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because the liquor bas no taste, and is as limpid as patients, in whose welfare she was much interested, rock water. At first the patients did not suffer from it, and she was told that they had suffered a relapse, that batafter some repetitions of the poison, they gradually fresh symptoms bad supervened, that a deadly languor lost the appetite, and became subject to goaring pains overcame them, benea!h whose wasting influence in the stomach, followed by debility, disease of the they gradually declined. Of its cause she could learn langs, bectic fever, and death.
nothing. The physicians told her that the disease was The use of slow poisons was not, however, confined unknown, and defied their utmost skill. She again to the Continent; for a remparkable instance of it enquired at the expiration of a fortnight;, some of the happened in this country during the reign of James Ist., patients were dead, others still lingered in hopeless in the murder of Sir Thomas Orerbury, wbich was agony-animated skeletons, whose only signs of life perpetrated in the Tower of London, by the orders of were the voice, sight, and breath. Within two months Viscount Rochester, and is mentioned by several of all were dead, and medical skill was as completely our bistorians. The unfortunate prisoner is said to foiled upon their examination after death, as it had bave taken poison, in very minute quantities, with been in their treatment." almost every article of his food. Cantharides and Encouraged by this saccess, Madame de Bringilliers arsenic were mised with the pepper and the salt; commenced operations upon her brothers and sister, lupar caustic was rubbed over his meat; and wben bis The sister escaped by leaving Paris, but one of the health failed, poisoned jellies and preserves ministered brothers expired in two months, and the other about to his fastidious appetite. His strength was obviously fire months after they had been subject to the influence declining, but after this treatment had been continued of poison; the pain of the stomach, sickness, burning in for six months, Rochester became impatient; and his the chest, anxiety of mind and exhaustion, as well as fears being excited lest Orerbury should yet live long the disorganization of the stomacb, intestines, and liter, enough to divulge some unpleasant secrets of which
observed on examination of the bodies after death, he was in possession, the prisoner's existence was at indicating corrosive action of the substances which length terminated, either by corrosive sublimate, or by they had been taking. There can indeed be no doubt suffocation, but by which of these means it is not respecting the nature of the poisors, for on the death quite certain.
of Sainte-Croix, corrossive sublimate, vitriol, antimody, In tbe year 1676, the Marquise de Brinvilliers was lunar caustic, and opium, together with an acrid prefound guilty of several murders, and was executed at paration, of which the chemical composition could not Paris. Having formed a criminal attachment to a man be detected, were found in his cabinet; while a paper, of the name of Sainte-Croix, who was afterwards suffo. writtten by the Marcbioness, and detailing many of cated by the fumes of some deleterious compounds her crimes was likewise discovered in his house. which he was preparing, they resolved to relieve Besides those just enumerated, Professor Baldinger, themselves from the power and remonstrances of the whose authority is quoted by Beckmann, states that Narchioness's relations by poison ; and her father was sugar of lead was an ingredient in one of the most without hesitation sacrificed. The first dose of poison subtle poisons. “There is no doubt,” he says, " that was given to him in soup, and M. d'Aubray suffered the slow poison of the French and Italians, commonly so much pain after it, that he sent for a physician, I called succession powder, (poudre de la succession,) who considered the illness to be an attack of indigestion, owes its origin to sugаr of lead. I know a chemist, and under that impression prescribed for him. M. who superintends the laboratory of a certain prince d'Aubray continued, however, in great pain, and in the on the confines of Bohemia, and who, by the orders space of a few days he expired. Her father being (perhaps not very laudable,) of his patron, has spent tbus disposed of, two brothers and a sister still lived to much time and labour in strengthening and moderating censure the conduct of Madame de Brinvilliers, and to poisons. He has often declared, that of sugar of lead, share the wealth which had been left by their parent with the addition of some more volatile corrosire, & These obstacles could not be endured ; and the very slow poison could be prepared, which, if swallowed Marchioness, with “her accomplice, Sainte-Croix, by a dog or other animal, would insensibly destroy it decided that they should be removed.” “But this time,” in the course of some weeks or months," without any says Dumas, " to avoid suspicion, it was necessary to violent symptoms. employ a poison less rapid in its action, than that In relating the foregoing cases, the limits of a lecture which had killed M. d'Aubray. They recommenced would not permit of my entering further into details, their experiments, not upon animals, lest the difference than was necessary to show what substances were of organization might defeat their views, but in anima used as slow poisons, and what symptoms ensued. vili. The Marchioness was known as a pious and These are the facts which illustrate the accumulative charitable woman, ever ready to relieve the distressed, action of poisons, in contrast to that of medicines; and and sharing with the Sisters of Mercy the attendance for fuller information, I beg to refer those who may upon the sick, to whom she sent wine and medicine at be curious in such matters, especially to Beckmann's the hospitals. Thus it caused no surprise to see her at « History of Inventions ;" to Mackay, on “ Popular the Hotel Dieu, distributing biscuits and preserved Delusions;" and to the “Crimes Célébres," of A. fruits to the convalescent; and her kindness was Damas. gratefally acknowledged. One month subsequent to! It is much to be feared that the crime of slow this, she revisited the hospital, to enquire after some poisoning is by no means extinct. In the last century
it was certainly practised; for early in the reign of cannot coincide with bim in such an opinion, if, be George the third, Mary Blandy was tried and hanged means that the disease is considered as inflammatory at Oxford for poisoning her father, by repeated doses in all its stages; and I believe that the opinions, of of arsenic, and many still more recent instances are the majority of practical men, besides those of a great reported.
host of authors, are opposed to its being absolutely In most of the cases which I have mentioned, death of an inflammatory nature, or hyperæmic. Of thirty. took place in conscquence of the destruction of the
eight authors, whose opinions are quoted by Dr. digestive powers, by the operation of corrosive poisong
Copland, in his Dictionary, Art. “Hooping-Cough,” upon the alimentary canal, the symptoms of which I
eighteen considered it as an irritative disease, eight
as purely nervous, and only twelve as inflammatory. have several times witnessed, though in a very slight
It may be asked why, with such a number of the ideas degree, when arsenic and nitrate of silver have been
of the learned recorded on this subject, I should preprescribed as medicinos; and of the action of par
sume to propound another hypothesis ? My reply cotics and sedatives upon the nervous system. Farther is, that not one of them, even including that (the best,) examples can scarcely be necessary. The formidable of the accomplished lexicographer himself, appears to induence which medicines exert when administered so me as being perfectly satisfactory in embracing and as to act accumulatively, ought to make us very seri. explaining all the phenomena of pertussis ; for although ously consider, not only the primary, but likewise the some of them admil its specific nature, they do not secondary and subsequent effects of whatever we may trace the influence of the specific element through all be about to prescribe; for although the frequent repe
the phases of the disease. tition of a small dose is 'acknowledged to be in mavy !
The gist of Dr. Fife's argument is to show that cases highly beneficial, it is equally true that some per
oma pertussis is distinct from bronchitis, and the major medicines may in this manner induce chronic inflam.
portion of his paper is occupied by the proofs ; but mation of the vervous membrane of the stomach and
while he shows pretty clearly what it is not, he does intestines; that others may gradually impair' the per.
not define as evidently what it is, inasmuch as its
pathology, as far at least as I can ascertain, is come vous power; and that a third kind may so change the
prised by him in the following propositions : composition of the avimal duids, as to substitute morbid
"Ist. The larynx is mainly implicated in the produce deposits in the various tissues for those which " are, tion of the paroxysm of cough, the chest being con naturally formed by the process of healthy nutrition. paratively passive, and the violence and convulsive Thus, while by judicious management, the accumulative i nature of the cough resembling that which arises from action of medicines may be employed as a most effica che pressure of foreiga bodies in the larynx. cious mode of relieving many constitutional disorders, 2nd. The hoop or whoop is physiologically requisite and especially those of a more chronic description, to compensate for the interruption which respiration without proper caution we may lay the foundation of
on wa may lay the foundation of sustains during a paroxysm. diseases, more mortal than those which it was our 3rd. The vomiting which terminates the cough, in 'object to cure.
all probability, has its origin in the participation of the stomach in the morbid condition of the larynx.
4th. Hence the actual seat and nature of pertussis
are essentially referrible to some morbid condition ON THE PATHOLOGY OF HOOPING-COUGH.
of the pneumogastric nerve, which influences the By T. OGIER WARD, M.D., Oxon.
secretion of the mucus so frequently discharged from
the stomach. TO THE EDITOR OF THE PROVINCIAL MEDICAL AND
Now, admitting the truth of the first proposition, SURGICAL JOURNAL.
the second is by no means a corollary to it; for, Sir,
although a deep inspiration always follows the expulsive In the number of the Provincial Journal for June efforts of a cough, yet it is by no means “physiologically 16th, there is a paper by Dr. Fife, of Newcastle, “On requisite" that this inspiration should be attended by the Pathology and Treatment of Pertussis," to which a whoop; pathologically, however, it is requisite that my attention has been more particularly directed, the whoop should occur, as this is the characteristic by that disease baving been rather prevalent lately of the disease. Again, as Dr. Fife has omitted to state in this place, and by my desire to ascertain whether in what consists the morbid state of the larynx, we any new light had been thrown upon its nature. In are not much enlightened by the third proposition, this expectation, I must say, I have been disappointed that the stomach participates in this condition, whatand it is because I agree with Dr. Fife in the importance ever it may be; nor is the conclusion respecting the of our having settled notions respecting its pathology, pneumogastric nerve at all borne out by the premises
that I cannot adopt the view he has taken of its that the stomach and larynx are equally affected. It · exclusively nervous character, an experience of nearly may be so, but there is no proof given, physiological · twenty years having convinced me that such a view or pathological, that it is so. Even if we take it for is too narrow to be a safeguard for practice. I there. granted that the pneumnogastric nerve is the point de fore venture to send you this letter as a kind of depart of the symptoms, Dr. Fife ought to have ina commentary and appendix to the theory, to which formed us how this morbid condition of the nerve has Dr. Fife has given the sanction of his name.
been produced. Dr. Fife sets out by stating his belief, that “the But with the intention of contrasting pertussis with doctrine of the inflammatory nature of hooping-cough bronchitis, Dr. Fise has laid down six other propositions is adrocated by the majority of the profession." I bearing on the pathology of the complaint, to which
as they are still insufficient to complete its illustration, accidental cold. I am, not, bowever, disposed to deny I have ventured to append seriatim ad explapatory that a violent attack of bronchitis or pneumonia may comment.
cause a cessation of the wboop, which I should explain Ist. “ Pertussis is essentially a disease peculiar to thus, either that the new and violent action set up by infancy and childhood."-Hooping-cough being one of the inflammation of the bronchi supersedes the specific the zymotic diseases, can only attack, as a general rule, disease ; or that the mechanical irritation of the the same individual once in the course of his life; and bronchi by the more acrid mucus, (the product of as it is readily “caught" and few persons enjoy an pure inflammation,) excites a slight and frequent cough, immunity from it, the younger members of the family sufficient to expel the offeuding matter before it accuare most liable to it, simply because the elder hare mulates to so great an amount as to require for its already passed the ordeal; still there are many instances removal a series of convulsive actions, such as are of persons advanced in life, suffering from the disease for exbibited during a paroxysm of booping-cough. the first time. Another proof that it is not essentially In accordance with, and supplemental to, the forepeculiar to infancy may be taken from the cases, by no going incidental remarks, I would describe pertussis as means unusual, where, in large families affected with a zymotic disease, affecting primarily the mucous pertussis, the mother or nurse has been seized with a membrane of the air-tubes and the blood, and cough closely resembling that of the children.
secondarily the medulla oblongata and respiratory 2nd. “The cough is convulsive, always occurs in nerves, producing a violent and convulsive cough, paroxysms, and very often assumes a periodic type ; I attended with a peculiar sound characteristic of the and it commonly terminates in romiting.”—This propo- disease. I purposely omit from this definition the sition admits of no dispute, because until the disease state of the stomach, as the complaint may exist in its has assumed these characteristics together with the perfect form without any affection of that organ; and whoop, we cannot say whether it be pertussis or mere i propose to derote the remainder of this paper, except bronchitis.
a few words upon the treatment, to the completion of 3rd. “The patient is comparatively well during the the arguments already adduced in support of this intervals."-If, by “comparatively well,” Dr. Fife means definition of hooping-cough. comparatirely with patients suffering from mild bron. If the essential character of zymotic diseases is that chitis or simple catarrh, the expression may be correct they are transmissible by contagion, which, exciting a in a degree, otherwise, it cannot be admitted that the peculiar ferment in the blood, renders it ever after majority of patients affected with pertussis, except in incapable of receiving the same impression, and thus a slight degree, can be deemed well at all; for their secures to the patient an immunity from future attacks, almost constant leuco-phlegmatic appearance after the we bare greater reason to claim the admission of disease has existed for some time, clearly indicates that pertussis among them. than that of any now grouped there is some great obstacle to the due oxygenization together in this class of complaints; for a second of the blood. Indeed the emphysematous state of the seizure by booping-cough is far more rare than of lungs in most fatal cases, whaterer may have been the small-pox, measles, or scarlatina. In each of these complications, militates strongly against such a favour- diseases we observe a local affection, attended with a able view of the condition of the patients during the constitutional disturbance of a febrile kind. In small. intervals of the cough.
pox it is the dermis and deep seated portion of the 4tb. “ It almost invariably occurs as an epidemic." - mucous membrane of the tongue, fauces, larynx, and Pertussis being an infectious disease must necessarily conjunctiva; in scarlatina it is the papillæ of the skin prevail more or less in an epidemic form. Indeed, we and tongue, and the mucous membrane of the nares have no right to assume that it is ever sporadic; for and throat, with the tonsils; in measles it is the until we know the real nature of contagion and infec- capillaries of the skin, and of the mucous membrane tion, we cannot assign limits of either time or space to of the eyes, nares, and respiratory passages, that constitheir influence in pertussis more than in small-pox, tute the pathognomonic seat of the complaint. So and to admit this latter complaint to be sporadic would pertussis affects the respiratory mucous membrane, be to beg the whole question of its origin, which has and some pathologists would also include the gastric been so long a subject of dispute.
under its influence; and in like manner, its first inva5th. “ It is not attended with fever, or, when this sion exhibits more or less of a febrile character, the occurs, it does not bear any proportion to the frequency symptoms of the early stage of hooping-cough being or violence of the paroxysms.—That pure pertussis is purely catarrhal. As in other zymotics there is always unattended by fever will scarcely be admitted as a a state of indisposition that precedes the appearance general rule by those who know how difficult it is to of the characteristic eruption, so I conceive the dubious distinguish it from bronchitis during the early part of primary catarrh of pertussis serves as a forerunner its course. That the fever does not bear any propor- to the outbreak of the perfect form of the disease, tion to the violence or frequency of the paroxysms is distinguished by the wloop and by a profuse secretion true, because these depend upon a cause that is not of mucus. fully brought into play until the inflammatory stage is But the very term zymotic necessarily inplies a orer.
diseased condition of the blood, the source of life and 6th. “The whoop is lost as soon as inflammation of of all secretions; and although we shall probably the bronchi begins."— From wbat has just been stated, nerer be able to ascertain what changes are produced I conceive this proposition is true only as far as it in that fluid by the poison it has imbibed, nor wherea relates to intercurrent bronchitis, and not by any means fore each poison selects a peculiar locality for the constantly so even in this case; for we often observe display of its effects, still we cannot doubt that the the force and frequency of the cough aggravated by a blood, directly, by its properties or products, or
ON THE PATHOLOGY OF HOOPING-COUGH.
indirectly, by its action on the nerves and brain, is the effort. Lastly, if we apply our ear to the chest of a exciting cause of the series of symptoins to which we patient during the whoop, we find that very little air give the name of pertussis. The disease, as has been penetrates into the lungs. Moreover, the amount of stated, in the majority of cases, assumes the features morbid changes in the larynx found in fatal cases of of common catarrh, the chief distinction being a change pertussis, is quite insufficient to cause so great an in the voice, and an acute tone of the cough, accord. obstruction to the entrance of air to the chest, being ing to Dr. Copland,-a difference far too slight to enable usually confined to a little thickening, with more or the medical attendant to decide upon the nature of less redness of the mucous membrane ; and, as no the complaint, except during the prevalence of an analogous sounds are produced in other diseases affectepidemic, although the cough of pertussis has generally ing respiration, besides those above mentioned, we are a violent convulsive character from the first. A little driven to the conclusion that the whoop, the cbaracterlater, the diminished amount of febrile disturbance, istic of the second stage of pertussis, is produced by which is pertussis subsides, but in catarrh and bronchitis a spasmodic contraction of the glottis, and therefore aigments, pari passu, with the violence of the cougb, ) is dependent upon some affection of that portion of the affords a better criterion; still the diagnosis can never nervous respiratory system that presides over the be sure until the whoop has been heard, and with motions of the larnynx. this sound the first stage of booping-cough terminates, | The excito-motory system of the larynx consists of and the second is established.
the superior laryngeal nerve, the afferent, and the As the symptoms of the first stage present few or inferior laryngeal or recurrent nerve, the efferent, no peculiarities, we cannot affirm that the pathology together with the medulla oblongata, as the central of pertussis at this period differs from that of bronchitis sensorium or medium of communication between them. or catarrh, and the consideration of its specific nature Thus the laryngeal receives an impression, and transmits would only embarass us, without throwing any light it to the medulla, which instantly regulates the moveupon this point; we therefore may conclude that the ments of the laryngeal muscles through their motor disease, as in these affections, consists in an irritation nerve-the recurrent; or, if the medulla be directly of the mucous membrane of the air-passages, which, affected by an irritant, it may direct the motions of producing an increased secretion of mucus, excites the larynx through the recurrent, irrespective of any the effort of coughing to remove the obstruction thus impression from the laryngeal. Such an irritant I created to the access of air to the lungs.
conceive to exist in the poisoned blood of pertussis, The second stage, however, is remarkable for the which also modifies the secretion of the respiratory occurrence of the whoop, which is so peculiar a mucous membrane, so as to render it preternatural in symptom, and so distinguishing a characteristic of the quantity and tenacity. Hence both the above modes disease, that an investigation of its causes, mechanical of irritation are present in hooping-cough; for there and physiological, must almost necessarily lead us to is an increased secretion of a tenacious morbid mucus, an explanation of all the other phenomena of looping that requires a series of powerful repulsive efforts for cough.
its dislodgement and expulsion from the chest; and As it is universally admitted that the whoop is pro- these same efforts by loading tbe medulla with vitiated duced from the larynx, a sketch of the condition of blood, impeded in its return to the lungs, so interfere this organ in certain complaints,-as croup, ædema with its function in the co-ordination of the muscular glottidis, and laryngismus stridulus, in which analogous efforts of the chest and larynx, that the glottis still sounds are beard, will serve to exbibit the mechanical preserves its state of contraction, at the same moment cause of this symptom; but it is only by a reference that the chest is striving to expand itself for the to its specific nature, that we can account for its re-admission of air to the exhausted lungs. I use occurrence unattended by morbid changes, equal in the word preserves, because no efforts of coughing degree or extent to those that are usually met with sufficiently powerful to expel the mucus can be in the above diseases. In croup, it is the narrowing made, unless the glottis be considerably contracted at of the passage of the glottis and larynx, by the tuinefac. the moment of expiration. tion of its mucous membrane, or by a fibrinous exuda. That congestion or irritation of the medulla oblongata tion, that makes both the expulsive, as well as the is sufficient to produce the spasmodic contraction of inspiratory, effort of the cough, liable to be mistaken the glottis that causes the whoop, we have a strong for the cough and whoop of pertussis. In ædema of confirmation, in tbe source of crowing inspiration the glottis there is a still greater amount of contraction being frequently traceable to this cause; and in some of the larynx ; yet the expiration is pretty free, and it cases the contraction is so energetic that it does not is only the inspiration that is attended with an abnormal relax till after the death of the patient, which takes sound, arising from the atmospheric pressure forcing place in consequence of the spasm producing asphyxia. iuwards the swollen edges of the rima glottidis, and But we derive yet stronger arguments in farour of this thus obstructing the passage. In laryngismus stridulus, view, from the consideration of many of the exciting or crowing inspiration, there is every reason to believe causes of the paroxysms of hooping-cough, the inthat the peculiar sound of the respiration is owing to Auence of which is to be explained by their effect in a spasmodic closure of the larynx, although very great inducing such a state of the medulla. Thus, all violent obscurity rests upon the pathology of this disease and sudden emotions, and their expressions, as crying, Dr. Fife's comparison of the whoop to the pressure of laughing, shouting, and all efforts, disturb the action a foreign body in the larynx, indicates its origin from of the heart, which either directly, or by re-action, mechanical obstruction. 'Again, if we try to imitate expels the blood towards the head with greater force, the sound, we can only do so by nearly closing the and immediately excites the cough. Again, during glottis at the same moment that we make an inspiratory / sleep there is a tendency to congestion of the braio, independently of the horizontal posture, which also tbird order arise from organic changes induced in the augments it, and hence the cough is troublesome at congested blood by the influence of accidental cire night. It may be objected that similar causes will cumstances, or hereditary predisposition. Hence it provoke an access of cough in other catarrhal affec follows, that the morbid appearances in fatal cases of tions, and especially in asthma; but, admitting this to pertussis may be very various, though in my own be the case, I contend that the cough is not so easily experience congestion of the brain and lungs, with excited, nor is it so violent in ordinary catarrhs as in emphysema of the latter organs, hare been most usually pertussis, and the exception of asthma favours rather met with. I have never met with pure crepitation in than opposes this view, as there is always a greater or pertussis, though mucous rattles, with bronchial respiless "amount of cerebral congestion in the nervous ration, are very common physical signs, and for these form of that disease.
reasons, and that alleged by Dr. Fife, that the ferer The prolongation of the paroxysms of coughing bears no proportion to the violence of the symptoms, after the first series of expulsive efforts, and the conse- I do not believe that hooping-cough must be attended, quent whoop have terminated, is to be explained by though it is preceded, by bronchitis; and therefore, the persistence of some irritation, either of mucus in when there is no fever present, I can only attribute the bronchi, or of food in the stomach, for when these the mucous rattle, to increased secretion from conhave been emptied of their contents, the paroxysm gestion of the lungs. terminates. The consideration of this symptom of In order to complete our accouut of the pathology, vomiting has bitherto been omitted, because it is it remains for us to shew by what means pertussis neither peculiar to booping-cough, nor invariably wears itself out during its third period, or that of present, and because it is more or less an attendant decline. As it differs from the other infectious diseases upon all severe fits of coughing, from whatever cause, in in not being attended with any visible local manifesta, many persons. Indeed, when we reflect upon the tion of its action, we cannot state with certainty, hore numerous sympathies of the stomach, besides its own the blood casts off the zymotic element; but reasoning affections, that may induce vomiting, it is almost from the analogy of the rest, in which the breath, impossible to fix upon any one sole cause of the almost all the secretions, and more particularly the symptom in hooping-cough ; for instance, the vomiting specific products of the malady, are contagious, re may be the effect of the mechanical compression of may infer that the emunctories of the body are the the parietes of the stomach by the efforts of coughing, outlets by which the morbid products make their which also overcome the resistance of the other escape. Still there is no such speedy convalescence as sphincters; or it may arise from the irritation of the we frequently see in the others; the cough may become Jaryds and bronchi, by the mucus being transmitted to rapidly less frequent and violent, but it does not cease the stomach, as occurs when the fauces and larynx are suddenly, and leave the patient with nothing but tickled by a feather; or from a similar transmission of debility to contend against. This slow convalescence, the specific irritation by means of the par vagum, to bowever, is quite consistent with the view that has the stomach; or it may be the result of congestion of been taken of the nervous nature of the cough, and it the brain by the cough, either simple or specific, pro- is well known how difficult it is for the system to shake ducing its usual effect of vertigo and sickness. On off any habit of a convulsive kind,-as hysteria, chorea, these grounds the solution of this question may be and epilepsy; and the facility with which the disease fairly left for future discoveries. At present our view returns under the infuence of a common cold, or other of the pathology of the cough is not rendered clearer, irritation, even months after it is supposed to be cured, wbichever we may adopt as being the cause of the | is a strong support to the idea of its essentially nervous vomiting that'occasionally attends it.
character in the latter stages. I conceive, then, that From what bas been stated, we may briefly recapitu. the system. relieves itself of the dregs of hooping. late the series of events that constitute the pathology cough (to use a zymotic metaphor,) by the secretions; of pertussis in the following order of sequence :- but the disease not baring, like the other zymotics, any Specific toxication of the blood, inducing irritation of special organ except the bronchial membrane on which the bronchi and increased secretion of mucus, and to exert its force, the purification of the blood, and consequent congestion of the lungs; toxication, and bence the convalescence, is more protracted than ia congestion of the brain and medulla oblongata by the them. blood, now rendered still more vitiated by the pull With regard to the treatment of pertussis, in mild monary congestion, which, producing specific irritation cases I have found that recommended by Dr. Fife, of the respiratory nerves, renders them more easily viz., emetics and sedatires, with an occasional mild affected by slight stimuli, and causes irregular con- | :percurial to correct any disordered secretions, quite tractions of the muscles under their influence, so as to sufficient to carry the patient through the disease with produce a spasmodic cough of a peculiar kind. comfort and safety. But when tbe cough is violent,
By this view of the pathology of pertussis, its com- the features poffy, the eyes bloodshot, and there is plications are easily explained. The bead symptoms general oppression, with mucous rattles in the lungs, I are the effects of the congestion of the brain, from the cannot agree with Dr. Fife in his objection to depletion violence of the cough opposing the return of the blood | by leeches, (I have never used general bleeding,) as I to the chest. The abdominal complications also are find them to have frequently a most remarkable effect mostly referrible to the same cause. Of the chest in relieving the congestion and mitigating the parox. affections, some arise from the mechanical effects of ysms when applied to the head and chest. Of the two the blood and air expelled from, and compressed with modes, however, when both organs are affected, I have violence within, their vessels, by the efforts of coughing; found most benefit from their application to the head. : others from simple congestion of the blood ; ubile a l It is chiefly in consequence of its leading to this