AN
INAUGURAL DISSERTATION
ON THE
CYNANCHE TRACHEALIS.
SUBMITTED TO THE PUBLIC EXAMINATION
OF THE
FACULTY OF PHYSIC,
UNDER THE AUTHORITY OF THE
TRUSTEES OF COLUMBIA COLLEGE
IN THE
STATE OF NEW-YORK:
WILLIAM SAMUEL JOHNSON, LL. D. President;
FOR THE DEGREE OF
DOCTOR OF PHYSIC; 
ON THE THIRTIETH DAY OF APRIL, 1793.
By SAMUEL BORROWE,
Citizen of the State of New-York.
Whence in bright floods the VITAL AIR expands,
And with concentric spheres involves the lands;
Pervades the swarming seas, and heaving earths,
Where teeming Nature broods her myriad births; 
Fills the fine lungs of all that BREATHE OR BUD; 
Warms the new heart, and dyes the gushing blood; 
With life's first spark inspires th' organic frame,
And, as it wastes, renews the subtile flame. 
DARWIN.
NEW-YORK:
Printed by T. and J. SWORDS, Printers to the Faculty of Physic of
Columbia College, No. 27, William-Street.
1793.

IMPRIMATUR.
Samuel L. Mitchill. 

TO
GOZEN RYERSS,
AND
JOHN C. DONGAN,
OF
STATEN-ISLAND;
THIS
DISSERTATION
Is most respectfully inscribed,
By their much obliged Friend,
The AUTHOR.



AN
INAUGURAL DISSERTATION
ON
CYNANCHE TRACHEALIS.
THERE is perhaps no disease to which children
are subject, that proves more certainly destructive,
if left to nature, than the Cynanche Trachealis. Such
was its supposed fatal nature, that not long since
many have been suffered to expire without calling
in any medical assistance, as it was conceived to be
irremediable; owing to the then unsuccessful me-
thod of treating it.
With respect to the nature and cause of Chynanche
Trachealis, there has lately been a variety of opi-
nions entertained, which have given rise to as great a
variety of remedies, and of very opposite kinds.
Almost every Physician has had a different me-
thod of cure. As they could not all be right, thou-
sands 

(6)
sands of the sick, no doubt, must have fallen a sa-
crifice to the disease, for want of medical discernment,
or by rcason of a blind attachment to an improper
plan.
We have accordingly seen one set of men warmly
recommending the sthenic mode of cure, prescribing
contrayerva, Peruvian bark, &c. with a view, as
they express it, of counteracting the virus, or cor-
recting the tendency of the fluids to putrefaction.
How much to be feared are such Practitioners,
who, in spite of modern experience to the contrary,
still adhere to that delusive, and I may say, danger-
ous system. the humoral pathology! And how much
to be pitied are those unfortunate patients who come
under their immediate care!
On the other hand, we observe another set of men,
who, with great propriety, advise the asthenic method
of cure.*
Others have said that there are two species of this
disease, spasmodica and humida.† That there may
be a Cynanche Trachealis Spasmodica. I will not at-
tempt to deny; but in all those cases which I have
had
* Cullen's First Lines, and a Letter from Richard Bayley, Surgeon,
to William Hunter, M. D.
† Rush's Inquiries and Observations, page 120. 

(7)
hid an opportunity of observing, there did not ap-
pear to be any thing like spasm.
In this Dissertation, I shall, therefore, confine my-
self to that species which Doctor Rush calls Cynan-
che Trachealis Humida. I shall first attempt a re-
view of some of the opinions that have been advanced
with respect to its nature and causes, and then en-
deavour to point out what appears to me to be the
most proper method of cure.
HISTORY of the DISEASE.
THE celebrated Doctor Francis Home has ob-
served, that the Cynanche Trachealis is confined to
the sea coast, and mentions as a proof of this opi-
nion, that it seldom occurs in Edinburgh, while, in
Leith and Musselburgh it is very common. He
likewise observes, that it frequently appears along
the coast of Fife, the maritime parts of Airshire and
Galloway.*
From
* A Treatise on the Diseases of Children, London printed, 1772, in
which there is an extract from Home's Book on the Croup.
When I shall have occasion to speak of Home's opinion in future, I beg
leave to refer the reader to the above mentioned Treatise, as I have not
been able to procure Home's original observations on this disease. 
 

(8)
From these facts, Home draws a general conclu-
sion, that this disease is peculiar to the sea shore.
This I am disposed to doubt, for, upon inquiry, it is
found, that the Cynanche Trachealis frequently pre-
vails in the most inland situations.*
I was lately informed by Zina Hitchcock, a re-
putable Physician in Washington county, that the
Cynanche Trachealis frequently occurred in the neigh-
bourhood of Fort Edward, which is two hundred
and twenty-one miles from the sea shore.
Many more facts on this head might be mention-
ed, but I conceive those already stated sufficient to
do away the opinion of Home, with respect to this
disease having a necessary connection with maritime
regions.
In another place Home has asserted, that the Cy-
nanche Trachealis only occurs in the colder seasons.
This is erroneous, for it is known to prevail in the
heat of summer.† There is no situation, no climate,
nor season exempt from it. But I have observed,
that it more frequently prevails during those seasons
in which there are the greatest vicissitudes.
There
* Cullen's First Lines of the Practice of Physic.
† This fact was communicated to me by Dr. Samuel L. Mitchill, one
of whose brothers died of this disease in the month of August. 
 

(9)
There has been much dispute about the seat of
this disease. Some have supposed its situation to be
in the glottis; others, that it was seated in the
trachea only.* Dissections, however, prove that
it is not confined to the glottis and trachea alone,
but that it extends into the extreme branches of the
bronchia.†
The Cynanche Trachealis may be said to be pecu-
liar to children, as it is never known to attack per-
sons after the age of twelve or fourteen years.
This disease has been considered as contagious,‡
but from the observations which I have been able to
make, it does not appear to depend in any degree on
contagion. I have never seen an instance in which
it appeared to be communicated from one person to
another, although they were placed in a situation
favourable to receive it, had there been any contagion.
From these circumstances I am induced to con-
clude, that this disease is not to be considered as con-
tagious; and therefore, does not require all that
B caution
* Treatise on the Diseases of Children, page 154.
† Dr. Bard's Inquiry into the Nature, Cause, and Cure of Angina
Suffocativa, page 22.
‡ Bard's Inquiry, &c, 

(10)
caution that was formerly taken of keeping healthy
children apart from those labouring under Cynanche
Trachealis.
It is not uncommon for this disease to attack the
same child repeatedly. Whether this proceeds from
the force of habit, or from the peculiar irritability
of the child, I shall not attempt to determine. The
latter however appears to be the most reasonable con-
jecture.
DIAGNOSIS.
CULLEN, in his Synopsis Nosologiæ Methodicæ,
has placed this disease in the class of Pyrexiæ, and
order of Phlegmasiæ. As the pathognomonick symp-
toms are collectively viewed in the definition, I here
give it in the words of that learned Nosologist.
" Respiratione difficili, inspiratione strepente, voce
raucâ, tussi elangosa, tumore fere nullo in faucibus
apparente, deglutitione parum difficili et febre sy-
nocha."*
The
* Culleni Synopsis Nosologiæ Methodicæ. 
 

(11)
The most distinguishing characteristics of Cynan-
che Trachealis, are the hoarse dry cough, and shrill
found in inspiration, which is compared to air passing
through a brazen tube,* to the crowing of a young
cock;† and it is likewise said to be similar to the
barking of a young dog.‡ Together with these
symptoms there is a pain about the larynx, great dif-
ficulty of respiration, and a sense of suffocation; the
cough is remarkably dry, the pulse is for the most
part frequent, and the patient is extremely uneasy,
continually throwing the arms and legs about, fre-
quently turning from side to side, often placing the
hands to the throat, as if he was choaking. In the
earlier stages of this complaint, the face is considera-
bly flushed; but in the latter stages, it becomes pale
and frequently of a livid appearance. As the disease
advances, there comes on a disposition to sleep, which
appears to be produced in part, by the strength be-
ing exhausted, in consequence of the great anxiety
and struggling of the patient, whereby the circula-
tion ultimately becomes languid. If roused from
this apparent sleep, the uneasiness is considerably in-
creased in consequence of the circulation being quick-
ened; whereby a greater quantity of blood is sent to
the
* Cullen's First Lines of the Practice of Physic.
† Bard's Inquiry, &c.
‡ Rush's Observations, &c. 

(12)
the lungs in a given time. Together with these
symptoms, the difficult respiration continues to in-
crease, which, in a very short time, terminates the
existence of the unfortunate patient.
This is the common course of Cynanche Trachealis
if left to nature, and, I fear, too frequently when a
cure is attempted.
Rush mentions that there are small red blotches
sometimes observed on the skin. This I consider as
an accidental occurrence, and therefore not requiring
any particular attention.
It is said that the fauces are swelled and somewhat
inflamed.* That this may sometimes take place, I
shall not attempt to deny; but I have never been
able to discover the least appearance of inflammation
or swelling in the fauces, though I have been par-
ticularly careful in examining a number of patients
with the Cynanche Trachealis, while I was under the
tuition of the late celebrated Physician and extensive
Practitioner, Charles M'Knight; and likewise those
patients that have since come under my care.
It is mentioned that the Cynanche Trachealis comes
on with the usual symptoms of a common catarrh.†
I rather
* Cullen's First Lines.
† Cullen's First Lines, vol. i. page 352.

(13)
I rather suppose this to be a mistake, for I have seen
many children in the earliest stages of this disease,
and the peculiar symptoms that are above enume-
rated were the first appearance of indisposition.
REMOTE CAUSE.
THE remote causes may, perhaps, with some
degree of propriety, be divided into the predispo-
nent and occasional.
The predisponent cause appears to me to be a
certain irritability peculiar to children, as the Cynan-
che Trachealis is never known to attack a person af-
ter the age above mentioned, viz. twelve or fourteen
years.
With respect to the occasional or exciting cause,
there are many opinions. Home supposes that
the peculiar stimulus of the air near the sea, may
be considered as the occasional cause. The marine
air (says he) supplies a stimulus calculated to increase
the secretion of mucus from the glands of the trachea
and lungs. He supposes that a great quantity of sea
salt is carried into the atmosphere, which being in-
spired into the lungs, stimulates the orifices of the
glands 
 

(14)
glands dispersed on the internal surface of the trachea
and bronchia, and thereby increases the secretion of
mucus, which forms the preternatural membrane.
This is ingenious theory; but I believe it will be
found contrary to fact. The only case in which ma-
rine salt is suspended in the atmosphere, is when the
surf is very great, and the spray is forced by the wind
to a considerable distance from the shore, as happens
on the south side of Long-Island, where the spray is
carried to the distance of several miles on the land;
so that a briny fluid in some cases trickles in drops
from the leaves of the trees. Notwithstanding that
the air is so greatly impregnated with saline particles,
this disease is not found to be more rise there than
in the most inland situations.
This holds good with respect to many parts of the
West-Indies, as in Turk's-Island, &c. where the shore
is continually washed by the sea. But I cannot learn
that the Cynanche Trachealis is more frequent there
than in the places more remote from the sea coast.
From the foregoing considerations I am induced
to conclude, that the sea air is not the occasional cause
of this disease; that is, from the salt it contains.
After a fair and candid examination of the occa-
sional causes of Cynanche Trachealis, I am inclined to
think, 

(15)
think, with Cullen, that the principal are cold and
moisture applied to the body which was previously
much heated. This accounts for this disease occur-
ring most frequently when the greatest vicissitudes
of weather take place.
PROXIMATE CAUSE.
THE proximate cause of diseases has hitherto es-
caped, and probably will for a long time continue to
elude the most accurate researches of man. It is
therefore with the greatest diffidence that I shall offer
an opinion on this subject.
The proximate cause of Cynanche Trachealis has
been supposed to be an inflammatory action of the
vessels on the internal surface of the trachea. This
supposition does not by any means account for all the
phænomena, and is indeed contrary to fact; for
dissections prove that there is no primary inflamma-
tion in the Cynanche Trachealis.
Ronaldus Martin, Professor of Anatomy at
Stockholm, discovered by dissection that this preter-
natural membrane extended even into the most mi-
nute ramifications of the bronchia; where it resem-
bled 

(16)
bled the membrane that lines an egg-shell. In this
case there was not the least vestige of inflammation
in the trachea or lungs.* Bard likewise mentions se-
veral dissections which he made of patients who died
of Cynanche Trachealis, in which the preternatural
membrane was completely formed; and, in most of
those cases, there was not the least appearance of in-
flammation. He mentions also the case of a patient
who died in consequence of an inflammation of the
trachea, and on dissection there was not any of this
membrane formed. Here then there is both a posi-
tive and a negative proof, that inflammation is not
the cause of the before mentioned membrane. Rush
makes the following observation: " I acknowledge
that I have generally seen both species that have been
mentioned, without inflammatory symptoms, and
sometimes without fever, especially in the first stage
of the disease."† In those cases which are said to
be attended with inflammation, I consider it as an
effect of the mechanical action of the preternatural
membrane on the tender and delicate surface of the
trachea.
It has been asserted that the Cynanche Trachealis
depended on a disposition to putridity; in consequence
of
* Bard's Inquiry into the Nature, Cause, and Cure of Angina Suffo-
cativa, page 22.
† Rush's Observations and Inquiries. 
 

(17)
of which, there was such a state of the vessels on
the internal surface of the trachea induced, as caused
them to effuse a fluid which is disposed to inspissate.
If I should for a moment admit the improbable
idea that there is a putrid state of the body, I should
then ask those who contend for this opinion, how they
can account for the formation of the morbid mem-
brane that is constantly found in the trachea and bron-
chia of patients who have died of this disease. If
there is a putrid state induced, there is of course a
diminished cohesion of the particles of matter. If
there is a want of cohesion in the component parts
of the body, or, in other words, if the solids and
fluids are in a dissolved state, as was formerly said,
how is it possible for them to secrete a substance which
is possessed of so great a degree of tenacity as the
membrane before mentioned?*
If we carefully attend to the history of this disease,
we shall find that there is no symptom of putridity
attending it, except the debility that accompanies the
last stage should be considered as such, which can be
accounted for more rationally than on the supposition
of the body's being in a putrid state. Independent
C of
* Bard, in his Inquiry into the Nature, Cure, and Cure of Angina
Suffocativa, observes, that this membrane is somewhat similar to Sham-
moy leather. 

(18)
of any reasoning on this subject, the remedies to
which the Cynanche Trachealis is found to yield, af-
ford sufficient proof that it is not a putrid disease.
From what I have been able to observe, I am of
opinion that the proximate cause of Cynanche Tra-
chealis is a peculiar morbid action of the vessels on
the internal surface of the trachea and bronchia, where-
by a fluid is secreted which forms the tough mem-
brane.
The next object is to ascertain what the real nature
of this membrane is. It is supposed by some, to
be inspissated mucus,* and by others, coagulable
lymph.†
I am not willing to admit the supposition of its
being mucus; for I know of no fact or experiment
by which it is evinced that mucus can acquire such a
degree of cohesion as this membrane is found to pos-
sess, in so short a time, viz. a few hours. If it is
mucus, why does.not every child that labours under
a common catarrh get the Cynanche Trachealis?
And why does it not attack adults?
These are objections to its being mucus, which I
conceive it is not easy to remove. It may not be
improper
* Bard's Inquiry, &c. Rush's Observations; and Home on the Croup.
† Bayley's Letter to Dr. Hunter.

(19)
improper to observe, that the gastric juice is not ca-
pable of acting on this membrane, or of producing
any change in it, while mucus is perfectly dissolved
in the stomach.
It is found that children who have recovered from
the Cynanche Trachealis, have, for several days, pas-
sed in their stools large portions of this membra-
nous substance, which retained a great share of its
former tenacity.
This fact was some time since communicated to me
by Doctor Samuel L. Mitchill; since which, I have
had an opportunity of observing it in several cases
which came under my care. 
In this way we may account for the recovery of
children who have not thrown up the membrane
in the act of vomiting; for, as they coughed it from
their lungs, it was immediately taken into the sto-
mach.
This membrane not appearing on giving an emetic,
has given rise to an opinion that it is not formed in
every case of Cynanche Trachealis; and, in all proba-
bility, has induced many to suppose that this disease
was spasmodic.
That this morbid membrane is composed of coagu-
lable lymph, I am disposed to deny; for the co-
agulable 

(20)
agulable lymph is never separated from the blood in
a state disposed to assume a membranous form in the
body, except in cases of great inflammation, which
is proved does not take place in this disease. As a
further evidence that no primary inflammation takes
place in this disease, it may not be improper to ob-
serve, that the blood, when drawn from a vein, under
the most favourable circumstances, to produce a se-
paration of gluten, does not shew any tendency of
that kind, at any stage of the disease; and it is al-
lowed, that in every case of considerable inflamma-
tion or predisposition to it, that the blood, when taken
from a large orifice, in a full stream, shews, when
cold, a portion of its gluten separated.
I shall here take the liberty of inquiring into the
propriety of Cullen's placing this disease in the order
of Phlegmasiæ: his definition of which is,
" Febris synocha, phlogosis; vel dolor topicus,
simul laesa partis internæ functione; sanguis missus,
et jam concretus superficiem coriaceum albam often-
dens."
Here, then, is certainly a mistake; for the Cynan-
che Trachealis is deficient in two of the principal
characteristics of the order in which it is placed, viz.
inflammation, and the buffy appearance of the blood.
From 

(21)
From taking this view of the subject, I am in-
clined to think that this membranous lining which is
so constantly found within the trachea and bronchia
of those who have died of Cynanche Trachealis, is
neither inspissated mucus nor coagulable lymph, but
a substance sui generis, produced by the peculiar
morbid action of the vessels on the internal surface
of the trachea and bronchia.
PROGNOSIS.
THE prognosis of this disease is principally to
be drawn from the difficulty of breathing, and the
peculiar shrill found in the act of inspiration, toge-
ther with the dry cough.
When the respiration becomes very laborious,
cough dry, and the diseased peculiarity of the voice
is considerable, we may conclude the patient to be
in an extremely dangerous condition. If these symp-
toms continue to increase, and the face becomes pale,
or puts on a livid appearance, the pulses sink, and
there should be other marks of great debility, we
may venture to prognosticate certain death.
On the contrary, if the cough is moist, or attend-
ed with expectoration, the respiration free and easy,
we may with some degree of certainty predict a fa-
vourable termination.
EXPLANATION 

(22)
EXPLANATION of the SYMPTOMS.
HOME divides this disease into two stages, the
first inflammatory, the second putrid. What could
have induced him to make this groundless and need-
less division, I can scarcely imagine, since it is found
on dissection, that neither inflammation nor putridity
are attendant on the Cynanche Trachealis.
That there is a stage of excitement and a stage of
debility, I am willing to admit. But they can be
accounted for on the true laws of the Animal Eco-
nomy, better than on the supposition of inflammation
and its consequence, putridity.
I shall attempt to account for the first stage of
Cynanche Trachealis, or what Home calls the inflam-
matory stage, in the following manner: When a
child is attacked with this disease, he is extremely un-
easy, and continually turning from side to side. This
restlessness causes some considerable increase of the
circulation, and the face becomes flushed, These
symptoms have given rise to the opinion that there
was really inflammation present. But it is well
known that all these symptoms may, and do fre-
quently occur, without inflammation, as in the hot
stage of an intermittent fever.
The 

(23)
The stage of debility, or that which Home calls pu-
trid, may be accounted for in this way: The mor-
bid membrane that is found lining the trachea in this
disease, extends into the most minute ramifications
of the bronchia. The bronchia being thus coated
with a dense expansion, the air cannot perform its pro-
per operation upon the blood in the lungs. Hence
no decomposition of the respirable part os this fluid
takes place; and of course the circulating mass does
not become oxygenated. The want of oxygene in the
blood may be the cause os the livid appearance os
the sace in the latter stages os this disease.
As the membrane extends into the minute
branches of the bronchia, the difficulty of breathing
increases, which cannot be explained on the suppo-
sition os putridity; but can very clearly be accounted
sor, by supposing that the blood is deprived os its
natural stimulus, the oxygene, or base os vital air.
This likewise accounts for the feeble state of the
pulse in the advanced stage of the Cynanche Trachealis;
for it is a well established fact, that the circulation
and energy of the system depends on the respira-
tion. Consequently, if the respiration is in any con-
siderable degree affected, debility must ensue, and
all the vital functions suffer an interruption in pro-
portion to the degree of obstructed respiration. I
therefore 

(24)
therefore suppose, that most patients who die of Cy-
nanche Trachealis, expire in consequence of a sub-
duction of that stimulus which is necessary for the
support of animal life, and not by spasm * or putri-
dity.†
METHOD of CURE.
THE first indication of cure in Cynanche Trachea-
lis, is to deplete the system, which is most effectu-
ally done by letting blood, in considerable quantity,
from the jugular vein, arm, or any part most conve-
nient; but the jugular is to be preferred. The ve-
næ section should be repeated, if there are marks of
a full habit, or if the difficulty of breathing should
not be relieved by the first operation.
When I recommend blood-letting, it is on a dif-
ferent principle from that on which it is commonly
advised in this disease, viz. that of abating inflam-
mation; which, I have endeavoured to prove, does
not originally accompany this disease, nor essentially
appertain to it.
It must be allowed that respiration becomes neces-
sary in proportion to the quantity of blood contained
in
* Bayley's Letter to Dr. Wm. Hunter.
† Home on the Croup. 

(25)
in the system. If we diminish the quantity of blood,
of course respiration becomes less necessary. Hence
a person breathes more freely, in consequence of a
smaller quantity of blood passing through the lungs
in a given time. In proportion to the greater or
smaller quantity of blood which passes through the
lungs, the presence of vital air becomes more or
less necessary to oxygenate it; for without oxygene
life cannot exist.
In this disease, the oxygene is with extreme diffi-
culty, and in small quantity communicated to the
blood, in consequence of the interposition of the
silmy concretion which inverts the bronchia. If this
is admitted, we can account for the great relief
which blood-letting affords patients affected with
Cynanche Trachealis, which is almost instantaneous,
and therefore cannot be accounted for upon the sup-
position of this disease being inflammatory. Blood-
letting may be of service in another way. We
know, that when blood is drawn from the human
body in considerable quantity, and that in a short
space of time, its effects are very great. The change
thus brought about in the system, by the rapid eva-
cuation of blood, may operate on the vessels of the
trachea and bronchia in such a manner as to induce an
action in them, contrary to that which exists in the
D morbid 

(26)
morbid state, and in this way cure, or at least pre-
vent the increase of this disease. Emetics are then
to be given, to throw off the tough matter from
the lungs and trachea. The propriety of giving
emetics, in Cynanche Trachealis, has been doubted by
Home. He supposes that emetics promote the se-
cretion of mucus in the lungs, without causing it to
be evacuated, and in this way increases the complaint.
This reasoning will not do for I think there is the
highest improbability that mucus does produce the
peculiar membrane.
Throwing aside all theory, the great success that
constantly attends the use of emetics in Cynanche
Trachealis, is sufficient to recommend them as power-
ful remedies. There are many instances in which
the early administration of an emetic has totally
removed the complaint in the space of a few hours,
by causing the patient to discharge the membrane
from the trachea; and in other cases has caused a
loosening or separation of it; and afterwards, by the
effort of coughing, it has been entirely brought off.
In children who are so young that they have not the
power or understanding to expectorate, it has been
taken into the stomach, and after some time makes its
appearance in their stools, as has been before observed.
Besides the effect of throwing off this membrane,
emetics 

(27)
emetics produce a great revolution in the system, by
the concussion they give the whole body; they must
of course have a great tendency to interrupt or alter
that peculiar morbid action of the vessels on the in-
ternal surface of the trachea. Emetics likewise de-
termine to the surface of the body, and keep the
bowels regular; two circumstances of very great con-
sequence in the cure of this disease,
The steam of warm water has been highly recom-
mended to be taken into the trachea, with a view to
dissolve this membrane. This I consider as an insig-
nificant remedy, for it has been found that even the
maceration of this membrane in warm water for
several days, has had little or no effect in destroying
its tenacity. Besides, it is a remedy that cannot be
used but with extreme difficulty, particularly with
young children. I therefore think it may with pro-
priety be neglected.
A blistering plaister is next to be applied to the
throat, which, by determining to the surface, af-
fords great relief in Cynanche Trachealis, and appears
to be well calculated to produce the change so de-
sirable in this disease. There is, however, one very
great disadvantage sometimes resulting from the ap-
plication of blisters to the throat: They are apt to
produce 
 

(28)
produce disagreeable ulcers, which often end in mor-
tification and consequent death. The occurrence of
these ulcers may be accounted for from the parts be-
ing kept in continual motion, by the uneasiness of
the child, which exposes the blistered surface to the
continual action of the air. This, joined to the
friction, produces irritation and inflammation, which
sometimes terminate in mortification. I therefore
think that "blisters should be applied with the greatest
caution, and not suffered to remain on longer than
merely to act as rubefacients.
Calomel has been much recommended, particularly
by Rush.* In what manner calomel acts, is not
easily explained. I suppose, however, it is not by
correcting acrimony, as has been imagined;† for
calomel occasions a happy change in so short a time,
that it appears impossible for it to be absorbed, and
in that way produce its effects. I rather suppose,
that it acts in the manner which Rush observes,‡
or, that it acts by stimulatjng the stomach and bow-
els, which causes a derivation to them, whereby the
morbid action of the vessels on the internal surface of
the trachea is interrupted.
The
* Rush's Inquiries, &c.
† Bard's Inquiry, &c.
‡ " In what manner does calomel act in this disorder? Is it by in-
" creasing the secretion of mucus in the numerous glands of the fauces,
" æsophagus, stomach, and bowels; and thereby lessening the excretion
" of it in the TRACHEA?" 


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The warm bath is a remedy on which great de-
pendence is to be placed, for, by its great power of
determining to the surface of the body, it is found
to relieve the difficulty of breathing which con-
stantly accompanies this disease,
The cure of Cynanche Trachealis is, therefore, to
be effected by the remedies already mentioned, viz.
blood-letting, blisters, emetics, warm bath, and
calomel.
As a proof of the propriety of the plan I have
recommended, I will subjoin five cases of Cynanche
Trachealis which were successfully treated by It.
CASE I.
ON the 20th December, 1792, a son of Mr.
Farrier, aged two years, was attacked with a hoarse,
dry cough, and great difficulty of breathing. The
mother put the child into a warm bath; but finding
the symptoms increased, at two o'clock, P. M. sent
for Doctor Hamersley, who directed a gentle emetic,
which 

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which operated very well. At three o'clock the
Doctor requested me to visit the child with him: as
we found him labouring under all the symptoms of
a distinctly marked Cynanche Trachealis, we judged
it advisable to let blood; four ounces were taken
from the jugular vein. The warm bath was repeat-
ed; after which the symptoms were somewhat re-
lieved: we then ordered four grains of emetic tartar
to be dissolved in four ounces of water, and directed
two drachms of the solution to be taken every fifteen
minutes till it operated as an emetic. This caused
the child to throw up a great quantity of viscid mat-
ter; produced a moisture on the skin, and opened his
bowels. At nine o'clock we visited him again, and
directed the emetic solution to be repeated; half an
hour afterwards the child was seized with a fit of
coughing and vomiting, which caused the vein to be
forced open, and he lost (agreeable to the mother's
information) near five ounces of blood; after which
he rested very well all night. At eight o'clock on
the morning of the 21st, the child was much better
in every respect; there remained, however, some
degree of the peculiar found of the voice; to re-
move which we directed oxymel scill. one tea-spoon-
ful to be taken every hour. This had the happy effect
of keeping up a moisture on his skin, and caused
him to cough up a considerable quantity of ropy
matter. 

(31)
matter. The following day the child appeared to
be perfectly well, and continued so without the aid
of any other remedies.
CASE II.
ON the 18th December, 1791, I was sent for
to see a daughter of Mr. James M'Kay's, who was
the day before attacked with Cynanche Trachealis.
From the extreme difficulty of breathing that she
laboured under, I thought it advisable to let blood;
I therefore opened a vein, and suffered her to bleed
ad deliquium. After she recovered from the fainting
she was put into a warm bath, and puked freely
with a solution of emetic tartar, which had likewise
the beneficial effect of producing an evacuation from
her bowels. Two hours after I visited her again,
and finding the difficulty of breathing not altogether
removed, I directed the emetic solution and warm
bath to be repeated; at the same time a blistering
plaister was applied to her throat. The following
day her bowels were opened with calomel, and on
the fourth day she was perfectly well, except the
soreness of the blister.
CASE 

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CASE III.
A child of Mr. Walter Reed's was, on the 26th
November, 1792, seized with a hoarse, dry cough,
and laborious respiration. The following day I was
desired to visit him, at which time he was apparently
in the greatest distress, and, in short, had a most
complete Cynanche Trachealis. I immediately open-
ed a vein in the arm, and took from it six ounces of
blood; on which he shewed symptoms of deliquium.
He then took small portions of emetic tartar, which
caused him to throw up a considerable quantity of
viscid matter. The warm bath was then used, when
his skin became moist, and he passed several large
portions of a membranous substance by stool. The
next day he took a small dose of calomel, which
brought away, by stool, a great quantity of the
preternatural membrane; the child was thereby
greatly relieved; and by keeping his bowels open
with calomel, in a few days he was perfectly restored
to health.
CASE 


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CASE IV.
A child of Mr. Jacob Brown's, one year and seven
months old, was attacked with Cynanche Trachealis.
On the 31st December, 1792, at eleven o'clock P.
M. I was requested to visit him. The violence of
the symptoms called loudly for immediate assistance:
I therefore opened the jugular vein, and took away
near eight ounces of blood; ordered a warm bath,
and an emetic solution, which relieved the difficulty
of breathing, caused him to heave up some viscid
matter, and likewise to pass considerable in his stools.
The skin appearing to be dry, I directed the bath
to be repeated, and small portions of the emetic to
be taken in such a manner as to keep up a constant
nausea. The third day the child was perfectly re-
lieved of the difficulty of breathing, and in a few
days more appeared to be in perfect health. About
six weeks after, he had a return of the complaint,
and notwithstanding every thing was done for his re-
lief, he died on the fifth day of the disease.
E CASE 

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CASE V.
MR. John Hillyer called on me the 26th January,
1793, to visit a child of his which had been com-
plaining for several days: When I first saw the
child, he appeared to be gasping for breath; his face
was pale, or rather inclining to a livid appearance;
his pulse extremely weak and frequent; in short, all
those symptoms appeared which accompany what
Home calls the putrid stage of Cynanche Trachealis.
From the disease having been of several days stand-
ing, and from the violence of the symptoms, I al-
most despaired of saving the child. Willing, how-
ever, to give him every possible chance of recovery,
and being fully satisfied that putridity was not the
cause of the debility, I immediately opened one of
the jugular veins, from which near seven ounces of
blood were drawn. The child appeared to faint; I
then stopped the blood, and on recovering, he
breathed much more easy. I now pursued the same
method as in the former cases, with respect to the
bath and emetics. In addition to which, a blister-
ing plaister was applied to the throat, and, to my
great satisfaction, after seven days the child was per-
fectly relieved of the complaint.
In 

(35)
In this last mentioned case, agreeable to the opi-
nion that was formerly entertained of this disease,
antiseptics should have been freely administered.
What would have been the consequence of such a
plan? The answer is plain—certain death.
After having given the plan of cure, above re-
commended, so satisfactory a trial, there does no
longer remain a doubt with me, that the supposi-
tion of this disease being attended with putridity is
erroneous; and has of course been productive of
much mischief.
FINIS.