed in a bathing-tub with its belly upon a cushion of hay; and a pail of water of 12o Reaumur, was then poured quickly from the head along the spine. The symptoms, after the first affusion, soon diminished; the operation was repeated at intervals, ten times, and the child recovered. He has since employed it with like success in the first stage of the disease; and Dr. Miller, another physician of St. Petersburgh, is said to have been still more lately as fortunate as himselft. The plan is certainly worthy of trial in our own country. Under the genus LARYNGISMUS belonging to the second order of the preceding class, I have observed that the spasmodic affection there described, from its inducing a sense of suffocation, and possessing various other symptoms resembling those of croup, has often been mistaken for this last complaint, and been denominated spasmodic croup; though without the pathognomic sign of a membrane-like exudation, and for the most part without any inflammation whatever. It attacks children suddenly, most frequently in the night, and is apt to return in paroxysms, with short intervals of ease: whilst the real acute croup has no intervals, but continues its alarming course till it destroys the patient or yields to the means made use of. During the action of the spasm in the former case, however, there is a considerable hoarseness and shrillness in the voice, and, from the struggle, a profuse perspiration about the head and face. M. Boyer, Traité des Maladies Chirurgicales, &c. Tom, vii. Paris, 1821. + Extract of a Letter from Dr. Von dem Busch of Bremen, to Dr. Eberle of Philadelphia. Jan. 6, 1822. GEN. VII. SPEC. VI. E. Bronch Violent as these symptoms are, they commonly yield to a brisk antimonial emetic: after the operation of which the patient commonly falls into a sound sleep, and awakes lemmitis with little remains of the complaint. acuta. Common or Yet it never should be forgotten that croup is a disease acute croup. of a mixt character, spasmodic as well as inflammatory; and that hence in proportion as we entrench upon the strength of the system, we increase the tendency to spasmodic action, and the disposition to render this action general. I was lately consulted in the case of an infant most judiciously treated both in regard to the abstraction of blood and the use of calomel, which seemed in every respect to answer; insomuch that on the ensuing morning the breathing was easy, the cough quiet, the skin soft and moist, the night had been passed comfortably, he had several times sucked his full, and was declared to be making a rapid progress to recovery. But in the evening of the same day he was attacked with a strong convulsion-fit, accompanied with a considerable degree of stupor: the fit became hemiplegic, the stupor never wholly left him, and he died on the day after. In such cases I would so far follow the Russian practice as to advise the child to be laid on a blanket on his chest and to be well sponged with cold water over the head and down the spine; and the operation to be repeated frequently. I did advise it in the instance now adverted to; but it was feared, on the part of those who were consulted with me, that, if the plan should not succeed, we should be exposed to much popular opprobrium, and the feeling of timidity prevailed. E. Bronch lemmitis croup: or The SECOND OF CHRONIC VARIETY OF BRONCHLEMMITIS, I have introduced chiefly on the high authority of Dr. chronica. Warren, who calls it, as I have already observed, a bron- Chronic chial polypus; a term which, as it often has done, may Bronchial lead to mistakes; and which, in its application to any polypus. other part of the body, does not import the febrile action which exists as a characteristic of this disease. A con- How far noticed in earcrete parenchymatous material, obstructing the bronchi- lier times. al vessels, coughed up in smaller or larger masses, some SPEC. VI. lemmitis chronica. Chronic croup: or Bronchial polypus. Not distinctly noticed till Warren's account. GEN. VII. times easily and without any attachment to the sides of 6 E.Bronch- the bronchial tubes, and sometimes so extensively inosculated by radicles or radiating vessels as to produce a fatal hemorrhage on their being thrown up, with violence, has been noticed from a very early period in the history of medicine to the present day. Bartholine, Tulpius, Ruysch, Gretz, and Morgagni, have all been appealed to as giving examples of this affection; and it is very possible that even Hippocrates may allude to something of the kind in the case of Phericydes who, he tells us, was accustomed to bring up from his lungs in a fit of coughing, yaanтúdea "white milky concretions"; and at length before he died οἷον ἐκ μύξης μυκητὰ, ξυνεστηκήτα, λευκῷ φλέγματι περιεχόμενα, “ firm mucus like-excres cences, surrounded with white phlegm". But the com-" plaint does not seem to have been distinctly described, till Dr. Warren's history of it in the Transactions of Illustrated. the College+. The case by which he chiefly illustrates it, and which is here chiefly alluded to, is that of a young lady eight years of age, of a strumous habit, who was suddenly attacked with a difficulty of breathing, attended with a short, dry, and almost incessant cough; but without any pain in the side or chest. The symptoms diminished in the ensuing night, and the complaint appears to have been productive of little inconvenience for six weeks; when it returned with additional severity, with costive bowels, a white but moist tongue, and a pulse too quick to be counted. Bleeding, purgatives, and the oxymel of squills relieved her, but the breathing was still laborious; she had wasting nightsweats, and the pulse beat from a hundred to a hundred and twenty strokes in a minute for the ensuing twelve days, at the close of which period, she woke suddenly in the night and was almost choked in bringing up, by coughing, what Dr. Warren calls "a large polypous concretion". It came up without either blood or mucus, and instantly gave her great relief. For two months af * De Morb. Popular. Lib. vII. Sect. xli. + Vol. I. Art. XVI. SPEC. VI. chronica. Bronchial polypus. terwards she seldom passed three days without coughing GEN. VII. up masses of the same kind, but none so large: she was BE.Bronchtolerably easy when sitting still or in motion in the open lemmitis. air; and though her pulse never beat less than a hun- Chronic dred and twenty strokes in a minute, she had a good croup: or appetite, gained some degree of strength and flesh, and entirely lost her night-sweats. She was now suddenly attacked at night with another paroxysm of distressful breathing, and a sense of suffocation, and in the morning threw up a larger membranous concretion than at any time antecedently, and in the course of the four ensuing days, a quantity quite as large as in the six preceding weeks. From this time the oppression on the lungs returned irregularly after intervals of five, eight, ten, or twenty days, always followed and always relieved by an expuition of the same concrete material; till at the close of a twelvemonth from the first attack, the patient complained of a pain in the right heel, an abscess formed there, and the os calcis was found carious. From this time the bronchial affection ceased, the breathing was perfectly free, and no more concretion was at any time thrown up. expecto rated, how accounted for at first: Dr. Warren conceived this concrete substance to have Concrete been an inspissated matter secreted by the mucous glands substance of the bronchial vessels. But the existence of fibrin, as a constituent part of the blood, was unknown at the period in which he wrote; and his plates and description of the membranous matter expectorated, show evidently that, like that discharged in croup, and often from the intes- but incortinal canal, it was composed of this formative element rectly. intermixed with gluten, secreted in layers, and affecting a tubular structure. "Some of these polypi", says he, 66 are of a much firmer texture than others, and bear shaking in water without breaking to pieces. Others are so tender that a very gentle motion in water breaks off a great many of their smaller branches. They are solid, composed of lamina, which are easily separated from each other, and are manifestly of a texture less and less firm as you approach the centre or axis, which consists |