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The sudden invasion of meningeal hæmorrhage, however, will serve to distinguish them from each other. It is known that this is not usually the case in granular meningitis, which succeeds a stage of very evident premonitory symptoms (stage of incubation). Besides, on in meningeal hæmorrhage the vomitings are not constant, and conith bris stipation does not exist, while it is obstinate in granular meningitis.


The object of the treatment is, amongst these children, at the commencement of the disease, to divert the flow of blood, which is the cause of the hæmorrhage, from the brain. The application of two leeches behind the ears, once or several times repeated, according to the strength of the patients; bleeding from the arm; the employment of dry cupping on the back and on the chest, may usefully concur to this result.

Direct refrigerants on the head may also be made use of; but they must only be employed with those precautions of which we have spoken in the chapter on meningitis.

The bowels should also be kept freely open by mild purgatives; the syrup of peach flowers, the syrup of chicory, calomel, &c.: medicines, the revulsive action of which, may oppose the progressive advance of the symptoms.




The term coryza is applied to inflammation of the mucous membrane of the nasal fossæ. There are different kinds of coryza. 1st, acute inflammatory coryza. 2nd, pseudo-membranous inflammatory coryza. 3rd, chronic coryza and syphilitic coryza.

The anatomical alterations of this disease are, for inflammatory coryza, redness, swelling, and a diminution in the consistence of the tissue of the membrane which covers the nasal fossæ. It is not necessary that the swelling should be very considerable in order to obstruct the cavity of the nose, which, as is known, is very small in young children.

In the pseudo-membranous coryza, membranous concretions are write found here and there of greater or less extent, sometimes isolatedt. from one another. They present the usual characters of plastic exudations. The mucous membrane which they cover is always, is swollen, of a vivid red, and bleeding in certain points. Very commonly re

the false membranes are not situated in the interior of the nasal fossæ but only at the orifice of the nostrils. The obstacle which they offer, dr to the exercise of the respiratory functions is the same, but it is more easily overcome.


In chronic coryza, the mucous membrane is pale, thickened in aut several places and covered with incrustations more or less thick and dry. These crusts are especially observed at the entrance of the nostrils. There they are reddish, formed by coagulated blood; they is renew themselves frequently, for the child incessantly picks them off. Coryza, which is always a slight disease in the adult, may become a very dangerous one in children at the breast. Billard and M. Fuckver Rayer have, amongst the first, faithfully traced the history of this disease.

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This disease results from the action of cold, from the damp air chile us and the chilling of the extremities by the urine of children, if the frequent changing of them is neglected. It is produced by the exposure to the heat of too strong a fire or to the action of the sun, and by 144 sudden variations of temperature, at the time of the changes of the


The child often sneezes and ejects by the nostrils mucous threads, at first clear, afterwards yellow, greenish, and purulent. The nose is


red and swollen; it sleeps with the mouth open, breathes clamorously, bạn chưn with difficulty, and when the obstacle is considerable, finds itself unable to suck. As often as it is presented to the breast, it wishes to suck and cannot succeed, for suction is impossible, of which any one may convince himself by imitating this act after having pinched the nose. The child withdraws itself in despair, uttering violent cries, and expressing by the gestures and by the movements of the face the deprivation and the pain which it experiences. Soon pressed by hunger, and in the impossibility of satisfying it, the child becomes more and more disturbed, and dies of fatigue, pain, and inanition, if it cannot be made to respire through the nostrils. In the mean time it is necessary to feed it by the spoon.

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This is obviously a very anxious position. It compromises the life of the child, which runs the risk of dying of hunger if it is very young. A young infant may perish from a coryza in four or five days. This disease is much less serious in older children. It is only dangerous when there is a difficulty in the exercise of respiration and of suction. Inflammation of the pituitary membrane

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[Part III. may, however, sometimes extend itself to the membranes of the brain and occasion an acute hydrocephalus, of which Billard has reported an example.

Houl Hyth Coryza is rather common amongst those young children subject to colds. It is usually not serious. The same is the case with the

coryza which precedes certain eruptive fevers, and especially measles. The The pseudo-membranous coryza and the chronic coryza are, on the contrary, very serious diseases.

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chrence The nostrils should be relieved of the mucosities and incrustations which close them up, by lotions of marshmallow, linseed, of elder flower, or of milk obtained from the breast of the mother or of the are must nurse. In the pseudo-membranous coryza, injections should be made Lirious with a glass syringe of a solution of nitrate of silver, 14 grains to 1 oz. of distilled water; or of sulphate of copper, 44 grains to 3j of water; or of sulphate of zinc in the same quantity. It is much better, however, to touch the orifice of the nostrils very lightly with a stick of nitrate of silver, and afterwards to inject a little tepid water.

In chronic coryza, the same means should be made use of, and to them may be added, when that is possible, insufflations of alum. 60 grains.


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Lastly, if the nasal obstruction is such that it entirely prevents turespiration and suction, the physician should attempt the introduction of a small silver tube into each nostril; it should be flattened, and curved from before backwards following the course of the floor of the fossæ, and afterwards fixed under the nose with the neighbouring tube. These two provisionary canula allow the passage of air, and prevent the child from dying at once, by giving the disease time to cure itself.

In syphilitic coryza the same symptoms are observed; its nature only is different, and it requires a special treatment. It will be described further on in speaking of the syphilis of infants.


147. Nasal snuffling is the symptom of severe acute and chronic coryza.

148. The coryza of infants, which produces obstruction of the nasal fossæ, is often fatal, in consequence of the obstacle it offers to sucking. 149. Syphilitic coryza is the most formidable of the varieties of coryza; but, however, it is cured more easily than the others.



The diseases of the larynx in children at the breast are always very serious. The slightest alteration of this organ occasions its narrowing, and as it is already very narrow, life may be rapidly compromised.

Simple or erythematous laryngitis, oedematous laryngitis, membranous laryngitis or croup, stridulous laryngitis or false croup, form the different varieties of the inflammation, of which the mucous membrane of the larynx may be the seat.


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The first is a disease of slight importance, is accompanied by fever, and is characterized by a rather frequent cough, hoarse and without hoop. Its termination is always favourable. All that is necessary is to keep the patients warm and to give them demulcent drinks. The second variety is very rare; some examples of it are given by tupelant Billard. It is an oedema of the glottis, a very serious disease, and nearly always fatal. It begins, like a simple cold, by a slight cough, which becomes stridulous, and by a considerable obstruction of the respiration. From this a state of asphyxia results, which necessitates the operation of tracheotomy.

Croup and false croup form the two latter varieties. consider them more in detail.

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The name of croup is given to that disease of the larynx in which the inflamed mucous membrane is covered by a fibrinous layer of new formation, which is called false membrane.


Croup is a much more frequent disease in cold and humid countries than in those of temperate climate; it is a disease which especially attacks the population of the north of Europe. It develops itself particularly amongst children, and more frequently in boys than in girls. It is observed amongst new-born children and in children at the breast. Billard, Dewees, M. Trousseau, have reported instances Chile.

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of this. I have met with this
M. Scoutteten has seen it in his
nevertheless, more frequent in the
two and eight or ten years.

[Part III.

disease in a child eight days old.
daughter, six weeks old.
It is,
period of life comprised between

If croup should be considered as a disease of infancy, it must not be concluded that adults are exempt from it. It has been met with in persons from eighteen to twenty years, and even amongst old people

He has even, in a case of this woman who had attained her

in their seventy-second year. M. Trousseau has likewise observed
it in persons much advanced in life.
disease, practised tracheotomy on a
fortieth year.

Croup usually attacks the same individual but once, yet Howe,
Vieusseux, Albers, Jurine, report remarkable instances of recurrence.
M. Paul Guersant has seen a very remarkable example of it, he has
even operated twice in the same child in an interval of two years.

Croup is an epidemic disease. This characteristic is a difficult one to establish at Paris, where most of the cases are disseminated and lost as regards each medical man who is limited to a portion of the field of public health. There, there is no general epidemic; only partial epidemics are observed developed in a quarter, in a house, or in a hospital devoted to infants. Still more must these epidemics be declared very unfrequent, for only one has been observed at the hospital for children at Paris, and that was not well characterized. The epidemic character especially reveals itself in limited localities. It is impossible to mistake it when it is observed in a province and in districts where nothing is ignored, and where the ravages caused by this disease in the population can be closely followed.

Croup, then, is an epidemic disease. It much more frequently appears in a sporadic state; and it is thus that it is generally observed at Paris. Its contagious nature is far from being demonstrated; still, this question must not be answered in the negative, for croup often follows pseudo-membranous angina. Now, the contagion of this . latter disease has been demonstrated in the most positive manner by the observations of MM. Bretonneau and Trousseau.* It is, then, possible that croup, which, by its nature, very much resembles pseudomembranous angina, may, like it, be transmitted by contagion. I say possible, for in the present state of science, a more positive expression cannot be made use of. It is, consequently, proper to separate those children labouring under croup, from other children whose health has not, as yet, experienced any attack.

[The evidence of the epidemic nature of croup collected by Valleix, Berge, Fleury, Canstatt, Wunderlich determines the point most satisfactorily in the * Bretonneau, Recherches sur l'inflammation spéciale du tissu muqueux, et en particulier sur la diphthérite. Paris, 1826.

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