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contact with the membrane. There often occurs, also, at a very early period, an abundant secretion of mucus, which, in some infants, flows constantly from the nose, apparently without being attended by any degree of inflammation.

Coryza may be simple, or complicated with the more or less rapid formation of a pellicular exudation throughout the whole extent of the nasal fossæ; or, it may assume a chronic character, and occasion the death of the patient, by the disorganization which ensues.

The first indication of the disease is frequent sneezing. The inner surface of the nostril soon after becomes red, dry, and swollen. The cry of the infant is altered, from the impediment to the free passage of the air through the nose. A watery, or thin muculent fluid soon begins to flow from the nostrils; in a short time assuming a thick, white, opaque appearance, subsequently changing to a yellow, and becoming finally purulent; exhaling frequently a peculiar fetid odor. The child sleeps with its mouth open; the respiration is difficult and noisy; and, instead of the usual râle, a whistling sound occurs in the nasal fossa: this becomes greater, and the difficulty of respiration increases, in proportion as the discharge from the nose becomes thicker and more abundant: the nose acquires a red appearance externally, and is somewhat swollen, while the central portion of the upper lip, constantly irritated by the discharges from the nostrils, becomes frequently red, swollen, and excoriated. Often it is covered with a false membrane.

In severe cases the child experiences great difficulty in sucking, from its inability to breathe through the nose, in consequence of the diminution of the nasal cavities, caused by a submucous infiltration. of their lining membrane. As the discharge, by drying at the orifices of the nostrils, often completely closes them, every attempt to take the breast is attended with the utmost anxiety; the countenance of the infant becomes flushed, and it is obliged instantly to quit the nipple to prevent suffocation. Its restlessness and cries, as well as the expression of its face, indicate the utmost distress and suffering; which are increased by its sense of hunger, and the impossibility it experiences of satisfying it.

Worn down by fatigue, pain, and deficient nourishment, the infant may perish from inanition; or the brain becoming affected, extreme prostration and drowsiness may ensue, and sooner or later terminate in death; or death may be preceded by convulsions or acute meningitis, quickly terminating in effusion. In the more prolonged, or chronic form of the disease, the mucous membrane of the nares may become softened and destroyed, or the seat of an extensive ill-conditioned ulceration.

Dr. C. D. Meigs believes that the chief danger to the young infant affected with coryza results from one of two causes. The first and most common is the filling up of the nostrils with a plug of dried viscid mucus; the other, is the submucous infiltration, causing the sides of the cavity to collapse. Now as the nostrils are the principal -Dr. Meigs considers them to be the only-instinctive respirator y orifices in the young infant, it is evident, that so long as their obstruc

tion from either of the above causes continues, the aération of blood in the lungs must be imperfectly performed. As a necessary conse quence, the vitality of every tissue becomes impaired, and the functions of the several organs impeded or deranged.

The difficulty of respiration is always greatest in those cases in which the inflammation of the nasal mucous membrane gives rise to a pseudo-membranous exudation. In such cases, also the tonsils and fauces occasionally present a swollen and dark red appearance, their surface being covered with ash-colored specks, terminating, in some cases, in extensive ulcerations.

In violent cases, death may occur in three or four days, while in other instances, the symptoms are mild from the commencement, the inflammation very rapidly abates, the secretion gradually lessens in quantity and consistence, the respiration improves in proportion, and in a few days every symptom of the disease disappears.

The danger is always in proportion to the degree of tumefaction of the mucous membrane of the nares, and the abundance and tenacity of the excreted fluid. When the inflammation is slight, and the mucus of the nose is only a little more abundant and ropy than natural, the impediment to respiration is but slight, and the infant is able to suck without much difficulty.

The appearances discovered after death, in those who have fallen victims to this disease, are increased redness, with thickening and softening of the mucous membrane throughout the whole extent of the nasal fossæ, the membrane being generally thickly coated with pus or an opaque tenacious mucus. In some cases, small patches of a pseudo-membranous exudation are scattered over its surface. In other instances the exudation covers the whole interior surface of the nares, and extends from the superior part of the glottis, upwards, towards the sinus and cornua of the nasal cavity; the mucous membrane beneath, to which it firmly adheres, being much tumefied, and of a vivid red color; softening of the mucous membrane and extensive ulceration are frequently present. In chronic cases, various morbific affections of the alimentary canal, lungs, and brain, are frequently met with.

The disease, when it occurs as a primary affection, is usually the result of exposure to a cold or damp atmosphere, or of neglect in changing the diaper and clothing of the infant when these become wet with the urine. Billard enumerates, among its common causes,. exposure to a strong fire, and particularly to the light and heat of the solar rays. When children are taken out, he remarks, for the benefit of the air, on the return of spring, it is almost always observed that they sneeze, and are affected with a discharge from the nose. We apprehend, however, that the exposure to an atmosphere many degrees colder than that to which the child has been accustomed, has. more to do in the production of coryza in children, on their first being taken out in the spring, than the action of the sun's rays.

In light attacks, little treatment is necessary beyond the avoidance of the occasional causes of the disease, with proper clothing, and con-finement to rooms of a warm, equable temperature. The use of the

warm bath, daily, will be proper, however, in most cases, with the occasional use of some mild aperient, as castor oil, or magnesia and rhubarb. In more violent cases, the application of a few leeches to the root of the nose will be advisable, with some gentle diaphoretic. In some instances we have found the administration of a few grains of calomel, followed by a dose of castor oil, highly advantageous. A small blister to the nape of the neck will, also, often produce very considerable relief. In all cases great benefit will be derived from anointing occasionally the inner surface of the nostrils by means of a camel's hair pencil, with a few drops of glycerine, or the oil of sweet almonds.

'R.-Hydrochlor. ammoniæ, gr. xxvj. ad xxxvj.
Ipecacuanhæ, gr. ij—iij.

Ext. hyoscyami, gr. iij.-M. f. chart. No. xij.

One to be given every three hours, mixed in a little sugar and water.

Dr. Meigs' plan of treating coryza is to keep the interior of the nostrils, after they have been carefully freed from mucus, constantly anointed with some of the finer animal oils, or what he believes well adapted to the case, the cucumber ointment. The effect of this application will be, to cover the lower part of the aperture with a thin glazing of oil, upon which the viscosities will not rest and dry, but fall outwards upon the lip whence they may be readily wiped away, whereas upon the dry epithelial surface of the orifice, they are liable to adhere, and becoming inspissated, form hard, dry, and solid crusts or scabs.

Dr. Meigs also directs that a light flannel cap, fitting closely to the infant's head, should be applied and worn until the coryza disappears. This he has found to be alone sufficient, in a large number of instances, to effect a cure. There can be little doubt that in the majority of cases of simple coryza, occurring in young infants, the plan of treatment here recommended will be all that is necessary.

The infant should not be put to the breast during the stoppage of the nostrils, but the nurse's milk should be given with a spoon, or fresh cow's milk diluted with barley or rice-water, or with rennet whey, may be substituted.

If, after the inflammation is reduced, there should be formed any pellicular concretions in the nasal fossæ, Billard directs some fine calomel, or a mixture of sugar and alum finely powdered, to be gently blown into the nostrils.

In cases attended with pseudo-membranous exudation, the nitrate of silver in solution constitutes the most efficacious local application. Five to ten grains may be dissolved in an ounce of water-and ap plied to the interior of the nostrils by means of a camel's-hair pencil, several times a day, according to the severity of the case.

In chronic cases, alterative doses of calomel, with ipecacuanha, prepared chalk, and extract of hyoscyamus,' if conjoined with a proper diet, the daily use of the warm bath, and some light tonic, will, in general, effect a cure. A decoction of oak bark has been highly recommended when the disease has continued for many weeks, and the infant becomes pallid and very feeble. Underwood states that he

has known it to remove promptly the snuffling, and to give vigor to the patient in the course of a few days. A weak infusion of bark, the sulphate of quinia, or the persesquinitrate of iron, will, however, in most cases be found a better tonic than the oak bark.

1R.-Calomel. gr. iij.

Ipecacuanhæ, gr. iij.
Cretæ ppt. gr. xxxvj.

Ext. hyoscyami, gr. iv.-M. f. chart. No. xij.
One to be given every three hours.

When, in the course of the disease, symptoms of cerebral congestion or irritation, or convulsions occur, these are to be combated by their appropriate remedies-leeches behind the ears, or to the temples, warm sinapised pediluvia, cold applications to the scalp, blisters to the nape of the neck, and purgative doses of calomel, followed by castor oil, the sulphate of magnesia, or purgative enemata.

During convalescence from the more chronic cases, the restoration of the patient's strength is to be promoted by a well-regulated dietgentle daily exercise in the open air, in mild weather, and appropriate clothing.

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Bronchial inflammation, varying in extent and intensity, is a very common disease throughout every period of infancy and childhood. Its leading symptoms are cough, hoarseness, difficulty of respiration, and more or less febrile excitement. To these symptoms, in many cases, are conjoined soreness of the throat, running at the nose, sneezing, and a red and watery appearance of the eyes.

The disease commences, usually, with a slight degree of chilliness, or a complete chill, and some degree of languor, depression and drowsiness; followed, after a short period, by more or less febrile reaction. The patient, if old enough, now complains of dull, aching pains in the head, back, and extremities. The pulse becomes frequent, full, and somewhat tense; the face is slightly flushed; the surface is dry and harsh, but seldom much increased in temperature; the bowels are, in general, constipated, and the urine is small in quantity and highcolored. The eyes are often red and suffused, and a thin transparent mucus is discharged from the nostrils, attended with frequent sneezing. Cough and some degree of hoarseness, with soreness or a sense of roughness in the throat, are generally present from the commencement of the attack. Frequently, however, the cough is not developed until the second or third day. While its violence is always in proportion to the extent and intensity of the inflammation, it generally becomes more frequent and severe as the disease advances. In some cases the cough is attended with pain of the thorax, or at the base of the sternum. The respiration is, in general, more or less short, difficult, and oppressed, from an early period of the attack, and attended with a wheezing or rattling sound, heard first in the throat, and extending, subsequently, over the upper portion, and finally, over the entire chest. The respiration in mild cases is but little accelerated, but when the inflammation is intense and extended, it is always fre

quent, amounting, sometimes, to one hundred in a minute. The act of inspiration, in severe cases, is attended with a dilatation of the nostrils, and a heaving motion of the chest. The respiration becomes always more frequent in the progress of the disease.

During the first period of the attack, the infant at the breast sucks without much difficulty; subsequently, although it seizes the nipple with avidity, it can only suck for ten or fifteen seconds, when it will suddenly quit the breast, and throw its head backwards and continue in this position for some time, even after the cough has produced an expulsion of mucus.

The cough is at first dry, frequent, and distressing, but, in the course of the disease, is attended with an expectoration of mucus, at first scanty, but subsequently more free and copious. The expectoration consists, at first, of a thin, transparent sero-mucous fluid, or of a yel lowish frothy mucus, but subsequently of masses of a viscid, opaque, muco-purulent matter, of a yellowish or greenish color. In young children, the matter brought up from the lungs is most generally swallowed, or retained for some time in the fauces. In some few cases, the sputa are found to contain thin, white, soft fragments of a membranous appearance.

The difficulty of respiration is not uniform throughout the attack; the breathing being, occasionally, for a short period, tolerably easy, and then becoming suddenly extremely oppressed. The cough, likewise, often occurs in occasional fits, at irregular, but generally short intervals. As the expectoration becomes more copious, each fit of coughing is often attended by a paroxysm of suffocation, ending in vomiting.

The cough, difficulty of respiration, and febrile excitement, generally increase towards evening. At the commencement of the disease, there is a distinct remission of the fever in the morning, though usually of very short duration.

Upon percussion, in the early stage of the attack, the chest will usually be found sonorous throughout; at a later period, a circumscribed dulness may often be detected at some part.

When the child is old enough to describe its sensations, a feeling of weight, tightness, and soreness of the chest is generally complained of, but seldom any positive pain. When the paroxysms of cough are severe, infants are often known to scream, as if from pain, and the inspirations are, occasionally, suddenly arrested, and attended with an expression of suffering in the countenance, probably caused by an accompanying pleuritic inflammation. The countenance, in the milder cases, exhibits no particular change the cheeks are generally slightly flushed. In the progress of the disease, however, the eyes become surrounded with a dark circle, the countenance assumes an anxious, suffering expression, and the nostrils are dry and crusted. The lips are pale, but at intervals acquire a violet hue, especially after a violent paroxysm of coughing. Delirium occasionally occurs, particularly towards the close of the day, and at night.

With the advance of the disease, the cough and difficulty of respiration increase; the physical signs, resulting from the impediment to

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