Columbia 2Hntoer$tti> 
 
 mttit€ityttiMtm$wb 
 
 College of iPfjpsictans anb burgeons; 
 lUorarp 
 
Digitized by the Internet Archive 
 
 in 2011 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/inauguraldissertOOborr 
 
A N 
 
 INAUGURAL DISSERTATION 
 
 ON THE 
 
 CYNANCHE TRACHEALIS. 
 
 SUBMITTED TO THE PUELIC EXAMINATION 
 OF THE 
 
 FACULTY OF PHYSIC, 
 
 UNDER THE AUTHORITY OF THE 
 
 TRUSTEES OF COLUMBIA COLLEGE 
 
 IN THE 
 
 STATE OF NEW-YORK^ 
 WILLIAM SAMUEL JOHNSON, LL.D. Prefident; 
 
 FOR THE DEGREE OF 
 
 DOCTOR OF PH2~SIC; 
 
 ON THE THIRTIETH DAY OF APRIL, I 793- 
 
 By SAMUEL BORROWE, 
 
 Citizen of the State of New- York. 
 
 Whence in bright floods the vital air expands, 
 
 And with concentric fpheres involves the lands j 
 
 Pervades the fwarming feas, and heaving earths, 
 
 Where teeming Nature broods her myriad births; 
 
 Fills the fine lungs of all that breathe or bud \ 
 
 Warms the new heart, and dyes the gu/hing blood j 
 
 With life's firft fpark infpires th' organic frame, 
 
 And, as it waftes, renews the fubtile flame. Darwin. 
 
 NEW-YORK: 
 
 Printed by T. and J. Swords, Printers to the Faculty of Phyfic of 
 
 Columbia College, No. 27, William-Street. 
 
 — I793.— 
 
7$$ 
 
 w,***^ . 
 
 P ;.:... 
 
 
 * < *«^-i„.' 
 
 //^ 
 
 Imprimatur. 
 
 Samuel L> Mitchill. 
 
GOZEN RYERSS, 
 
 fi. N V 
 
 JOHN C, DON CAN, 
 
 o F 
 
 $ T AT | N-2 S I A N D: 
 
 This 
 
 DISSERTATION 
 
 Is moft refpeftfully infcribed, 
 
 <5y /£«> much obliged Friend* 
 
 The AUTHOR'. 
 
A N 
 
 INAUGURAL DISSERTATION 
 
 CYNANCHE TRACHEALIS. 
 
 JL HERE is perhaps no difeafe to which children 
 are fubjedt, that proves more certainly detractive, 
 if left to nature, than the Cynanche Tracbealis. Such 
 was its fuppofed fatal nature, that not long iince 
 many have been fufFered to expire without calling 
 in any medical amftance, as it was conceived to be 
 irremediable -, owing to the then unfuccefsful me- 
 thod of treating it. 
 
 With refpecl to the nature and caufe of Chynanche 
 Tracbealis, there has lately been a variety of opi- 
 nions entertained, which have given rife to as great a 
 variety of remedies, and of very oppofite kinds. 
 
 Aimed every Phyfician has had a different me- 
 thod of cure. As they could not all be right, thou- 
 
 funds 
 
( 6 ) 
 
 fands of the fick, no doubt, muft have fallen a fa* 
 crifice to the difeafe, for want of medical difcernment, 
 or by reafon of a blind attachment to an improper 
 plan. 
 
 a 
 
 "We have accordingly {qqu. one fet of men warmly 
 recommending the Jihenic mode of cure, prefcribing 
 contrayerva, Peruvian bark, &c. with a view, as 
 they exprefs it, of counteracting the virus, or cor- 
 recting the tendency of the fluids to putrefaction. 
 
 How much to be feared are fuch Practitioners, 
 who, in fpite of modern experience to the contrary, 
 ftill adhere to that delufive, and I may fay, danger- 
 ous fyftem, the humoral pathology I And how much 
 to be pitied are thofe unfortunate patients who come 
 under their immediate care ! 
 
 On the other hand, we obferve another fet of men, 
 who, with great propriety, advife the ajlhenk metho4 
 of cure.* 
 
 Others have faid that there are two fpecies of this 
 difeafe, fpafmodica and humid/fa.-[ That there may 
 be a Cynanche Trachealis Spafmodica I will not at- 
 tempt to deny* but in all thofe cafes which I have 
 
 had 
 
 * Cullen's Firft Lines, and a Letter from Richard Bayley, Surgeon, 
 to William Hunter, M. D. 
 
 ■j- Rufh's Inquiries and Observations, page iao, 
 
( 7 ) 
 
 had an opportunity of obferving, there did not ap- 
 pear to be any thing like fpafm. 
 
 In this DifTertation, I mall, therefore, confine my- 
 felf to that fpecies which Do&or Rufh calls Cynan- 
 che Trachealis Humida. I fhall firft attempt a re- 
 view of fome of the opinions that have been advanced 
 with refpecT: to its nature and caufes, and then en- 
 deavour to point out what appears to me to be the 
 moll proper method of cure. 
 
 HISTORY of the DISEASE. 
 
 THE celebrated Do&or Francis Home has ob- 
 ferved, that the Cynanche Trachealis is confined to 
 the fea coaft, and mentions as a proof of this opi- 
 nion, that it feldom occurs in Edinburgh, while, in 
 Leith and MufTelburgh it is very common. He 
 likewife obferves, that it frequently appears along 
 the coaft of Fife, the maritime parts of Airfhire and 
 Galloway.* 
 
 From 
 
 * A Treatife on the Difeafes of Children, London printed, 1772, in 
 which there is an extraft from Home's Book on the Croup. 
 
 When I mail have occafion to fpeak of Home's opinion in future, I beg 
 leave to refer the reader to the above mentioned Treatife, as I have not 
 been able to procure Home's original obfervatfons on this difeafe. 
 
( 8 ) 
 
 From thefe fads, Home draws a general conclu- 
 sion, that this difeafe is peculiar to the fea more. 
 This I am difpofed to doubt, for, upon inquiry, it is 
 found, that the Cynanche Trachealis frequently pre- 
 vails in the moft inland fituations.* 
 
 I was lately informed by Zina Hitchcock, a re- 
 putable Phyfician in Wafhington county, that the 
 Cynanche Trachealis frequently occurred in the neigh- 
 bourhood of Fort Edward, which is two hundred 
 and twenty-one miles from the fea more. 
 
 Many more facts on this head might be mention- 
 ed; but I conceive thofe already ftated fufficient to 
 do away the opinion of Home, with refpedt to this 
 difeafe having a necejfary connection with maritime 
 regions. 
 
 In another place Home has aflerted, that the Cy- 
 nanche Trachealis only occurs in the colder feafons. 
 This is erroneous, for it is known to prevail in the 
 heat of fummer.f There is no fituation, no climate, 
 nor feafon exempt from it. But I have obferved, 
 that it more frequently prevails during thofe feafons 
 iri which there are the greater!: viciffitudes. 
 
 There 
 
 * Cullen's Firfl; Lines of the Practice of Phyfic. 
 
 y This fact was communicated to me by Dr. Samuel L. Mitchill, one 
 of whofe brothers died of this difeafe in the month of Auguft, 
 
( 9 ) 
 
 There has been much difpute about the feat of 
 this difeafe. Some have fuppofed its fituation to be 
 in the glottis; others, that it was feated in the 
 trachea only.* Directions, however, prove that 
 it is not confined to the glottis and trachea alone, 
 but that it extends into the extreme branches of the 
 bronchia.-\ 
 
 The Cynanche 'Trachealis may be faid to be pecu- 
 liar to children, as it is never known to attack per- 
 fons after the age of twelve or fourteen years. 
 
 This difeafe has been confidered as contagious jt 
 but from the obfervations which I have been able to 
 make, it does not appear to depend in any degree on 
 contagion. I have never {qqvi an inftance in which 
 it appeared to be communicated from one perfon to 
 another, although they were placed in a fituation 
 favourable to receive it, had there been any contagion. 
 
 From thefe circumftances I am induced to con- 
 clude, that this difeafe is not to be confidered as con- 
 tagious; and therefore, does not require all that 
 B caution 
 
 * Treatife on the Difeafes of Children, page 154. 
 
 f Dr. Bard's Inquiry into the Nature, Caufe, and Cure of Angina 
 Suffbcativa, page 22. 
 
 J Bard's Inquiry, &c. 
 
( io 5 
 
 caution that was formerly taken of keeping healthy 
 children apart from thofe labouring under Cynancbe 
 
 1'rachealis. 
 
 It is not uncommon for this difeafe to attack the 
 fame child repeatedly. Whether this proceeds from 
 the force of habit, or from the peculiar irritability 
 of the child, I mall not attempt to determine. The 
 latter however appears to be the mofl reafonable con- 
 jecture. 
 
 DIAGNOSIS. 
 
 CULLEN^, m his Synopfts Nofologia Methodic*, 
 has placed this difeafe in the clafs of Pyrexia, and 
 order of Phlegmajia. As the pathognomonick fymp- 
 toms are collectively viewed in the definition, I here 
 give it m the words of that learned Nofologift. 
 
 " Refpiratione difficili, infpiratione ftrepente, voce 
 rauca, tuffi clangofa, tumore fere nullo in faucibus 
 apparente, deglutitione parum difficili et febre fy- 
 
 nocha."* 
 
 The 
 
 * Culleni Synopfis Nofolpgise Metfiodics. 
 
f II ) 
 
 The moft diftinguifhing chara&eriftics of Cynan- 
 che Tracbealzs, are the hoarfe dry cough, and fhrill 
 'found in infpiration, which is compared to air pafTmg 
 through a brazen tube* to the crowing of a young 
 cock\\ and it is likewife faid to be fimilar to the 
 barking of a young dog.\ Together with thefe 
 fymptoms there is a pain about the larynx? great dif- 
 ficulty of refpiration, and a fenfe of fufFocation •, the 
 cough is remarkably dry, the pulfe is for the niofl 
 part frequent, and the patient is extremely uneafy, 
 continually throwing the arms and legs about, fre- 
 quently turning from fide to fide, often placing the 
 hands to the throat, as if he was choaking, In the 
 earlier ftages of this complaint, the face is confidera- 
 bly flufhed; but in the latter ftages, it becomes pale 
 and frequently of a livid appearance, As the difeafe 
 advances, there comes on a difpofition to fleep, which 
 appears to be produced in part, by the ftrength be- 
 ing exhaufted, in confequence of the great anxiety 
 and ftruggling of the patient, whereby the circula- 
 tion ultimately becomes languid. If roufed from 
 this apparent fleep, the uneafinefs is considerably in- 
 creafed in confequence of the circulation being quick- 
 ened j whereby a greater quantity of blood is fent to 
 
 the 
 
 * Cullen's Firft Lines of the Pra&'ce of Phyfic, 
 
 ■\ Bard's Inquiry, &c. 
 
 $ Rufh's Qbf?rval;ions, &c. 
 
( n ) 
 
 the lungs in a given time. Together with thefe 
 fymptoms, the difficult refpiration continues to in- 
 creafe, which, in a very' fhort time, terminates the 
 exiftence of the unfortunate patient. 
 
 This is the common courfe of Cynanche Trachealis 
 if left to nature, and, I fear, too frequently when a 
 cure is attempted. 
 
 Rum mentions that there are fmall red blotches 
 fometimes obferved on the fkin. This I confider as 
 an accidental occurrence, and therefore not requiring 
 any particular attention. 
 
 It is faid that the fauces are fwelled and fomewhat 
 inflamed.* That this may fometimes take place, I 
 Jfhall not attempt to deny ; but I have never been 
 able to difcover the leaft appearance of inflammation 
 or fwelling in the fauces, though I have been par- 
 ticularly careful in examining a number of patients 
 with the Cynanche Tracbealis, while I was under the 
 tuition of the late celebrated Phyflcian and extenflve 
 Practitioner, Charles M'Knight ; and likewife thofe 
 patients that have fince come under my care. 
 
 It is mentioned that the Cynanche Trachealis comes 
 on with the ufual fymptoms of a common catarrh.-j- 
 
 I rather 
 
 * Cullen's Firft Lines. 
 
 ■f Cullen's Firft: Lines, vol. i. page 352. 
 
( n ) 
 
 I rather fuppofe this to be a miftake, for I have feea 
 many children in the earlieft ftages of this difeafe^ 
 and the peculiar fymptoms that are above enumer 
 rated were the firft appearance of indifpolitiom 
 
 REMOTE CAUS^ 
 
 THE remote caufes may, perhaps, with fome 
 degree of propriety, be divided into the predifpo- 
 nent and occafional. 
 
 The predifponent caufe appears to me to be a 
 certain irritability peculiar to children, as the Cynan- 
 che Trachealis is never known to attack a perfon af- 
 ter the age above mentioned, viz. twelve or fourteen 
 years. 
 
 "With refpecl: to the occafional or exciting caufe, 
 there are many opinions. Home fuppofes that 
 the peculiar ftirnulus of the air near the fea,_ may 
 be confidered as the occafional caufe. The marine 
 air (fays he) fupplies a ftirnulus calculated to increafe 
 the fecretion of mucus from the glands of the trachea 
 and lungs. He fuppofes that a great quantity of fea 
 fait is carried into the atmofphere, which being in- 
 fpired into the kings, ftimulates the orifices of the 
 
 glands 
 
( H ) 
 
 glands difperfed on the internal furface of the trachea 
 and bronchia, and thereby increafes the fecretion of* 
 mucus, which forms the preternatural membrane. 
 
 This is ingenious theory •, but I believe it will be 
 found contrary to fad. The only cafe in which ma- 
 rine fait is fufpended in the atmofphere, is when the 
 furf is very great, and the fpray is forced by the wind 
 to a confiderable diftance from the fhore, as happens 
 on the fouth fide of Lang-I/land, where the fpray is 
 carried to the diftance of feveral miles on the land ; 
 fb that a briny fluid in fome cafes trickles in drops 
 from the leaves of the trees. Notwithstanding that 
 the air is fo greatly impregnated with faline particles, 
 this difeafe is not found to be more rife there than 
 in the moft inland fttuations. 
 
 This holds good with refpect to many parts of the 
 Wefi-IndieSy as in Turk's- I/land, &c. where the fhore 
 is continually warned by the fea. But I cannot learn 
 that the Cynanche Trachealis is more frequent there 
 than in the places more remote from the fea coaft. 
 
 From the foregoing considerations I am induced 
 to conclude, that the fea air is not the occafional caufe 
 of this difeafe ; that is, from the fait it contains. 
 
 After a fair and candid examination of the occa-. 
 iional caufes of Cynanche Trachealis, I am inclined to 
 
 thinly 
 
I %6 ) 
 
 think, with Cullen, that the principal are cold and 
 moifture applied to the body which was previoufly 
 much heated. This accounts for this difeafe occur- 
 ring moft frequently when the greater!; viciflitudes 
 of weather take place. 
 
 PROXIMATE CAUSE. 
 
 THE proximate caufe of difeafes has hitherto es- 
 caped, and probably will for a long time continue to 
 elude the moft accurate refearches of man. It is 
 therefore with the greateft diffidence that I mall offer 
 an opinion on this fubject. 
 
 The proximate caufe of Cynanche Trachealis has 
 been fuppofed to be an inflammatory action of the 
 veffels on the internal furface of the trachea. This 
 fuppofition does not by any means account for all the 
 phenomena, and is indeed contrary to fact; for 
 directions prove that there is no primary inflamma- 
 tion in the Cynanche 1'rachealis. 
 
 Ronaldus Martin, Profeflbr of Anatomy at 
 Stockholm, difcovered by difTection that this preter- 
 natural membrane extended even into the moft mi- 
 nute ramifications of the bronchia ; where it refem- 
 
 bled 
 
( 16 ) 
 
 bled the membrane that lines an egg-mell. In this 
 cafe there was not the leart veftige, of inflammation 
 m the trachea or lungs* Bard likewife mentions fe- 
 veral directions which he made of patients who died 
 of Cynanche Tracbealis, in which the preternatural 
 membrane was completely formed j and, in moft of 
 thofe cafes, there was not the lean: appearance of in- 
 flammation. He mentions alfo the cafe of a patient 
 who died in confequence of an inflammation of the 
 trachea, and on direction there was not any of this 
 membrane formed. Here then there is both a pofl- 
 tive and a negative proof, that inflammation is not 
 the caufe of the before mentioned membrane. Rum. 
 makes the following obfervation: " I acknowledge 
 that I have generally (ten both fpecies that have been 
 mentioned, without inflammatory fymptoms, and 
 fometimes without fever, efpecially in the firft ftage 
 of the difeafe."-f In thofe cafes which are faid to 
 be attended with inflammation, I confider it as an 
 effect of the mechanical action of the preternatural 
 membrane on the tender and delicate furface of the 
 trachea. 
 
 It has been aflerted that the Cynanche Tracbealis 
 depended on a difpofition to putridity •, in confequence 
 
 of 
 
 * Bard's Inquiry into the Nature, Caufej .and Cure of Angina Suffo- 
 cativa, page 22. 
 
 •f Rufh'a Obfervations and InquirieSt 
 
( *7 ) 
 
 of which, there was fuch a ftate of the veflels on 
 the internal furface of the trachea induced, as caufed 
 them to effufe a fluid which is difpofed to infpifiate. 
 
 If I mould for a moment admit the improbable 
 idea that there is a putrid ftate of the body, I mould 
 then afkthofe who contend for this opinion, how they 
 can account for the formation of the morbid mem- 
 brane that is constantly found in the trachea and Iron- 
 chia of patients who have died of this difeafe. If 
 there is a putrid ftate induced, there is of courfe a 
 diminished cohefion of the particles of matter. If 
 there is a want of cohefion in the component parts 
 of the body ; or, in other words, if the folids and 
 fluids are in a diflblved ftate, as was formerly faid, 
 how is it poffible for them to fecrete a fubftance which 
 is poflefled of fo great a degree of tenacity as the 
 membrane before mentioned?* 
 
 If we carefully attend to the hiftory of this difeafe, 
 we fhall find that there is no fymptom of putridity 
 attending it, except the debility that accompanies the 
 laft ftage mould be confidered as fuch, which can be 
 accounted for more rationally than on the fuppofition 
 of the body's being in a putrid ftate. Independent 
 
 C of 
 
 * Bard, in his Inquiry into the Nature, Caufe, and Cure of Angina 
 SufFocativa, obferves, that this membrane is fomewhat fimiiar to Sham- 
 moy leather. 
 
( 18 ) 
 
 of any reafoning on this fubject, the remedies to 
 which the Cynanche T'rachealis is found to yield, af- 
 ford fufficient proof that it is not a putrid difeafe. 
 
 From what I have been able to obferve, I am of 
 opinion that the proximate caufe of Cynanche Tra- 
 chealis is a peculiar morbid action of the veffels on 
 the internal furfaceof the trachea and bronchia, where- 
 by a fluid is fecreted which forms the tough mem- 
 brane. 
 
 The next object is to afcertain what the real nature 
 of this membrane is. It is fuppofed by fome, to 
 be infpiffated mucus,* and by others, coagulable 
 lymph, f 
 
 I am not willing to admit the mppofition of its 
 being mucus ; for I know of no fact or experiment 
 by which it is evinced that mucus can acquire fuch a 
 degree of cohefion as this membrane is found to pof- 
 fefs, in fo fhort a time, viz. a few hours. If it is 
 mucus, why does not every child that labours under 
 a common catarrh get the Cynanche Trachealis? 
 And why does it not attack adults ? 
 
 Thefe are objections to its being mucus, which I 
 conceive it is not eafy to remove. It may not be 
 
 improper 
 
 ♦ Bard's Inquiry, &c. RuTh's Obfervations; and Home on the Croup. 
 ■f- Bayley's Letter to Dr. Hunter. 
 
( i9 ) 
 
 improper to obferve, that the gaflric juice is not ca- 
 pable of afting on this membrane, Or of producing 
 any change in it, while mucus is perfectly difiblved 
 in the ftomach. 
 
 It is found that children who have recovered from 
 the Cynanche Tracbealis, have, for feveral days, paf- 
 fed in their ftools large portions of this membra- 
 nous fubftance, which retained a great fhare of its 
 former tenacity, 
 
 This fact wasfome time flnce communicated to me 
 by Dodor Samuel L. Mitchill ; fince which;, I have 
 had an opportunity of obferving it in feveral cafes 
 which came under my care. 
 
 In this way we may account for the recovery of 
 children who have not thrown up the membrane 
 in the act of vomiting ; for, as they coughed it from 
 their lungs, it was immediately taken into the fto- 
 mach. 
 
 This membrane not appearing on giving an emetic, 
 has given rife to an opinion that it is not formed in 
 every cafe of Cynanche Trachealis ; and, in all proba- 
 bility, has induced many to fuppofe that this difeafe 
 was fpafmodic, 
 
 That this morbid membrane is compofed of coagu- 
 lable lymph, I am difpofed to deny j for the co> 
 
 agulable 
 
( 20 ) 
 
 agulable lymph is never feparated from the blood in 
 a ftate difpofed to affume a membranous form in the 
 body, except in cafes of great inflammation, which 
 is proved does not take place in this difeafe. As a 
 further evidence that no primary inflammation takes 
 place in this difeafe, it may not be improper to ob- 
 ferve, that the blood, when drawn from a vein, under 
 the moft favourable eircumftances, to produce a fe- 
 paration of gluten, does not mew any tendency of 
 that kind, at any ftage of the difeafe •, and it is al- 
 lowed, that in every cafe of considerable inflamma- 
 tion or predifpofitionto it, that the blood, when taken 
 from a large orifice, in a full ftream, fhews, when 
 cold, a portion of its gluten feparated. 
 
 I mall here take the liberty of inquiring into the 
 propriety of Cullen's placing this difeafe in the order 
 of Phlegmasia? : his definition of which is, 
 
 " Febris fynocha, phlogofis; vel dolor topicus, 
 fimul laefa partis internae functione ; finguis miflus, 
 et jam concretus fuperficiem coriaceam albam often- 
 dens." 
 
 Here, then, is certainly a miftake ; for the Cynan- 
 che Trachealis is deficient in two of the principal 
 characleriftics of the order in which it is placed, viz. 
 inflammation, and the buffy appearance of the blood. 
 
 From 
 
( « ) 
 
 From taking this view of the mbject, I am in- 
 clined to think that this membranous lining which is 
 fo conftantly found within the trachea and bronchia 
 of thofe who have died of Cynanche Tracheal^ is 
 neither infpiflated mucus nor coagulable lymph, but 
 a fubftance fui generis^ produced by the peculiar 
 morbid action of the veflels on the internal furface 
 of the trachea and bronchia. 
 
 PROGNOSIS. 
 
 THE prognosis of this difeafe is principally to 
 be drawn from the difficulty of breathing, and the 
 peculiar fhrill found in the a£t of inspiration, toge- 
 ther with the dry cough. 
 
 When the refpiration becomes very laborious, 
 cough dry, and the difeafed peculiarity of the voice 
 is conliderable, we may conclude the patient to be 
 in an extremely dangerous condition. If thefe fymp- 
 toms continue to increafe, and the face becomes pale, 
 or puts on a livid appearance, the pulfes fink, and 
 there mould be other marks of great debility, we 
 may venture to prognosticate certain death. 
 
 On the contrary, if the cough is moift, or attend- 
 ed with expectoration, the refpiration free and eafy, 
 we may with fome degree of certainty predict a fa- 
 vourable termination. 
 
 EXPLANATION 
 
( 22 } 
 
 EXPLANATION ot th? SYMPTOMS, 
 
 HOME divides this difeafe into two ftages, the 
 firft inflammatory, the fecond putrid. What could 
 have induced him to make this groundlefs and need- 
 lefs division, I can fcarcely imagine, fince it is found 
 on direction, that neither inflammation nor putridity 
 are attendant on the Cynanche Trachealis. 
 
 That there is a ftage of excitement and a ftage of 
 debility, I am willing to admit. But they can be 
 accounted for on the true laws of the Animal Eco- 
 nomy^ better than on the fuppofition of inflammation 
 and its confequence, putridity. 
 
 I mall attempt to account for the firft ftage of 
 Cynanche Trachealis, or what Home calls the inflam- 
 matory ftage, in the following manner : When a 
 child is attacked with this difeafe, he is extremely urt- 
 eafy, and continually turning from fide to fide. This' 
 reftleflhefs ca'ufes fome confiderable increafe of the 
 circulation, and the face becomes flufhed. Thefe 
 fymptoms have given rife to the opinion that there" 
 was really inflammation prefent. But it is well 
 known that all thefe fymptoms may, and do fre- 
 quently occur, without inflammation, as in the hot 
 ftage of an intermittent fever. 
 
 The 
 
( 2 3 ) 
 
 The ftage of debility, or that which Home calls pu- 
 trid, may be accounted for in this way : The mor- 
 bid membrane that is found lining the trachea in this 
 difeafe, extends into the moft minute ramifications 
 of the bronchia. The bronchia being thus coated 
 with adenfe expansion, the air cannot perform its pro- 
 per operation upon the blood in the lungs. Hence 
 no decompofition of the refpirable part of this fluid 
 takes place •, and of courfe the circulating mafs does 
 not become oxygenated. The want of oxygene in the 
 blood may be the caufe of the livid appearance of 
 the face in the latter ftages of this difeafe. 
 
 As the membrane extends into the minute 
 branches of the bronchia, the difficulty of breathing 
 increafes, which cannot be explained on the fuppo- 
 fition of putridity •, but can very clearly be accounted 
 for, by fuppofing that the blood is deprived of its 
 natural ftimulus, the oxygene, or bafe of vital air. 
 This likewife accounts for the feeble ftate of the 
 pulfe in the advanced ftage of the Cynanche'Trachealis ; 
 for it is a well eftablifhed fad:, that the circulation 
 and energy of the fyftem depends on the refpira- 
 tion. Confequently, if the refpiration is in any con- 
 fiderable degree affe&ed, debility muft enfue, and 
 all the vital functions flirTer an interruption in pro- 
 portion to the degree of obftru&ed refpiration. I 
 
 therefore 
 
( 2 4 ) 
 
 therefore fuppofe, that moft patients who die of Cy- 
 nanche Tracbealis, expire in confequence of a fub- 
 du&ion of that ftimulus which is necefiary for the 
 fupport of animal life, and not by fpafm* or putri- 
 dity.f 
 
 METHOD of CURE. 
 
 THE firft indication of cure in Cynanche 'Trachea- 
 lis, is to deplete the fyftem, which is moft effectu- 
 ally done by letting blood, in confiderable quantity, 
 from the jugular vein, arm, or any part moil conve- 
 nient; but the jugular is to be preferred. The ve- 
 na? fection mould be repeated, if there are marks of 
 a full habit, or if the difficulty of breathing mould 
 not be relieved by the firft operation. 
 
 "When I recommend blood-letting, it is on a dif- 
 ferent principle from that on which it is commonly 
 advifed in this difeafe, viz. that of abating inflam* 
 mation •, which, I have endeavoured to prove, does 
 not originally accompany this difeafe, nor eflentially 
 appertain to it. 
 
 It muft be allowed that refpiration becomes necef- 
 iary in proportion to the quantity of blood contained 
 
 in 
 
 * Bayley's Letter to Dr. Wm. Hunter. 
 + Home on the Croup. 
 
{ 2 5 ) 
 
 in the fyftem. If we diminifh the quantity of blood, 
 of courfe refpiration becomes lefs neceffary. Hence 
 a perfon breathes more freely, in confequence of a 
 fmaller quantity of blood pafling through the lungs 
 in a given time. In proportion to the greater or 
 fmaller quantity of blood which paries through the 
 lungs, the prefence of vital air becomes more or 
 lefs neceflary to oxygenate it; for without oxygene 
 life cannot exift. 
 
 In this difeafe, the oxygene is with extreme diffi- 
 culty, and in fmall quantity communicated to the 
 blood, in confequence of the interposition of the 
 filmy concretion which invefts the bronchia. If this 
 is admitted, we can account for the great relief 
 which blood-letting affords patients affected with 
 Cynanche Tracbealis, which is almorl: inftantaneous, 
 and therefore cannot be accounted for upon the fup- 
 pofition of this difeafe being inflammatory. Blood- 
 letting may be of fervice in another way. We 
 know, that when blood is drawn from the human 
 body in confiderable quantity, and that in a fhort 
 fpace of time, its effecls are very great. The change 
 thus brought about in the fyftem, by the rapid eva- 
 cuation of blood, may operate on the vefTels of the 
 trachea and bronchia in fuch a manner as to induce an 
 action in them, contrary to that which exifts in the 
 D morbid 
 
( 26 ) 
 
 morbid ftate, and in this way cure, or at leafl pre- 
 vent the increafe of this difeafe. Emetics are then 
 to be given, to throw off the tough matter from 
 the lungs and trachea. The propriety of giving 
 emetics, in Cynanche Trachealis, has been doubted by 
 Home. He fuppofes that emetics promote the fe- 
 cretion of mucus in the lungs, without caufing it to 
 be evacuated, and in this way increafes the complaint. 
 This reafoning will not do, for I think there is the 
 higher! improbability that mucus does produce the 
 peculiar membrane. 
 
 Throwing a/ide all theory, the great fuccefs that 
 conftantly attends the ufe of emetics in Cynanche 
 Tracbealis, is fufficient to recommend them as power- 
 ful remedies. There are many inftances in which 
 the early adminiftration of an emetic has totally 
 removed the complaint in the fpace of a few hours, 
 by caufing the patient to difcharge the membrane 
 from the trachea ; and in other cafes has caufed a 
 loofening or feparation of it ; and afterwards, by the 
 effort of coughing, it has been entirely brought off. 
 In children who are fo young that they have not the 
 power or understanding to expectorate, it has been 
 taken into the ftomach, and after fome time makes its 
 appearance in their ftools, as has been before obferved. 
 Beiides the effecl: of throwing off this membrane, 
 
 emetics 
 
( 27 ) 
 
 emetics produce a great revolution in the fyftem, by 
 the concuffion they give the whole body ; they mull: 
 of courfe have a great tendency to interrupt or alter 
 that peculiar morbid action of the veffels on the in- 
 ternal furface of the trachea. Emetics likewife de- 
 termine to the furface of the body, and keep the 
 bowels regular •, two circumftances of very great con- 
 fequence in the cure of this difeafe, 
 
 The fleam of warm water has been highly recom- 
 mended to be taken into the trachea^ with a view to 
 difTolve this membrane. This I confider as an inlig- 
 nificant remedy, for it has been found that even the 
 maceration of this membrane jn warm water for 
 feveral days, has had little or no effect in deftroying 
 its tenacity. Befides, it is a remedy that cannot be 
 ufed but with extreme difficulty, particularly with 
 young children. I therefore think it may with pro- 
 priety be neglected,, 
 
 A bliftering planter is next to be applied to the 
 throat, which, by determining to the furface, af- 
 fords great relief in Cynanche Trachealis, and appears 
 to be well calculated to produce the change fo de- 
 firable in this difeafe. There is, however, one very- 
 great difadvantage fometimes refulting from the ap- 
 plication of blifters to the throat : They are apt to 
 
 produce 
 
( 28 ) 
 
 produce difagrceable ulcers, which often end in mor- 
 tification and confequent death. The occurrence of 
 thefe ulcers may be accounted for from the parts be- 
 ing kept in continual motion, by the uneafinefs of 
 the child, which expofes the bliftered furface to the 
 continual action of the air. This, joined to the 
 friction, produces irritation and inflammation, which 
 fometimes terminate in mortification. I therefore 
 think that blifters mould be applied with the greateft 
 caution, and not fuffered to remain on longer than 
 merely to act as rubefacients. 
 
 Calomel has been much recommended, particularly 
 by Rum.* In what manner calomel acts, is not 
 eafily explained. I fuppofe, however, it is not by 
 correcting acrimony, as has been imagined;-}- for 
 calomel occafions a happy change in fo fhort a time, 
 that it appears impofTible for it to be abforbed, and 
 in that way produce its effects. I rather fuppofe, 
 that it acts in the manner which Rufh obferves, J 
 or, that it acts by ftimulating the ftomach and bow- 
 els, which caufes a derivation to them, whereby the 
 morbid action of the vefTels on the internal furface of 
 
 the trachea is interrupted. 
 
 The 
 
 * Ruin's Inquiries, &c. 
 
 -j- Bard's Inquiry, &c. 
 
 % " In what manner does calomel a£i in this diforder ? Is it by In- 
 ee creafing the fecretion of mucus in the numerous glands of the fauces, 
 " sefophagus, fiomacb, and bowels 5 and thereby leffer.ing the excretion 
 (l of it in the trachea ?". 
 
( *9 ) 
 The warm bath is a remedy on which great de- 
 pendence is to be placed ; for, by its great power of 
 determining to the furface of the body, it is found 
 to relieve the difficulty of breathing which con- 
 ftantly accompanies this difeafe. 
 
 The cure of Cynanche 'Trachealis is, therefore, to 
 be effected by the remedies already mentioned, viz. 
 blood-letting, blifters, emetics, warm bath, and 
 calomel. 
 
 As a proof of the propriety of the plan I have 
 recommended, I will fubjoin five cafes of Cynanche 
 Trachealis which were fuccefsfully treated by it. 
 
 CASE I. 
 
 ON the 20th December, 1792, a fon of Mr. 
 Farrier, aged two years, was attacked with a hoarfe, 
 dry cough, and great difficulty of breathing. The 
 mother put the child into a warm bath ; but finding 
 the fymptoms increafed, at two o'clock, P. M. fent 
 for Doctor Hamerfley, who directed a gentle emetic, 
 
 which 
 
'( 30 ) 
 
 which operated very well. At three o'clock the 
 Doctor requeued me to vifit the child with him : as 
 we found him labouring under all the fymptoms of 
 a diftindly marked Cynanche Trachealis, we judged 
 it advifable to let blood; four ounces were taken 
 from the jugular vein. The warm bath was repeat- 
 ed; after which the fymptoms were fomewhat re- 
 lieved : we then ordered four grains of emetic tartar 
 to be diflblved in four ounces of water, and directed 
 two drachms of the folution to be taken every fifteen 
 minutes till it operated as an emetic. This caufed 
 the child to throw up a great quantity of vifcid mat- 
 ter; produced a moifture on the fkin, and opened his 
 bowels. At nine o'clock we vifited him again., and 
 directed the emetic folution to be repeated ; half an 
 hour afterwards the child was feized with a fit of 
 coughing and vomiting, which caufed the vein to be 
 forced open, and he loft (agreeable to the mother's 
 information) near five ounces of blood ; after which 
 he refted very well all night. At eight o'clock on 
 the morning of the 21ft, the child was much better 
 in every refpect; there remained, however, fome 
 degree of the peculiar found of the voice ; to re- 
 move which we directed oxymel frill, one tea-fpoon- 
 ful to be taken every hour. This had the happy effect 
 of keeping up a moifture on his fkin, and caufed 
 him to cough up a considerable quantity of ropy 
 
 matter. 
 
( 3* ) 
 
 matter. The following day the child appeared to 
 be perfectly well, and continued fo without the aid 
 of any other remedies.. 
 
 CASE II. 
 
 ON the 1 8th December, 1791, I was fent for 
 to fee a daughter of Mr. James M'Kay's, who was 
 the day before attacked with Cynanche Trachealis. 
 From the extreme difficulty of breathing that ihe 
 laboured under, I thought it adyifable to let *blood j 
 I therefore opened a vein, and fufrered her to bleed' 
 ad deliquium. After me recovered from the fainting 
 me was put into a warm bath, and puked freely 
 with afolution of emetic tartar, which hadlikewife 
 the beneficial effect of producing an evacuation from 
 her bowels. Two hours after I vifited her again, 
 and finding the difficulty of breathing not altogether 
 removed, I directed the emetic folution and warm 
 bath to be repeated j at the fame time a bliftering 
 philter was applied to her throat. The following 
 day her bowels were opened with calomel, and on 
 the fourth day fhe was perfectly well, except the 
 forenefs of the blifter, 
 
 CASE 
 
( 32 ) 
 
 CASE III. 
 
 A child of Mr. Walter Reed's was, on the 26th 
 November, 1792, feized with a hoarfe, dry cough, 
 and laborious refpiration. The following day I was 
 defired to vifit him, at which time he was apparently 
 in the greateft diftrefs, and, in fhort, had a mod 
 complete Cynanche 1'racbealis. I immediately open- 
 ed a vein in the arm, and took from it fix ounces of 
 blood ; on which he (hewed fymptoms of deliquium. 
 He theft took fmall portions of emetic tartar, which 
 caufed him to throw up a confiderable quantity of 
 vifcid matter. The warm bath was then ufed, when 
 his fkin became moift, and he paffed feveral large 
 portions of a membranous lubftance by ftool. The 
 next day he took a fmall dofe of calomel, which 
 brought away, by ftool, a great quantity of the 
 preternatural membrane •, the child was thereby 
 greatly relieved; and by keeping his bowels open 
 with calomel, in a few days he was perfectly reftored 
 to health. 
 
 CASE 
 
( 33 ) 
 
 CASE IV. 
 
 A child of Mr. Jacob Brown's, one year and fevea 
 months old, was attacked with Cynanche Trachealis. 
 On the 31ft December, 1792, at eleven o'clock P. 
 M. I was requeued to vifit him. The violence of 
 the fymptoms called loudly for immediate afliftance : 
 I therefore opened the jugular vein, and took away, 
 near eight ounces of blood-, ordered a warm bath, 
 and an emetic folution, which relieved the difficulty 
 of breathing, caufed him to heave up fome vifcid 
 matter, and like wile to pafs confiderable in his ftools. 
 The fkin appearing to be dry, I dire&ed the bath 
 to be repeated, and fmall portions of the emetic to 
 be taken in fuch a manner as to keep up a conftant 
 naufea. The third day the child was perfectly re- 
 lieved of the difficulty of breathing, and in a few 
 days more appeared to be in perfect health. About 
 fix weeks after, he had a return of the complaint, 
 and notwithfianding every thing was done for his re- 
 lief, he died on the fifth day of the difeafe. 
 
 E CASE 
 
t 34 )' 
 
 CASE V. 
 
 MR. John Hilly er called on me the 26th January, 
 1793, to vifit a child of his which had been com- 
 plaining for feveral days: When I firft faw the 
 child, he appeared to be gafping for breath ; his face 
 was pale, or rather inclining to a livid appearance ; 
 his pulfe extremely weak and frequent ; in fhort, all 
 thofe fymptoms appeared which accompany what 
 Home calls the putrid ftage of Cynanche Trachealis. 
 From the difeafe having been of feveral days Hand- 
 ing, and from the violence of the fymptoms, I al- 
 moin defpaired of faving the child. Willing, how- 
 ever, to give him every poffible chance of recovery, 
 and being fully fatisfied that putridity was not the 
 caufe of the debility, I immediately opened one of 
 the jugular veins, from which near (even ounces of 
 blood were drawn. The child appeared to faint; I 
 then flopped the blood, and on recovering, he 
 breathed much more eafy. I now purfued the fame 
 method as in the former cafes, with refpect to the 
 bath and emetics. In addition to which, a Witter- 
 ing plainer was applied to the throat, and, to my 
 great fatisfaction, after feven days the child was per- 
 fectly relieved of the complaint. 
 
 In 
 
( 35 ) 
 
 In this lafl mentioned cafe, agreeable to the opi- 
 nion that was formerly entertained of this difeafe, 
 antifeptics mould have been freely adminiftered. 
 What would have been the confequence of mch a 
 .plan ? The anfwer is plain — certain death. 
 
 After having given the plan of cure, above re- 
 commended, fo fatisfaclory a trial, there does no 
 longer remain a doubt with me, that the fuppofi- 
 tion of this difeafe being attended with putridity is 
 erroneous; and has of courfe been productive of 
 much mifchief, 
 
 FINIS. 
 
COLUMBIA UNIVERSITY LIBRARIES 
 
 This book is due on the date indicated below, or at the 
 expiration of a definite period after the date of borrowing, as 
 provided by the rules of the Library or by special arrange- j 
 ment with the Librarian in charge. 
 
 DATE BORROWED 
 
 DATE DUE 
 
 DATE BORROWED 
 
 DATE DUE 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 C28(l!4l)M100 
 
 
 
 
14 
 
 Borrow© 
 
 C'J f