any difficulty of diagnosis will be of comparatively little consequence, since the treatment of the two diseases is much the same. In early infancy, we occasionally observe considerable obstruction about the throat, producing somewhat of a croupy sound both in inspiration and exspiration, but especially during the former, and without any difficulty of swallowing. It appears to depend entirely upon a want of muscular power about the velum; it lasts for a variable period, and cannot very readily be mistaken for croup. When in an acute attack of common catarrh, the inflammation is most actively developed in the mucous membrane of the larynx and trachea, or for a time happens to be limited to these parts, we occasionally have considerable difficulty of breathing, and a harshness or hoarseness of the cough and voice, which bear some resemblance to croup. A consideration, however, of the age of the patient, the progress of the case, and the development of fresh and less equivocal symptoms, will, in general, enable us to decide in the very few instances in which such a doubt can arise. A sudden and severe attack of the eruptive fever of measles, has been mistaken for croup; but the watery eye, the sneezing, and the discharge from the nose usually observed in measles, together with the history of the case, will for the most part sufficiently point out the distinction.

Symptoms of croup may be induced by foreign bodies accidentally introduced into the larynx, or by tumours or abscesses pressing upon that organ; whilst symptoms somewhat resembling those of spasmodic croup are not unfrequently produced by dentition, and often precede, alternate with, or even form a part of general convulsions.

Prognosis.-Croup is a most dangerous disease, and

the prognosis ought perhaps in most instances to be unfavourable, or at least extremely guarded; for however slight the attack, and however flattering the appearances, it must be remembered that a spasm of the glottis, or a portion of detached false membrane forced into that opening, may suddenly and unexpectedly destroy life, at any period of the complaint. If the attack be of moderate severity, if the child be naturally of good constitution, and assistance be sought early, our chance of success will be proportionably great. When the febrile state abates, when an universal moisture bedews the surface, when the effort during inspiration becomes less marked, and when the patient succeeds in expectorating a portion of false membrane, with manifest relief to the respiration, we have reason to hope that a favourable change is taking place; but if, on the contrary, the effort during inspiration and the sense of suffocation and consequent jactitation become aggravated, if the face assume a livid paleness, if the head be thrown back, if the eyes stare, if the voice be entirely lost, if the attempts to cough do not amount to more than a forcible husky expiration, there will be but too great reason to apprehend, that the powers of life must shortly give way, and the patient perish.

Causes. Although some have been inclined to consider florid and irritable children most liable to croup, it must be acknowledged that very little has hitherto been positively ascertained respecting the causes which predispose to the complaint; and if we do occasionally observe several members of a family affected at the same time or in succession, it is probably attributable, rather to all of them being placed under the same circumstances in regard to locality, than to an hereditary tendency. The most common exciting cause, appears to be cold and damp; and

hence the greater prevalence of the disease in low than in elevated situations. There is little reason to suppose that it ever proves contagious, although it now and then appears to prevail as an epidemic.

Treatment. The two principal objects in the treatment of this disorder are, to subdue the inflammation and to allay irritation. As there is some reason for believing that the peculiar inflammatory product which proves so great a source of danger, results from the kind, rather than from the mere intensity of the inflammation, we ought, in regard to depletion, to be guided more by the degree of febrile excitement present and by the age and constitutional powers of the patient, than by the mere obstruction to the breathing. Accordingly, if the febrile symptoms are acute, and if the child be of good constitution, blood may in the first instance be taken from the arm, to the amount of from four to eight or ten ounces, according to the age and the effect produced. If there be any doubt about the propriety of general depletion, from two or three to eight or ten leeches may be applied to the external throat, their application being followed by a poultice, or by sponging with very hot water or decoction of poppyheads. Immediately after the depletion, an emetic may be given, either of ipecacuanha or, what is more powerful, of the tartar emetic. As soon as the vomiting has ceased, calomel should be freely administered,-two, three, or four grains, with a grain of ipecacuanha, and one, two, or three of extr. of conium or of extr. of hyoscyamus, every four or five hours; or, the calomel may be given with the ipecacuanha in powder, whilst the anodyne is added to a diaphoretic mixture of liq. ammon. acetatis, with which we may join ten or fifteen minims of antimonial wine. By these means, and by the warm bath, we must endeavour

to subdue the inflammation and prevent the occurrence of spasm of the glottis; the emetic being repeated from time to time as circumstances shall indicate. In proportion to the greater age of the patient, will be the propriety and expediency of substituting Dover's powder and the stronger preparations of opium, for the milder anodynes mentioned. The patient should be confined to bed, and his apartment maintained at a moderately warm and steady temperature; he must live upon slops, be kept as quiet as possible, and if sufficiently intelligent be requested to abstain from talking. At a more advanced period of the disorder, it may be advantageous to administer the reputed expectorants with anodynes, and to support the powers of life by ammonia and by a more liberal allowance of nourishment. Should the patient be threatened with suffocation, we have no alternative but to recommend the operation of tracheotomy, however small may be the chance of thereby saving the patient's life.

Spasmodic Croup.

Some children who have experienced an attack of ordinary croup in early life, continue perhaps for years afterwards, liable to have croupy symptoms reproduced whenever they become the subjects of the slightest catarrh. In other instances, children are every now and then seized with croupy cough and great difficulty of respiration, but unaccompanied by any febrile excitement or symptoms of local inflammation. From the latter circumstance, and from the attacks coming on suddenly and as suddenly disappearing, the affection has been regarded as spasmodic rather than inflammatory, and has accordingly received the name of Spasmodic Croup. It is probable, however, that in every instance, there is more or

less of an inflammatory state, although it is equally probable, that from a morbid susceptibility of the parts about the glottis, an extremely slight degree of inflammatory action may prove sufficient to excite spasm, and thereby produce the alarming symptoms. In such cases the treatment should be gentle. A mustard poultice may be applied to the throat, or the patient immersed in a warm bath. A purgative medicine, by the mouth or by glister, should be administered, and afterwards some saline mixture containing an anodyne of extr. conii or extr. hyoscyami; or, according to the age of the patient, the stronger preparations of opium. In the more severe cases, an emetic may be given at the commencement, followed by the warm bath, local fomentations, moderate doses of calomel, and an anodyne diaphoretic mixture. After an attack of spasmodic croup, the general health should be improved, and the irritability of the system at large, and of the glottis in particular, diminished by great attention to the state of the bowels, by the use of mild vegetable or mineral tonics, by good nourishing diet, country air, the cold bath, and by the employment of stimulating and anodyne embrocations,―flannel being at the same time constantly worn round the throat.

HOOPING-COUGH, OR WHOOPING-COUGH.

The Tussis Convulsiva of many authors, the Pertussis of Dr. Cullen, and commonly known by the name of Kinkcough or Chin-cough.

The hooping-cough appears to consist in a specific inflammation of the air passages, incident to infants and children, rarely attacking adults, usually occurring but once