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UNITED STATES  OF AMERICA
WASHINGTON, D.C.
B19574
21 
 
 
AN
INAUGURAL DISSERTATION
ON
CYNANCHE TRAGHEALIS.

ST THOMPSON MDuNALDt I    ' ?£■
    OF VIRGINIA,    V'"a     "^ \
,\
</>
HONORARY MEMBER OF THE PHILADEPH
        MEDICAL SOCIETY.
   PHILADELPHIA:
PRINTED BY MATHEW CAREY,
 N° 118, MARKET STREET.
IA \£_ .
MAT 13, l80S- 
>av: 
AN
    INAUGURAL DISSERTATION
                  i

          FOR THE DEGREE OF


   DOCTOR of  MEDICINE;


   SUBMITTED TO THE EXAMINATION OF THE


AEVEREND JOHN EWING, S. S. T. P. PROVOST,


    THE TRUSTEES AND MEDICAL FACULTY

               OF THE

  University of Pennsylvania:
OJI THE 27th DAY OF MAY, 1802*
'<7ff7ffi 
 
TO
Mr.  ALFRED THRUSTON.
          HILST dedications  are  generally the vehi-
cles of supplication, for protection to a work, or a channel
through which the courteous author pours forth adulation
to his patron, far more disinterested motives induce me
thus to dedicate my inaugural dissertation to you.  I hope
you will consider it as a mark of that friendship which com-
menced between us almoft in infancy, and increased as
we grew  up to  manhood.   Bred up as you  and I have
been in the same schools, and under the same tutors, par-
takers of each others* toils and amusements; I do not know
to whom I could with so much propriety pay this tribute
of esteem as to yourself.

   With my most cordial wish for your general welfare,
and particularly for success in your profession, I sub-
scribe myself,

                    Your Friend and Servant,
w
THOMPSON  M'DONALD. 
 
INTRODUCTION.
     IN thus subjecting myself to the criticisms of the
world, I hope it will be recollected by the gentle reader,
that it is not the refult of my choice : far from it, I would
rather glide through the process of graduation in obscu-
rity, than subject myself to the flurs of the disingenuous,
did not the laws of the University oblige me to come for-
ward with an  inaugural dissertation.  As a duty then,
(however disagreeable) I enter on the task, and the con-
sideration of its being compulsory, will, in a great mea-
sure, apologise for its imperfections.

   In choosing  the Cynanche Trachealis for the subject
of my dissertation,  I must confess it was more for my
own convenience, than from a conviction of the import-
ance of the subject: had circumftances permitted, I cer-
tainly  should have  selected something of  more import-
ance to the medical reader.
   On  examining the  different authors who have treated
of this disease, I find there is considerable variety in their
opinions;  some considering it as a topical disease, whilst
others consider it as uniformly connected with fever.  In
the following dissertation I shall consider the disease as
consisting of two species, inflammatory,  and spasmo-
dic : I think I  am  warranted in this divifion, not  only
from the authority of some respectable authors, but also
from my own experience. 
/iOJVTJ-r  '-!:r\<i 
A
            DISSERTATION

On the  Cynanche  Trachealis.
     T
      -L HERE  are few diseases that have  received
a greater variety of names, than the one now under con-
sideration : almost every author who has written on  the
subject, has thought himself privileged to give  it what
appellation appeared to him most proper. I have  chosen
the term Cynanche Trachealis,  not that I have a predi-
lection for one term more than an other; but because
the professor of the institutes, and practice  of medicine
in this University, has  made use of the term in his in-
quiries and observations, and for the same reason he  has
there assigned for his making use of the term (viz.) that
it included both the inflammatory and spasmodic species.

  The Cynanche Trachealis was thought  by those  au-
thors who first treated of the disease, to be  confined
entirely to the state of infancy; but late and melancholy
experience difqualifies  the supposition.  The  death of
the late General Washington will ever remain a memento
to the American physician, that age is not a barrier to
the ravages of this disease : by  it, at the advanced age
of sixty eight, that ever-reverenced personage was carried
off the stage of life in  the most excruciating torment.

  Whilst the deplorable case just stated, (without  ad-
verting  to  numerous others on record) establishes  the
                         B 
10
fact, that ths adult  occasionally falls a sacrifice to  the
disease ;  I need scarcely offer an  instance of its  taking
place in infancy; for who has not almost every month in
the year seen, or  heard of, instances of  that  tender  but
innocent part of the  creation falling victims to this moll
formidable malady ?  Nay,  contrary to  the assertions of
authors, I have seen it take place whilst the infant was at
the breast, and within  six months after birth.  From all
the information that I can collect, I suppose that there is
at least ninety nine cases of this disease  in  infancj^, to.
one that takes place in the adult state.

   This disease takes  place at all seasons of the year j
and in all fituations.   I  believe that the Cynanche Tra-
chealis is to be met  with more  frequently in the spring,
and autumn (as other  inflammatory diseases are) than
the  more uniform seasons of summer and winter:  but
this by no means holds good as a general  rule.   And
although it is to be met with frequently in fituations the
moft healthy, I have every reason to believe,  from the
concurring  teftimony  of all  authors, that certain situa-
tions influenced by proximity to lakes,  marfhes,  rivers,
the sea, &c. may predispose the system to this disease
more than  others.   Cities, by  rendering  the systems
of children more effeminate, may be confidered in the
same point of view as  the causes above enumerated.

   It is observed by writers on the Cynanche Trachealis,
that those children of strong robust constitutions, and
sprightly dispositions, are more frequently the victims
of this disease, than  children whose constitutions are the
reverse of this.  How true this remark may be, I cannot
take upon me to  say, but I am confident it by no  means
holds good  as a general rule ; for I have seen the disease
rage with peculiar violence, in children of very delicate 
11
habits of body.   Perhaps it may appear from attentive  /
observation,  that the inflammatory species seizes on the
robuft, and sprightly; whilst the more delicate are sub-
ject to the spasmodic species.

   The Cynanche Trachealis has been supposed by some
 phyficians of the higheft respectability, to be contagious ;
 amongst the reft is the famous Swedifh phyfician, Roson-
 slein, whose authority  certainly stands high in the prac-
 tice of medicine ; and whose opinions ought to have great
 weight: but as other authors of equal respectability are
 silent as  to the contagious nature of the Cynanche.Tra-
 chialis; and as I can very eafily conceive of a great num-
 ber of persons being attacked by the disease, in a certain
 compass; or its  even being epidemic without being con-
 tagious, I therefore  reject contagion altogether: for I can
 as easily  conceive of contagion in pleurisy, or tetanus,
 as  in Cynanche Trachealis;  one  species being a fever
 with a local determination,  the other a spasmodic affec-
 tion of the muscles of the glottis.

    I have already hinted that I conceived there was two
 species of Cynanche Trachealis (viz.') Inflammatory and
  Spasmodic: 1ft. the Inflammatory Cynanche Trachealis
 I confider as a state of fever, with a local inflammation
  of the Trachea: 2nd.  the  spasmodic species I confider
  as an affection of the muscles of the larynx: this I think
  will more evidently appear by attending to the following
  phenomena. In the firft, or inflammatory Cynanche Tra-
  chealis, the disease  commences frequently in the day time,
  the symptoms are  not violent at firft, but increase gra-
  dually for a day or two, and during that time there is no
  intermiffions, or if any, they are  very flight:  a hoarse
  sounding voice, with  difficulty of breathing,  and a fever
  always attending from the beginning. 
12
   In the spasmodic species the symptoms come on sud-
 denly, in the most alarming manner, and attack moft fre-
 quently in the night, and without fever. In this species
 we have frequent intermissions which continue for some
 time, even for hours, or days, and then the  disease re-
 turns with as much violence as ever :  and what puts it
 beyond a doubt in my mind that this disease sometimes
 depends on spasm, is, its being removed so suddenly by
 antispasmodic remedies ; such as the warm bath, the fe-
 tid gums,  and particularly  a vomit.  If the  disease de-
 pended at all times on inflammation it  would be impos-
 sible for those remedies,  in such a short time, to give
 complete  relief.  In a girl of twelve years of age, who
 was threatened with  immediate death from suffocation;
 I saw the  disease completely relieved  in five  minutes,
 by a Ample dose of Tar. Emet. Add to this the teftimony
 of dissections wherein no inflammation exifted ; nor that
 invariable effect of inflammation of the Trachea, was to
 be found:  I mean the membrane always present in  the
 inflammatory species.

   Conceiving   it  pretty  well eftablished  that there
 are  two species  of  Cynanche Trachealis, I go on to
 consider each more particularly, and in the first place
 I shall consider the  Cynanche  Trachealis  attended
 with inflammation:   and here I may caution  the  young,
 and inexperienced  phyfician  to guard against the  in-
 sidious  approaches  of the disease:  for in the  firft
 place  the  symptoms are  but slight,  chiefly  those at-
 tending a  common  catarrh; such  as  slight chills, ac-
 companied with  heat.  The patient (if a child) becomes
 drowsy, deserts his  sportive amusements, and is fret-
 ful: at length there  is a hoarseness,  attended with  a
 dry cough, and difficulty of breathing, which  commences
sometimes  sooner,  sometimes later.  On examination 
13
 o£ the pulse we find  it full,., an<* frequent;  the  diffi-
 culty  of breathing  increases, the eyes are  dull,  the
 face flufhed, and sometimes  of  a full livid appearance
 owing, I suppose, to the obftruction to the passage of
 the blood through the lungs : there is a peculiar sound
 of the voice in this disease,  compared by different au-
 thors to the crowing of a cock, the barking of a small
 dog,  or fox, etc.  I do not know that any of these com-
 parisons are strictly just;  but a person who  has fonce
 heard  the sound, can never  be  deceived afterwards.
 Thus  this  formidable malady proceeds :  the difficulty of
 breathing increases, with violent action  of the muscles
 of the thorax, and abdomen:  towards the latter end of
 the disease the patient becomes drowsy, but is prevented
 from fleep by the difficulty of  breathing: the  system is
 exhaufted, the pulse  is small, quick,  and frequent; at
 length it becomes tremulous : and frequently convulsions
 which evidently appear to  proceed from strangulation,
 rid the unhappy sufferer of all its pains, and it sinks to
 repose in the arms of death.

   Such is the fatal catastrophe frequently attending this
 disease, if not  counteracted  in  due time by the most
 powerful remedies:  but unhappily the subjects  of the
 complaint  are  for the  most part too young to describe
 their disease : and parents, and nurses, are too ignonv it
 to detect it,  until it is  too late to apply  those remedies
 which  experience, and sound principles, have pointed out
 as the  most successful.

   This disease sometimes proves  fatal in four-and-twenty
hours : but more frequently death does not take place i!1!
the second, or third day: and sometimes it is protractt >
to the fifth day. 
u
  Where  death takes place in this species of Cynanche
Trachealis, it is proven by dissection to proceed from a
membrane  formed  by coagulable lymph, as some sup-
pose ; or inspissated mucus, as others suppose. I believe
that either one, or the other,  is capable of being formed
into such a membrane:  but from the similarity of the
membrane to the productions formed by inflammations in
other cavities of the body,  I am induced to attribute it
to coagulable lymph,  poured out from the inflamed sur-
face of  the proper  membrane lining the trachea.  This
preternatural membrane is  supposed to effect its  baneful
purpose fimply by filling up the cavity of the trachea ; and
thus obstructing the passage of the air to the lungs. But
upon a  closer view of the subject I think it will appear,
that even in this species of Cynanche Trachealis, death
is effected at last by a spasm of the muscles of the glottis:
from all the accounts  that I have seen of  dissections it
apppears that there  was always room enough for the pas-
sage of the air through the  membrane forming a hollow
tube.   The mere inspection of a preparation of the tra-
chea, will  convince any one that a tube much  smaller
than the trachea  will admit more air  than can pass
through the rima glottidis.   From  these considerations
I am led to conclude, that the  preternatural membrane
in the trachea acts  as  an extraneous substance, throws
the muscles of the glottis into spasmodic contraction,
closes effectually the rima glotidis,  and suffocation takes
place.

                    DIAGNOSIS.
   In the diagnosis it is of the greateft importance to  dis-
tinguish this disease  from catarrh,  as it is with this last
 that it is chiefly confounded, to the great danger and detri-
 ment of the patient; for frequently whilft the unwary pa-
 rents are nursing their tender offspring (as  they imagine 
15
for a slight cold) the fatal  moment passes, when medi-
cines can no longer be of  service ; and the child falls a
victim to the difease for the want of timely assistance.
   By attention, however, it may be distinguished from
catarrh, by the abfence of fneezing,  and no  defluxions
taking place from the eyes, and nose; and when the  dis-
 ease advances a little farther, by the stridulous sound of
the voice : but when the disease continues for some time,
 every doubt is removed.
   It  may be distinguished from the hooping cough by
this laft being contagious, and in the  intermissions of
coughing there is no difficulty of breathing, and no  stri-  '
dulous sound of the voice.
   It  may be distinguished from  all  the  diseases of the
fauces, by7 inspection : for the Cynanche Trachealis shews
no swelling,  or inflammation of  the fauces,  nor a diffi-
culty of swallowing.
   The proximate and remote  causes of this fpecies of
Cynanche  Trachealis are  the same,  as  the remote  and
proximate  causes  of  fever: therefore I do not think it
neceflary for me to specify them here, particularly  as I
do not conceive, that by so doing, I should contribute, in
in any degree, to  throw light on the mode  of treating
the disease.

                   PROGNOSIS.
   In  forming a prognosis in the Cynanche  Trachealis
the phyfician, (as  indeed in most acute diseases) should
be very cautious,  as it frequently happens that the most
experienced are deceived as to the iffue of  the  disease :
and as nothing subjects the profession so much to ridicule
as wrong prognosis, questions relating to the issue of the
disease should always be evaded: but if he is determined
to risque his reputation he must inquire the length of time 
16
 the person has been unwell, the violence with which the
 disease commenced, &c.
   Ir the disease came on by degrees, and  it has conti-
 nued for some time ; and if a stridulous sound of the voice
 in respiration attends, we may  apprehend danger: as it
 is then to be presumed  that the membrane is already
 formed, and of course requires the immediate application
 of the moft powerful remedies.
   But where there is  expectoration by coughing, and
 particularly where the fever, and other symptoms give
 way to the medicines which are to be pointed out here-
 after,  the prognostic will always be more favourable.   I
 should never give an unfavourable prognostic in this dis-
 ease, unlefs the most alarming symptoms were present;
 such as quick, short, and difficult respiration;  tremulous
 pulse, cold extremities, convulfions, &c.

                       CURE.
  In attempting the cure of the Inflammatory Cynanche
 Trachealis, our attention should be directed: 1st. To
 the disease of the whole system:  and, 2ndly, To the lo-
 cal affection of the Trachea.  To answer the first inten-
 tion, the moft powerful  remedy that presents itself is:
  1st. Blood-letting.  Blood should be drawn very co-
 piously from the arm.   All  authors agree in the propri-
 ety of this remedy: but late experience in this city points
 it out as the  only remedy that should be depended on in
 the early part of the disease.  But it is to be presumed
 that, after the inflammation of the Trachea has relieved
 itself by effusion,  this  remedy can no longer be fer-
 viceable.  It is impossible to point out the quantity of
blood that should be drawn j but the constitution, and
 age of the patient, the  violence of the  disease, and the 
                        17

inflammatory diathesis existing in the system, should be
attended to, and blood drawn accordingly.
  2ndly, Purging.  This as an antiphlogiftic  remedy is
of the greateft importance.  Calomel, as directed by Dr.
Rush, is moft to be depended on.
  Vomiting has been found an efficacious remedy in this
disease; given  on the first  attack, it acts as an expecto-
rant, clears the Trachea of the phlegm and mucus, which
so much  abound in children,  in this disease ; and after
the membrane  has been formed, it has been discharged
by the violent efforts in vomiting.
  Whilst thofe medicines are chiefly to be depended on,
the cure is by no means to be entrusted to them entire-
ly : but topical remedies should  be prescribed with the
greatest assiduity ; and first, blood should be drawn from
the part affected, by leeches.   If  the disease  is  violent,
and the inflammatory  diathesis great, five or six leeches
may be  applied to the  Trachea, and repeated if neceflary.
  Blisters,  particularly if we  cannot apply leeches,-
should be prescribed;  and I am of opinion they are much
to be depended on. They should be applied immediately
on the trachea, or between the shoulders.
  If the diseafe has advanced, and there is reason to be-
lieve there is a membrane  formed,  mercurial ointment
rubbed  on the external part of the throat, probably would
be  of service in loosening it, and preparing it for ex-
pulsion by other remedies.
  Breathing  the vapour of warm water, impregnated
with vinegar, I think, bids fair for being an useful reme-
dy ; it promotes expectoration powerfully.
  The  remedies above recommended should be applied
with promptness, as soon as it is determined that the dis-
                          c 
18
ease exists ;  and continued with assiduity until the cure
is accomplished. But should the time have elapsed when
these remedies might have been useful, and the dreadful
membrane is already formed, our chief dependence is to
be placed in the Seneca root, as recommended by Dr,
Archer.  It is a difficult matter to determine how this me-
dicine acts ; but as the same effect has been experienced
from  other medicines that act by their emetic and expec-
torant qualities ; and as this medicine appears to be pow-
erfully emetic and expectorant, as well as diaphoretic,  I
am disposed to attribute the good effects arising from it,
to the combined effects  of the operation of the medicine.
For I can very easily conceive, that, in a violent effort of
vomiting, and coughing, the air may be so forcibly driven
through the Trachea as to carry the membrane  with it.
It  is  presumable that in this process the membrane is
made loose, by a moisture being poured out from the ex-
halants of the proper membrane of the Trachea.
   I shall now in a few words say what appears to me
to be the nature of the

   SPASMODIC  CYNANCHE  TRACHEALIS:
 and in this species  Ave discover no fever at all at firft;
 but the  patient is suddenly  attacked, sometimes in the
 day time, but more frequently at night,  whilst under the
 balmy influence of sleep.   Children  frequently after go-
 ing to bed  in perfect health, are attacked  two or three
 hours after falling asleep, with a most  violent  difficulty
 of breathing, with a sense of suffocation. The fright
 which children are thrown into, by  being thus  suddenly
 attacked, increases the  complaint,  by  the violent exer-
 tions they make to relieve themselves.   In this species of
  Cynanche  Trachealis  there are intermissions for hours,
 or days, and then the disease will return as suddenly, and
 as violently as at first:  and unless the  child is relieved 
                         19

by coughing, vomiting, or purging, the patient will die
in the paroxyfm.   This is a description of the disease as
it usually appears : but Doctor Underwood, in his Trea-
tise on the  Diseases of Children, mentions a chronic  Cy-
nanche Trachealis, which he supposes to depend on spasm;
but with due submission to the Doctor's greater  expe-
rience and judgment, I would rather suppose it belonged
to the inflammatory species.  My reasons are as follow.
1st,  It comes on  gradually with a difficult}' of breathing,
and an expectoration of fmall bits of inspissated mucus,
or coagulable lymph.
   2ndly, It is moft troublesome in the season of the year
when other inflammatory diseases take place ; and
   3dly,  It is not attended with those  intermissions that
I have obferved  to  take place in the spasmodic species,
though in those chronic cases there are remissions  of the
complaint at times.  I am induced to believe, that in Cy-
nanche Trachealis, depending  purely7 on spasm, there is
no membrane formed at all.
   I  knew  a case of a lady, who, for several winters suc-
cessively, was attacked with those symptoms that are de-
scribed by authors in the chronic Cynanche Trachealis :
such as hoarsenefs, a difficulty of breathing; and every
morning, in the winter season, she expectorated a piece
of tough inspissated mucus, or phlegm, which reliev-
 ed her difficulty of breathing.  In  this case  antispasmo-
dic  medicines were  given without advantage, but the
complaint always went off at the return of spring.

                    DIAGNOSIS.
   The  diagnosis of this species  o[ Cynanche Trache-
alis,  is not,  I think, difficult: the symptoms come on vi-
olently, and suddenly ; and there is scarcely ever any fe-
ver present.  There is a symptom that takes place in this
disease, which, I think, is more frequent in this species,
than the Other:  I mean nn rrm^W^O^L^l--.*.-^—■«■ 
20
idl over the body, which generally relieves  the  patient.
That this symptom is confined to this species, I do not
take upon me to say,  but I am sure I have seen it oftener
in this than the inflammatory species.

                      CURE.
  In the cure of the spasmodic Cynanche Trachealis,
(he treatment is  considerably different from that of the
inflammatory species. I have generally seen the cure be-
gun with a vomit; in flight cases this will frequently re-
move  the   complaint, and will  always  moderate the
symptoms.
  The warm bath has been found, by experience, to be
of infinite service in  this species of Cynanche Trache-
alis.  The  patient should be immersed in the bath, and
continued for some time j but not so long as to relax the
system too much.
  Assafetida,  and opium, have also been found pow-
erful remedies in this  disease, particularly the former.
Doctor Underwood feems to have placed  particular con-
fidence in it.  These medicines should be given in tinc-
ture, as in that manner they are most conveniently given
to children, and  are more quick in their operation. The
assafetida has the advantage  of combining a laxative,
with its antispasmodic  operation.
  Mercury given so as to impregnate the system, should
be attempted,  and if successfully, we have every thing
to expect from it.  There is perhaps no medicine better
calculated  to  equalise the  excitability of  the  system,
than this.  Mercurial ointment rubbed externally on the
throat, should not be neglected;  and the vapour of warm
water,  slightly  impregnated with  vinegar, should  be
inhaled.
THE END. 
 
 
M^A,. Wist.
   WZ.

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