Generally speaking, indeed, the com mon means employed in the removal of other local inflammations, with the use of acid gargles, is the plan to be adopted in Cynanche ; yet the two following species require to be noticed separately.
C. trachealis. This disease rarely attacks infants until after they have been weaned ; it generally commences with a sensation of uneasiness, or somewhat of an obtuse pain about the upperpart of the trachea, which is increased on pressure, or a sense of constriction is perceived in the neighbourhood of the larnyx ; upon inspecting the fauces, little or no tumour is generally observed ; sometimes, how ever, there is some trifling degree of red ness; a hoarseness, and particular ring ing shrill sound of the voice, accompanies both speaking and coughing ; the noise appears to proceed as from a brazen tube, and has been not inaptly compared to the crowing of a cock ; there is dyspnaea, attended with a wheezing sound in the act of inspiration ; the cough which at tends the disease is commonly dry and short ; if any thing be expectorated, it is putriform, and mixed with small portions of a whitish membrane, similar to what is found in the trachea upon dissection, Which is, by that illustrious anatomist and physician, Dr. 13sillie, supposed to be formed by some peculiar action of the blood-vessels of the inner surface of the larynx and the trachea, which is super added to inflammation ; the face is some what livid, or is flushed. With these symptoms there is some degree of fre quency and hardness of the pulse, thirst, restlessness, and an unpleasant sense ofheat ; the deglutition is but little or not at all affected ; the urine, at the commencement of the disease, is general ly high coloured ; sometimes, however, it is limpid ; but in the advanced stage it is turbid : there is seldom any delirium ; sometimes, however, the patient seems stupid, and mutters to himself, and often in the perfect use of his senseshe is seized with great difficulty of breathing, and a sense of strangling about the fauces, and is suddenly carried off. This disease chiefly appears in the winter and spring ; it generally attacks the most robust and Kiddy children, and frequently comes on with the ordinary symptoms of catarrh. The remote causes are, cold, combined with a moist state of the atmosphere ; in fancy ; exposure to air passing over large bodies of water, and many of the causes producing the Phlegmasim, and the other species of Cynanche. It is said to he most frequently met with in marshy situations, and near the coast. The proximate cause appears to consist in an inflammation of the inner coat of the trachea and the ht.
rynx, together with an altered and pe culiar action in the blood-vessels of the parts ; and the adventitious membrane is the consequence.
We must attempt the curs of this disease by the remedies which arc recommended for the removal of inflam mation ; blood-letting, both general and topical, must be immediately had recourse to, and it must be repeated according to the strength of the patient, violence of the symptoms, state of the pulse, and the effects produced from it : repeated eme tics should be administered, and mild ca. thartics or laxative clysters should be at the same time employed ; blisters should be applied to the external fauces, or stimulating liniments, as the liniment of ammonia with oil of amber and tincture of cantharides, should be made use of; the warm bath should be ordered, and the vapour of warm water, with or without a portion of vinegar, should be frequently received into the fauces ; in every stage of the disease the antiphlogistic regimen is peculiarly necessary, and the patient should lie with his head raised high in bed : small repeated doses of calomel have been administered with the best ef fects, at the commencement and through out the whole course of the disease, as two or three grains two or three times in the course of the day. This disease sometimes attacks adults ; in which case the most powerful remedies against in flammation, together with the employ ment of emetics, must be immediately had recourse to, and persevered in with assi duity. There appear to be two varieties of this complaint ; the one just now de scribed, which may be termed the inflam matory, and the spasmodic ; which, from their different requisite mode of treat ment, it will be necessary to discriminate. The inflammatory Cynanche commonly at tacks the patient in a gradual manner, and is generally preceded for a few days by slight symptoms of pyrexy ; it never, when completely formed, intermits so as to lose its distinguishing mark, particular. ly in coughing : the heat, frequency of the pulse, and other symptoms of pyrexy, are in a much greater degree in this than in the spasmodic species. The spasmo dic Cynanche always attacks the patient in a sudden manner, and usually in the night-time : it often intermits, and in the intervals both the respiration and cough, if any exists, are free from the character istic sound of the above disease ; it must, of course, be treated with antispasmodics, as the musk, camphor, asafcetida, the warm bath, and sinnlar remedies.