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heat. When the internal fauces are viewed, they are sometimes without any appearance of inflammation; but frequently a redness, and even swelling, appear: and sometimes in the fauces there is an appearance of matter like to that rejected by coughing. With the symptoms now described, and particularly with great difficulty of breathing, and a sense of strangling in the fauces, the patienf; is sometimes suddenly taken off.
325. There have been many dissections made of infants who had died of this disease; and almost constantly there has appeared a preternatural piemb-rane lining the whole internal surface of the Upper part of the trachea, and extending in the same manner downwards into some of its ramifications. This preternatural membrane may be easily separated, and sometimes has been found separated in part, from the subjacent proper membrane of the trachea. This last is commonly found entire, that is, without any appearance of erosion or ulceration; but it frequently shews the vestiges of inflammation, and is covered by a matter resembling pus, like to that rejected by coughing; and very often a matter of the same kind is found in the bronchia, sometimes in considerable quantity.
326. From the remote causes of this disease; (rom the catarrhal symptoms commonly attending h; from the pyrexia constantly present with it j from the same kind of preternatural membrane being found in the trachea when the cynanche ma» ligna is communicated to it; and, from the vestiges of inflammation on the trachea discovered upon dissection; we must conclude, that the disease consists in an inflammatory affection of the mucous membrane of the larynx and trachea, producing an exudation analogous to that found on the surface of inflamed viscera, and appearing partly in a membranous crust, and partly in a fluid resembling pus.
327. Though this disease manifestly consists of an inflammatory affection, it does not commonly end either in suppuration or gangrene. The peculiar and troublesome circumstance of the disease seems to consist in a spasm of the muscles of the glottis, which, by inducing a suffocation, prevents the common consequences of inflammation,
328. When this disease terminates in health, it is by a resolution of the inflammation, by a ceasing of the spasm of the glottis, by an expectoration of the matter exuding from the trachea, and of the crusts formed there; and frequently it ends without any expectoration, or at least with such only as attends an ordinary catarrh.
329. When the disease ends fatally, it is by a
suffocation j seemingly, as we have said, depending upon a spasm affecting the glottis; but some, times, probably, depending upon a quantity of matter filling the bronchiae.
330. As we suppose the disease to be an inflammatory affection, so we attempt the cure of it by the usual remedies of inflammation, and which, for the most part, I have found effectual. Bleeding, both general and topical, has often given immediate relief; and, by being repeated, has entirely cured the disease* Blistering also, near to the part affected, has been found useful. Upon the first attack of the disease, vomiting, immediately after bleeding, seems to be of considerable use, and sometimes suddenly removes the disease. In every stage of the disease, the antiphlogistic regimen is necessary, and particularly the frequent use of laxative glysters. Though we suppose that a spasm affecting the glottis is often fatal in this disease, I have not found antispasmodic medicines to be of any use.
Of the Cynanche Pharyngaa.
331. In the Cynanche tonsillaris, the inflammation of the mucous membrane often spreads upon the pharynx, and into the beginning of the cesophagus, and thereby renders deglutition more difficult and uneasy; but such a case does not require to be distinguished as a different species from the common cynanche tonsillaris; and only requires that blood-letting, and other remedies, should be employed with greater diligence than in ordinary cases. We have never seen any case in which the inflammation began in the pharynx, or in which this part alone was inflamed: but practical writers have taken notice of such a case ; and to them, therefore, I must refer, both for the appearances which distinguish it, and for the method of cure.
Of the Cynanche Parotidcea.
332. This is a disease known to the vulgar, and among them has got a peculiar appellation, in every country of Europe; but has been little taken notice of by medical writers. It is often epidemic, and manifestly contagious. It comes on with the usual symptoms of pyrexia, which is soon after attended with a considerable tumour of the external fauces and neck. This tumour appears first as a glandular moveable tumour at the corner of the lower jaw; but the swelling soon becomes uniformly diffused over a great part of the neck, sometimes on one side only, but more commonly
on both. The swelling continues to increase till the fourth day; but from that period it declines, and in a few days more passes off entirely. As the swelling of the fauces recedes, some tumour affects the testicles in the male sex, or the breasts in the female. These tumours are sometimes large, hard, and somewhat painful; but in this climate, are seldom either very painful, or of long continuance. The pyrexia attending this disease is commonly slight, and recedes with the swelling of the fauces; but sometimes, when the swelling of the testicles does not succeed to that of the fauces, or when the one or the other has been suddenly repressed, the pyrexia becomes more considerable, is often attended with delirium, and has sometimes proved fatal.
333. As this disease commonly runs its course without either dangerous or troublesome symptoms, so it hardly requires any remedies. An antiphlogistic regimen, and avoiding cold, are all that will be commonly necessary. But when, upon the receding of the swellings of the testicles in males, or of the breasts in females, the pyrexia comes to be considerable, and threatens an affection of the brain, it will be proper, by warm fomentations, to bring back the swelling; and, by vomiting, bleeding, or blistering, to obviate the consequences of its absence.