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pletely line the larynx and trachea, or merely cover them in portions. In every instance, however, it must operate in some degree as an extraneous substance; by its dryness and unyielding nature must increase the inflammation and cough; and, if the disease be not arrested in its progress, must induce the suffocating and the fatal spasm. This malady is an enemy rapid in his march, and sometimes ere we can collect our scattered thoughts, will have planted his standard within the citadel of life, and have done his horrid work. A violent disease is naturally supposed to require a violent remedy. The medicinal agent, however, to be proposed as a remedy in this complaint is exceedingly mild. In truth it is no new medicine. The mode of application merely is new. The remedy is calomel, given in thick syrup, or in molasses simply, in very small and very frequently repeated doses, with the design that the fauces should for a length of time remain constantly smeared by the preparation. The quantity of calomel administered within a limited time has been such as the patient could well bear without excessive purging. With this remedy no other medicine has usually been united, except ung. hydrargyri, applied externally to the throat. In no instance has ptyalism been produced; and,

In bad cases of croup a little of the calomel has heen exhibited every half minute. The medicine has generally been given in larger quantities at first than afterward; but never in such quantities as to have a powerful and long continued action on the bowels.

404 DR. MACOMBER ON CYNANCHE TRACHEALIS.

since the writer adopted this mode of cure, though he has been situated on the sea coast, and has, within twenty years past seen numerous cases of what appeared to be cynanche trachealis, in no instance has he seen a fatal case.

A wish to produce an increased secretion of mucus from the muciparous glands of the fauces, larynx and trachea led to this mode of applying calomel. It was supposed, if the discharge of mucus from these glands could be expeditiously increased, that the mucus or lymph within the larynx would not become exsiccated in such a degree by the heat of the parts as to form the preternatural membrane, or what has been improperly called by some, the fatal membrane. In agreement with this theory the writer has frequently seen all the distressing symptoms gradually disappearing within an hour from the time of commencing the frequent exbibitions of calomel; and in a short time the disease has entirely vanished. He has not always however been thus fortunate. He has not unfrequently seen cases, in which the cough continued for a week, or longer ; though it soon lost its sbrillness, and indicated the presence of a loose phlegm. In these cases the calomel has been continued in quantities proportioned to the strength of the patient, and doses of some mild emetic have been exhibited, as occasion required. It may be here rationally conjectured, that the formation of the membrane had taken place, but that by the

frequent exhibitions of calomel an increased discharge of mucus had been produced, enveloping the preternatural membrane in its moisture, and in this manner rendering it less irritating, and less a source of coughing : but the membrane remains. It should be recollected, however, that the membrane is subjected to air, heat and moisture, three agents capable of breaking up its tenacity ; and that after this it may be readily thrown off by expectoration. During this state, emetics of ipecacuanha may assist the efforts of the system by promoting expectoration. While the cough however remains shrill, the writer has not seen any benefit from emetics. After the exhibition of tartrite of antimony, in such doses as to excite full vomiting, he has not unfrequently known the disease to return, attended with an increase of all its distressing symptoms.

The exhibition of calomel in any mode may undoubtedly be attended with success; but given in very large doses, as it sometimes has been in this disease, it is apt to produce hyper-catharsis, attended by a considerable degree of debility, and to fail of producing an increased discharge from the muciparous glands of the throat. It is concluded therefore, that in no way can a tendency to ptyalism, or an increased discharge of a fluid mucus from the glands of the fauces and larynx, be so expeditiously, so safely and so effectually excited, as by the exhibition of calomel, in the mode already prescribed.

Bleeding may remove inflammation of the throat and produce an immediate cure; but it will frequently fail, and in young subjects may induce a dangerous degree of debility, and an increased tendency to spasm. Epispastics may also have been attended with benefit in some cascs; but in no instance has the writer had occasion to resort to either of these remedies.

ARTICLE XIII.

Account of an operation at the Massachusetts General

Hospital. By J. C. Warren, M. D. Fellow of the Society. Professor of Anatomy and Surgery in Harvard University. Mary Litchfield, aged 49 years. Emphyma Encystis Steatoma.

Nov. 10, 1828. This patient has a tumor on the right cheek, which began to appear about twenty years ago, increased gradually till it arrived to about two thirds its present size, when it remained stationary till the last ten months. It commenced just above the angle of the jaw in front of the ear, and is bounded as follows, viz. the zygoma above,

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