tion into the œsophagus, and sometimes through the whole of the alimentary canal, propagating the putrefaction, and often exhausting the patient by a frequent diarrhoea.

The acrid matter poured out in the fauces being again absorbed, frequently occasions large swellings of the lymphatic glands about the neck, and sometimes to such a degree as to occasion suffocation.

It is seldom that the organs of respiration escape entirely unhurt, and very often the inflammatory affection is communicated to them. From dissections it appears, that, in the .cynanche maligna, the larynx and trachea are often affected in the same manner as in the cynanche trachealis and it is probable that, in consequence of that af fection, the cynanche maligna often proves fatal by such a sudden suffocation as happens in the proper cynanche trachealis; but there is reason to suspect, that, upon this subject, dissectors have not always distinguished properly between the two diseases.

316. These are the several fatal terminations of the cynanche maligna; but they do not always take place. Sometimes the ulcers of the fauces are of a milder nature; and the fever is more moderate, as well as of a less putrid kind; and when, upon the appearance of the efflorescence. on the skin, the fever suffers à remission; when

the efflorescence continues for three or four days, till it has spread over the whole body, and then ends by a desquamation, giving a further remission of the fever; this often entirely terminates by gentle sweats, on or before the seventh day; and the rest of the disease terminates in a few days more, by an excretion of sloughs from the fauces; while sleep, appetite, and the other marks of health, return.

From what is said in this, and the preceding paragraph, the prognostics in this disease may be readily learned,

317.. In the cure of this disease, its septic tendency is chiefly to be kept in view. The debility, with which it is attended, renders all evacuation by bleeding and purging improper, except in a few instances, where the debility is less, and the inflammatory symptoms more considerable. The fauces are to be preserved from the effects of the acrid matter poured out upon them, and are therefore to be frequently washed out by antiseptic gargles or injections; and the septic tendency of the whole system should be guarded against and corrected by internal antiseptics, espécially by the Peruvian bark given in substance, from the beginning, and continued through the course of the disease, Emetics, both vomiting and nauseating, prove useful, especially when employed early in the disease. When any considerable tumour

occurs, blisters applied externally will be of seryice, and, in any case, may be fit to moderate the internal inflammation,

SECT. III.

Of the Cynanche Trachealis.

218. This name has been given to an inflam mation of the glottis, larynx, or upper part of the trachea, whether it affect the membranes of these parts, or the muscles adjoining. It may arise first in these parts, and continue to subsist in them alone; or it may come to affect these parts from the cynanche tonsillaris or maligna spreading into them.

319. In either way it has been a rare occur rence; and few instances of it have been marked and recorded by physicians. It is to be known by a peculiar ringing sound of the voice, by difficult respiration, with a sense of straitening about the larynx, and by a pyrexia attending it.

320. From the nature of these symptoms, and from the dissection of the bodies of persons who have died of this disease, there is no doubt of its being of an inflammatory nature. It does not, however, always run the course of inflammatory affections, but frequently produces such an ob

struction of the passage of the air, as suffocates, and thereby proves suddenly fatal,

321. If we judge rightly of the nature of this disease, it will be obvious, that the cure of it requires the most powerful remedies of inflammation, to be employed upon the very first appearance of the symptoms. When a suffocation is threatened, whether any remedies can be employ→ ed to prevent it, we have not had experience to determine.

322. The accounts which books have hitherto given us of inflammations of the larynx, and the parts connected with it, amount to what we have now said; and the instances recorded have almost all of them happened in adult persons; but there is a peculiar affection of this kind happening especially to infants, which till lately has been little taken notice of. Dr. Home is the first who has given any distinct account of it; but, since he wrote, several other authors have taken notice of it, (see MICHAELIS De angina polyposa sive membranacea, Argentorati 1778); and have given different opinions with regard to it. Concerning this diversity of opinions, I shall not at present inquire; but shall deliver the history and cure of this disease, in so far as they have arisen from my own observation, from that of Dr. Home, and of other skilful persons in this neighbourhood.

323. This disease seldom attacks infants till af ter they have been weaned. After this period, the younger they are, the more they are liable to it. The frequency of it becomes less as children become more advanced; and there are no instances of children above twelve years of age being af fected with it. It attacks children of the midland countries, as well as those who live near the sea. It does not appear to be contagious; and its attacks are frequently repeated in the same child. It is often manifestly the effect of cold applied to the body; and therefore appears most frequently in the winter and spring seasons, It very commonly comes on with the ordinary symptoms of a catarrh; but sometimes the peculiar symptoms of the dis ease shew themselves at the very first,

324, These peculiar symptoms are the follow ing:-A hoarseness, with some shrillness and ringing sound, both in speaking and coughing, as if the noise came from a brazen tube, At the same time, there is a sense of pain about the larynx, some difficulty of respiration, with a whizzing sound in inspiration, as if the passage of the air were straitened. The cough which attends it is commonly dry; and, if any thing be spit up, it is a matter of a purulent appearance, and sometimes films resembling portions of a membrane. Together with these symptoms, there is a frequency of pulse, a restlessness, and an uneasy sense of