ment of hooping-cough, the assafoetida, zinc, and sesquioxide of iron appear to be those most deserving of trial. We have employed the assafoetida extensively, by itself, in solution, or in combination with the tincture of hyoscyamus, or the watery solution of opium, and have always been pleased with its effects. Dr. Lombard has often known frictions to the spine with the tincture of assafoetida, of great service, and we have found a plaster of assafoetida applied on the chest, promptly to relieve the cough which is liable to remain after the more acute symptoms have abated.

The oxide of zinc will, in many cases, be found a useful remedy in the second stage of the disease. Dr. Lombard has employed it extensively, in the dose of from four to twelve grains a day; he found it generally to abate the violence of the paroxysms, and has seen complete cures effected by it alone. In two very young infants, whose cough was attended with symptoms resembling epilepsy, the oxide of zine stopped both the cough and the fits. He has never seen any bad effects result from its use. Our own experience is also decidedly in its favor. Another remedy which appears to claim our attention, is the precipitated sub-carbonate of iron (sesquioxydum ferri). It was first recommended by Dr. Steymann, who directed two and a half grains every three hours, increasing one grain for each year of the child's age, beyond the first. Dr. Lombard gave it to the extent of from twenty-four to thirty-six grains, in water and syrup, or some cough mixture. "I think," he remarks, "I may assert with confidence, that the sub-carbonate of iron enjoys a remarkable property to lessen the violence of the paroxysms, to diminish their frequency, and after a time to arrest entirely the disease. It enjoys, besides, the advantage of strengthening the little patients, thus giving them the force to resist a complaint, which sometimes lasts for weeks, and generally leaves them in a state of exhaustion." In some patients he has seen it cause, during the first day or two after it was commenced with, a temporary increase of the cough, but which always subsided after two or three days, and did not prevent the good effects of the remedy. In the few cases in which we have had an opportunity of employing the remedy, its curative effects were not very strikingly evinced.

A great variety of other remedies have been proposed, for the cure of hooping-cough; as the tincture of cantharides, either alone, or combined with the tincture of bark, with quassia or with cicuta, &c.; by Lettsom, Sutcliff, Chalmer, Shäfer, Pearson, Beatty, Millar, and Bucholtz; the musk, by Stoll, Hufeland, Gesner, Löbel, and Dewees; sulphuret of potass, ten grains mixed with honey, morning and evening by Blaud; the liquor subacetatis plumbi, by Forbes; garlic, internally and externally, by Hufeland and Dewees; the arsenical solution by Ferriar, Simmons, and Eberle; the lobelia inflata, by Eberle and Andrews; and various fumigations, as of benzoin, tar, galbanum, nitrous acid vapor, &c., by Dohm, Watt, and Eberle.

The lobelia inflata is spoken of by some in terms of the highest commendation. Eberle states that he prescribed it for five or six years in a very considerable number of cases, generally with some advantage, and in several instances with decided success-it not only

mitigating the violence of the cough, but abbreviating, in many cases, the course of the disease. He directed the saturated tincture, in union with the syrup of squills, in doses of ten drops each, repeated four or five times daily, to a child two years old, and has raised the dose, in some cases, to twenty drops.

Dr. Golding Bird remarks (Guy's Hospital Reports, 1845), that in the second stage of pertussis after all inflammatory symptoms have subsided, and when, with a tolerably cool skin and clean tongue, the patient is still severely distressed by the more or less copious secretion of viscid mucus into the bronchi, each attempt to get rid of which, producing the exhausting and characteristic cough, he knows of no remedy which will be found to give such marked and often rapid relief to the child as alum. He gives it in doses of from two to six grains, to children from one to ten years of age, repeated every four or six hours. For a child of two to three years he employed generally the following formula—

R. Aluminis, gr. xxv.; extr. conii, gr. xij.; syrup. rhoados, 3ij.; aq. anethi, 3iij. M. Dose, a medium-sized spoonful, every sixth hour. He has never met with any inconvenience from the effects of the remedy on the bowels; on the contrary, in more than one instance it produced diarahoea.

In a recent edition of Underwood's Treatise, edited by Dr. Davis, of London, the latter remarks that, after a long trial, he is disposed to attach more importance to alum, as a remedy in hooping-cough, than to any other form of tonic or antispasmodic. He has been surprised at the speed with which, in many cases, it arrests the severe spasmodic fits of coughing; it seems equally applicable to all ages, and almost to all conditions of the patient. The fittest stage for its administration he believes to be the moist condition of the air-passages, and freedom from cerebral congestion; but an opposite condition would not preclude its use, should this not have yielded to other remedies. It generally keeps the bowels sufficiently open. He gives to an infant two grains three times daily; to older children, four, five, and up to ten or twelve grains may be given, mixed with syrupus rhoeados and water.

We have prescribed the alum during the second stage of pertussis, in a large number of cases, and invariably with the most decided benefit.

In the Annuaire de Thérapeutique for 1846, it is stated that M. Berger administers, during the convulsive stage of hooping-cough, the nitrate of silver, and with results singularly beneficial. He prescribes it in doses of from a sixteenth to a twelfth of a grain, at first three times, and afterwards four times a day. The remedy should not be administered in cases where the state of the digestive organs contra-indicates its employment.

M. Jules Guyot, in the Union Médicale, 1849, recommends a strong infusion of coffee, well sweetened, in the dose of a teaspoonful for a child of two years, and a dessertspoonful for a child of four years, repeated four times or oftener daily.

Dr. Simpson, of Edinburgh, has recently recommended the inhala

tion of chloroform as an effectual means of arresting and controlling the paroxysms of violent spasmodic cough in the more severe cases of the disease.

"Soon after the discovery of the anaesthetic effects of sulphuric ether, it struck me," remarks Dr. Churchill (Diseases of Infants and Chil dren), "that it would be likely to modify or suspend the spasm in hooping-cough; and having a case under my care, I directed a little (I suppose about half a drachm) should be spilled upon the nurse's hand, and held before the child's nose and mouth, at the commencement of a fit of coughing. I preferred this simple mode of administration (and do so still), because of the impossibility of thereby giving an over-dose. The effect surpassed my expectation: most generally the paroxysm was shortened more than one-half-often stopped immediately and the duration of the disease unquestionably considerably diminished. Since then I have tried the ether in twelve or fourteen cases, and chloroform in six. In one or two cases, no benefit accrued, in others great mitigation of the spasm, and in three or four, almost complete relief when the ether was applied at the beginning of a fit of coughing. Decidedly, also, in two-thirds of the cases, the course of the disease was much shortened, so that I look upon this as a valu able addition to our remedies. In no instance was insensibility or the least inconvenience occasioned."

Dr. Arnoldi, of Canada, has recently communicated his experience in favor of nitric acid as a remedy in hooping-cough. At whatever age the disease occurs, whether in a child at the breast or in a fullgrown adult, he administers nitric acid in solution, as strong as lemon juice, sweetened ad libitum. He has given, he remarks, to a child of two years of age, as much as one drachm and a half of concentrated nitric acid, in the above manner, per diem, and has never known the disease to resist its use beyond three weeks. In some instances under its employment he has seen the disease cured in eight or ten days. Dr. Gibb (Treatise on Hooping-Cough, London, 1854), declares that he has found the nitric acid to act almost as a specific. Dr. M'Nelley, of Fayetteville, Tenn. (Trans. Amer. Med. Asso., Vol. 6), has also employed the remedy, and with the most decided good effects.

Within a few years past very decided evidence has been adduced in proof of the efficiency of the bromide of ammonium in allaying the spasmodic cough of pertussis. Dr. Gibb has employed it extensively, and always with success. Dr. Harley, also, speaks highly of the remedy. He does not believe it acts by arresting the cough, but by preventing the occurrence of its most painful and disagreeable feature-the "whoop." (London Lancet, Sept. 1863.) Dr. Kuchenmeister (Zeitzschr. für Med., 1864) states that additional experience has confirmed the favorable opinion already expressed by him as to the value of the bromide of ammonium. Dr. Ritchie (Edinb. Med. Jour 1864), also bears testimony to the good effects of the remedy; though of a less decided character than that of the preceding authorities.

Dr. Ritchie usually prescribes the bromide of ammonium to the extent of from three to twelve grains a day; in divided doses, at intervals of six hours. This is less than what has been given by Dr.

Harley, who directs one grain for each year of the child's age, every eight hours. The intervals being regulated, however, by the constitution and development of the patient. To children of an advanced age larger doses are given. Dr. Gibb gives from two to three grains thrice daily to infants, and four, eight, or even ten grains to older children. Dr. Kuchenmeister gives of a concentrated solution of the remedy five drops three times daily, gradually increasing the dose to fifteen drops. Dr. Green (Trans. Penn. State Med. Soc., 1864) speaks in favorable terms of the remedy in doses of from two to six grains thrice a day. Drs. Gibb and Harley give the bromide of ammonium in water, Dr. Ritchie in syrup, and Dr. Green in mint or cinnamon water and syrup.

If bronchial irritation exists, Dr. Ritchie gives a mixture of ipecacuanha and squill, which is also the practice of Dr. Gibb. In complicated cases Dr. Ritchie has found the administration of an emetic frequently necessary.

A strong tea made from clover hay has been proposed as a remedy for the relief of the spasmodic cough of pertussis. We have employed it, and with apparently good effect. The tea should be very strong, and when cold, given in the dose of a large tablespoonful several times a day.

The topical application of a strong solution of the nitrate of silver to the larynx has been recommended as an efficacious remedy in hooping-cough. Dr. E. Watson, of Glasgow (Asso. Med. Journal, 1853), has employed it with the best results, when the disease was at its height, the paroxysms of coughing recurring every fifteen minutes. Under its use the spasmodic whoop was generally arrested within eight or ten days; an obvious mitigation ensuing upon the first application of the nitrate of silver. The remedy was also employed by him in cases where the disease appeared to be commencing the patients being the members of families in which it prevailed, and exhibiting the usual precursory symptoms of an attack. In these the development of the disease was arrested. Dr. Watson employed the nitrate of silver in the proportion of from fifteen to forty grains to an ounce of distilled water-applying the solution every second day, first to the fauces, and finally to the larynx.

He adduces in favor of the remedy, the experience of M. Joubert, of Cherion, who has employed it in sixty-eight cases of hooping-cough, of which number a speedy cure was effected in 40; great relief and shortening of the disease in 20; while no benefit occurred in 8.

The cases of the disease treated by Dr. Watson from beginning to end with the local application of the nitrate of silver were fifty-seven; in all a more or less speedy cure was effected-namely, in 38 cases, in from 10 to 14 days; and in 19 cases, in from three to four weeks. "Combining these two tables," he remarks, "we have, in the first. place, 125 cases of hooping-cough treated in this manner without one death. Only eight of the whole number resisted the treatment. Of the remainder, 78 were speedily cured, and 39 were greatly relieved and shortened."

During the employment of whatever narcotic or antispasmodic we

may adopt, its effects should be carefully watched, and if any symp toms appear, threatening the occurrence of disease of the brain or lungs; if the tongue becomes more and more red, the discharges from the bowels more and more frequent, thin, and vitiated, and tenderness of the epigastrium is observed upon pressure, it should be at once omitted, and leeches or cups applied to the temples, nape of the neck, or epigastrium, according to the seat of irritation, together with warm sinapised pediluvia, and the other remedies which the character and extent of the symptoms may indicate. By watching thus the incur. sions of disease in those organs most liable to become affected, and meeting it at its onset by an appropriate treatment, we shall save many patients, which by keeping the attention too much fixed upon the paroxysms of spasmodic cough, would be most certainly lost.

Towards the close of the disease, the patient will often be much benefited, and his convalescence confirmed, by the administration of some mild tonic; the bark either in substance or infusion, or the sulphate of quinia, has been highly extolled at this particular juncture. It is probable, however, that the use of the sesquioxide of iron may render the use of other tonics unnecessary.

During convalescence, the utmost attention should be paid to the clothing, diet, and exercise of the patient. Exposure to cold, indigestible food, or overfeeding, will be liable to produce a relapse. If the bowels are costive or sluggish, they should be kept regular by gentle laxatives; if diarrhoea attend, Dover's powder, or some light astringent will be proper, and if the discharges are thin or vitiated, small doses of calomel, combined with chalk, ipecacuanha, and extract of hyoscyamus, the warm bath, and a well regulated diet. In some cases, sponging the body daily with tepid salt water, has been found decidedly beneficial.

The principal writers on the disease, agree as to the importance, towards its decline, of change of air. After severe and protracted cases especially, it is, in fact, as remarked by Gregory, often the only thing that will give to the patient a chance of recovery. In many cases that had baffled all attempts to stop the cough, a change of air has accomplished the cure. It has been found equally indifferent, whether the patient be removed out of or into town, provided there is a change, and even a removal to a very short distance has been sufficient. The change, however, if possible, should be to the sea-coast, or to a high, dry situation in the country; unless, however, it be to a warmer climate, change of air is improper so long as the weather continues cold or changeable, but in the latter part of spring, during the continuance of summer, and in this climate, until late in autumn, it will be productive of the best effects. Where a permanent removal cannot be effected, daily exercise in the open air should not be neglected, always taking care to guard against cold and dampness, by proper clothing, and all other suitable precautions.

10. Foreign Bodies in the Larynx and Trachea.

Although it is not our intention to consider all the surgical affections of children, yet as the phenomena which result from the accidental