Medical inquiries and observations. By Benjamin Rush, M.D. professor of chemistry in the University of Pennsylvania.
Rush, Benjamin, 1746-1813., Redman, John, 1722-1808, dedicatee., Rush, Benjamin, 1746-1813. Appendix: containing, the new method of inoculating for the small pox.
Page  120

OBSERVATIONS ON THE Cynanche Trachealis.

I TAKE great pleasure in thus publicly acknow|ledging a mistake, which I committed in my letter to Doctor Millar, published by him in London in the year 1770, in supposing that there was but one species of this disorder, and that that was spasmodic. I am now satisfied, from repeated observations, that there is another species, which I shall take the liberty of calling the cynanche trachealis humida.

I EXCLUDE, as a species of this disorder, the cy|nanche trachealis maligna. Many of the symptoms of the cynanche trachealis occur in the malignant sore throat, but they should by no means constitute the name, or a species of that disease. I have seen the same symptoms in the scarlatina anginosa, and yet I never thought of ranking a cynanche trachealis scarla|tina among the species of that disorder. I have like|wise seen the cynanche trachealis in the last stage of the secondary fever of the small-pox, without supposing that it ought to derive a specific name from that disease. The species of diarrhoea would be innumerable, if, every time it occurred as a symptom of other disor|ders, it was to receive a specific name, and to be con|sidered as an idiopathic disorder.

Page  121 THE reasons which I offered in my letter to Doc|tor Millar, for believing that the cynanche trachealis is frequently a spasmodic disorder, continue to operate upon me with as much force as ever. But a number of dissections, related by different authors, satisfy me, that the cynanche trachealis humida is a distinct species from the spasmodic, and requires a different method of cure.

THE cynanche trachealis spasmodica is known,

1. BY coming on suddenly, and that generally in the night.

2. BY frequent and perfect intermissions of the symp|toms for hours, and in some instances for days, with|out the least sensible discharge from the trachea. And,

3. BY yielding to antispasmodic remedies, particu|larly to the warm bath.

IF these facts had left any reason to doubt of a spas|modic species of this disorder, I should have been con|firmed in the opinion, by the dissection of a child in the year 1770, who died by it, in whom no marks were to be found of a membrane, or even of mucus in the trachea. The lungs and trachea appeared to be in a sound state.

THE cynanche trachealis humida is known,

1. BY coming on gradually, and that most com|monly in the day time.

2. BY its continuing or increasing for several days without any remarkable remission, or even abatement of the symptoms.

Page  122 3. BY the discharge of phlegm or mucus from the trachea, and the occasional appearance of it in the stools. And,

4. BY not yielding to antispasmodic medicines.

MY opinion of the cause of the membrane which is formed in the trachea, continues to be the same as expressed in my former publication*, with this dif|ference, that I believe the membrane to be the effect of the humid species only, and that it is not an acciden|tal consequence of the spasmodic, as I once supposed. During the paroxysms of the disorder, the symptoms are nearly the same in both species. They are described by Doctor Millar, in his observations on the asthma and hooping cough, in the following words:

Children (says he) at play were sometimes seized with it, but it generally came on at night. A child who went to bed in perfect health, waked an hour or two af|terwards in a fright, with his face much flushed, or sometimes of a livid color; incapable of describing what he felt; breathing with much labor, and with a convulsive motion in the belly; the returns of inspiration and expiration quickly succeeding each Page  123 other in that particular sonorous manner, which is often observed in hysteric paroxysms. The child's terror sometimes augmented the disorder. He clung to the nurse, and if he was not speedily re|lieved by coughing, belching, sneezing, vomiting or purging, the suffocation increased, and he died in the paroxysm.

TO this description of the cynanche trachealis, I beg leave to add the three following observations.

1. THE noise which patients make in coughing in this disorder, resembles the barking of a young dog. This symptom is so universally present, that I always rely upon it as a pathognomonic sign of the disease before it is completely formed. I have observed this barking cough, in one instance of cynanche trachealis humida, to continue for several days after the patient was out of danger.

2. DURING the continuance of the disease there is frequently an eruption of little red blotches on the skin, which is accompanied by sensible relief to the patient. This eruption sometimes appears and disappears two or three times in the course of the disease.

3. THE disease is not confined wholly to children. I have seen two cases of the spasmodic species in adults.

DOCTOR Cullen has given birth to a controversy respecting the inflammatory nature of the cynanche trachealis. He has included it in the order of phleg|masiae in his class of pyrexia. I acknowledge that I have generally seen both the species that have been mentioned, without inflammatory symptoms, and some|times Page  124 without fever, especially in the first stage of the disorder. When either species has been attended by a hard pulse, it has been only in plethoric habits, or when it has been complicated with symptoms of catarrh or peripneumony.

PERHAPS it may appear improper, after such a declaration, to have adopted the name given to this disorder by Doctor Cullen. I should have had no objection to Doctor Michaelis's name of "angina po|lyposa," did it not exclude the spasmodic species of this disease; nor should I hesitate in adopting the more generic term of "suffocatio stridula" of Doctor Home, if the disease were not now so generally known by the name given it by Doctor Cullen.*.

THE remedies to be used in cynanche trachealis spasmodica, are, 1. Bleeding, when it is connected with pneumonic symptoms; 2. Vomits; 3. Purges; and, 4. Antispasmodic medicines, more especially the warm bath, opium, assafoetida and blisters.

THE remedies which are proper in the cynanche trachealis humida, are the three first which are men|tioned for the cure of the spasmodic species, and CALO|MEL. Our principal dependence must be placed upon this last medicine. A large dose of it should be given as soon as the disease discovers itself, and smaller doses should be given every day, while any of its symptoms continue. The bark is scarcely a more certain remedy Page  125 for intermittents, than calomel, when thus administer|ed, is in this species of cynanche.

IN what manner does the calomel act in this disor|der? Is it by increasing the secretion of mucus in the numerous glands of the fauces, oesophagus, stomach and bowels, and thereby lessening the excretion of it in the trachea? The analogy of the secretions and excre|tions, in other parts of the body, whether promoted by nature or art, seems to favour this conjecture.

I SHALL only add upon the subject of this disorder, that instances of its mortality have been very rare in Philadelphia, since the general use of the remedies which have been mentioned.