in the cavity of the chest. This irritation may be considered of two kinds: one attended with inflammatory action, in which case there is fever and pain on coughing, and seldom any expectoration. Here blisters, loss of blood, and the use of purgative and sudorific medicines, are necessary, with a low diet. The other with debility, in which case there is a considerable quantity of mucus poured out into the branches of the windpipe, and the cough is necessary to bring up the phlegm. This case is noticed under the head of CONSUMPTION of ELDERLY PEOPLE. The other kinds, from effusion of serum in the chest, particularly in the substance of the lungs, are noticed under the heads of ASTHMA and DROPSY OF THE CHEST. In these latter cases, opiate medicines, by checking expectoration, are dangerous remedies. In consequence of the tender structure of the lungs, their great vascularity, and their importance in the animal economy, cough should be regarded as a disease that should not be neglected. In my late treatise on the Management of the Stomach and Bowels, I have entered fully into the treatment of the varieties of cough, particularly the spasmodic, the winter, and the cough of gouty elderly people.

OF COW-POX. The matter for communicating this disease should be taken in an early state of the pustule, generally about the fourth or fifth day after the inoculation, by dividing the skin of the pustule with a lancet, and collecting thereon the clear limpid matter that exudes, with which the arm of the person to be infected should be so slightly scratched as not to draw blood. On the third or fourth day the part inoculated will appear a little red and prominent, which will keep increasing to about the ninth or tenth day, when the constitution will be infected, the signs of which are a slight fever, and a little enlargement of the glands in the pit of the inoculated arm. The part should be defended from the friction of the linen by applying a little gold-beater's skin; and if the surrounding inflammation should run high, the application of the discutient lotion (D), page 126.

From inattention to these particulars, it is probable the reports of the small-pox succeeding cow-pox inoculation have arisen: for unless the matter be in a proper state, and the constitution be infected, the person carnot be secured against the small-pox contagion. It may happen, that the inflammation excited by the inoculation with genuine cow-pox matter may remain local; i.e. the inflammation may go on so as to form a pustule, without any portion of the matter entering the system, when, of course, the subject must remain liable to small-pox infection. The same occurs from the small-pox matter, when the system is not favourable to its action, cases of which are by no means uncommon.

Cow-pox, like all other discoveries in medicine, has met with the opposition of those professional characters, who, from motives of lucre and jealousy, are base enough to deprecate or misrepresent discoveries highly advantageous to their own species. The contest between the interested friends and the enemies of vaccination, has been carried on with such heat and illiberality, that the assertions of either party are unworthy of notice. In consequence of the late recommendation of the cow-pox by the legislature, I resolved to embrace every opportunity to put it to the test of experience. For this purpose, I inoculated with smallpox matter about thirty children whom I had vaccinated within the last fifteen years, the whole of whom resisted it. The result of these experiments has induced me to recommend vaccination.

It has been said by the violent opponents of vaccination, that it is often succeeded by a cutaneous eruption resembling the itch; but the experience of disinterested practitioners has most satisfactorily proved the assertion to be false.

Several cases of small-pox subsequent to vaccination, have been published in the Monthly Gazette of Health, which prove that, on some peculiar constitutions, cow-pox does not produce a sufficient effect to secure the constitution against the influence of small-pox contagion; but even in them, the disease was remarkably mild; so that, if it should fail to afford security against the contagion of small-pox, it will assuredly act as a powerful mitigator of its virulence.

OF CRAMP, OR SPASM. When cramp attacks the stomach, it is generally the effect of flatulence, and often precedes or attends a fit of the gout. When it is the effect of indigestion, it may be relieved by a small tea-spoonful of the Spirit of Sal Volatile, in half a wine-glassful of water, to which, if the patient be of a gouty habit, or the spasm be obstinate, a tea-spoonful of Ether may be added, or the Anti-arthritic Mixture, page 110, may be taken. The Tincture of Ginger and Camomile, p. 61, may afterwards be employed with great advantage to prevent a recurrence, and should be persisted in as long as the patient is troubled with any symptom of indigestion. The Jamaica ginger powder generally succeeds in gouty cases, better than any other stimulant. (See GOUT and INDIGESTION.) If the spasm be so violent as to resist the use of æther and sal volatile, the Antispasmodic Mixture, p. 111, may be administered. A draught of warm water often affords immediate relief, particularly when the spasm precedes or occurs at the period of menstruation.

When spasms occur in the intestinal canal, the narcotic or anodyne clyster, p. 104, will be proper, or if the intestines be over distended with gas, the exciting or stimulating clyster in the same page, or if the bowels be confined, the Purgative Člyster (B),

page 103.

If the disease continue obstinate, the warm vapour bath should also be employed.

People subject to cramp in the stomach should wear flannel next the skin, and avoid fermented liquors and green vegetables, particularly for supper. (See INDIGESTION and SASSAFRAS NUT, p. 157.)

Cramp in the lower extremities is a very common attendant on the latter stage of pregnancy, in consequence of the pressure of the womb on the nerves leading to them, and particularly during labour, from the pressure of the head of the child. In either of these cases, it may be relieved by compressing the part affected with the hand, and sometimes by change of position, and by rubbing the part with dry flannel, or a flesh-brush. In obstinate cases, the application of æther and laudanum over the part affected has been found beneficial. When it occurs during pregnancy, the internal use of laudanum and æther, as the Antispasmodic Mixture, p. 111, will be proper. In this case particularly, the patient should avoid costiveness, by taking occasionally the Aperient Pills, p. 117, and should observe, as much as possible, a horizontal position. Cramp of the extremities may sometimes be speedily relieved by putting the opposite muscles into action; thus, when the muscles of the calf are affected, by putting those on the front into action, which is done by drawing up the foot, the cramp will often instantaneously go off.

For the cure of cramp, a variety of whimsical remedies are in great repute among the lower order of people, which being in themselves perfectly inefficacious, must depend on the imagination for success. Whatever affects the mind with surprise or horror, as the cracking of a roll of brimstone held in a warm hand, the wearing of rings formed of the nails or furniture of old coffins, and such like fanciful conceits, have certainly a wonderful effect on all spasmodic diseases.

OF CROUP.-This disease is an acute inflammation of the membrane lining the windpipe. It is chiefly incident to children, and rarely occurs till after weaning. It is most prevalent in low marshy countries, on the sea-coast, and in wet and cold seasons. It seems to be peculiar to some families, and, after one attack, the patient is very liable to a return even on slight exposure to cold.

SYMPTOMS. - It commences with pain about the upper part of the windpipe, which is increased on being pressed. The respiration is difficult, attended with wheezing, and a peculiar ringing or stridulous cough, resembling the crowing of a young cock, and a trifling expectoration of mucous matter. The face is somewhat livid, and often much flushed, and the swallowing little affected; there is also some degree of frequency and hard

ness of the pulse, great thirst, restlessness, and feverish heat. The wheezing and difficulty of breathing are increased by coagulated lymph, or sloughing of the membranous lining of the windpipe, which sometimes stops up the passage so as to produce sudden death.

CAUSES. It is occasioned by the application of cold combined with a moist atmosphere, particularly in the spring and

winter seasons.

TREATMENT. — On account of the situation and acute nature of this disease, immediate and active remedies should be employed to save the life of the patient; the chief of which are bleeding, purging, and blistering. On the first attack of the disease eight or twelve leeches should be applied over the windpipe, and a blister to the nape of the neck, and also over the windpipe, as soon as the bleeding from the orifices made by the leeches, will admit of it. If the pulse be strong, or the fever run high, the loss of blood from the arm will likewise be necessary. A dose of Emetic Tartar, should also be exhibited without delay; and if it should not operate on the bowels, a dose of the Basilic Powder, or Jalap and Calomel, may be given an hour after the operation of the emetic. If the skin should continue dry and hot, from ten to fifteen drops of the antimonial wine may be administered every three or four hours, with the Saline Mixture (A or B), p. 114; and in case they should fail of producing perspiration, the warm bath should be employed. The tincture of foxglove, in the dose of six or eight drops twice or thrice a day, has in some instances been found beneficial. The discharge of the blisters should be kept up, by dressing them with the weak mercurial ointment. This application, after the removal of the dead skin of the blister, has in so many instances produced such immediate relief, that I have been disposed to attribute the recovery of the children principally to it. The acetated ceruse and the Prussic acid, as directed for hooping-cough, is also a very valuable medicine in this disease. If the system be in a plethoric state, which is generally the case, the loss of blood from the arm, or by cupping, will be necessary, provided the bleeding by leeches has not sufficiently unloaded the system of bloodvessels. (See EMETICS, p. 27, and EVACUANTS, p. 32.

The warm vapour bath with the head inside, so as to inhale the vapour, is an important auxiliary. In the Gazette of Health, a case of Croup is given, in which this sudatory (see page 173) seemed to have acted most beneficially under the directions of Mr. la Beaume.

In a late number of the Monthly Gazette of Health, a practitioner in Yorkshire recommends an abstraction of blood from a vein till the patient faints. When the patient recovers from

the swooning fit, he is sometimes free from the disease. Since he adopted this practice, he states, he has not lost one patient by the disease. If the remedies above recommended should fail, the Prussic acid, in the dose of one drop three or four times a day, may be administered.-(See PRUSSIC ACID, p. 165.)

The patient should be supported with fresh milk, mixed with almond emulsion, or linseed tea, of which, in consequence of its thirst, it will take a sufficient quantity to support it. After the termination of the disease, the decoction of bark with liquorice will be necessary to prevent a relapse. Change of situation to a more light and dry air will also be advisable.

This disease sometimes attacks adults; when the same remedies, to a greater extent, are necessary.

In croup, and in all other maladies, the treatment should be regulated according to the stage and the influence it has had on the system. If the inflammation has so long existed in the membrane as to produce a kind of morbid membrane or lining, and the vital powers have considerably given way, it would be highly improper to have recourse to an active depleting treatment. When this morbid membrane of thickened lymph has formed, or the natural membrane is in a sloughing state, the advice and attendance of a scientific and experienced surgeon should not be neglected, as some lives have been saved by making an opening into the windpipe.

Two species of croup are noticed by medical writers; the one depending on inflammation of the inner coat of the windpipe, termed inflammatory croup, which is described above; the other from spasms, unattended with inflammation, termed spasmodic croup; - the latter species is of the nature of asthma, and comes on in the night-time. It often intermits, and, in the intervals, both the respiration and cough, if any exist, are free from the characteristic sound of the inflammatory croup. In the early stage of this disease, medicine has, in general, a very salutary effect; but, if it be suffered to continue long, it will prove very difficult to relieve or cure. The most efficacious remedies in this species are emetics of ipecacuan powder repeated every day, and the Antipertussic Mixture (A), p. 110.

DISTINCTION-Croup may be distinguished from inflammation of the throat, by the peculiar shrill ringing sound of the voice, and by the breathing being attended with a wheezing noise. The swallowing is also in general perfectly free, whereas in inflammation of the throat it is difficult.

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OF CUTS. The edges of a recently incised wound, termed a cut, if free from any foreign matter, should be brought into contact as soon as possible, and kept so by means of long strips of the diachylon plaster, spread on linen or leather, over which