The vulgar name of this disease in Pennsylvania is HIVES. It is a corruption of the word heaves, which took its rise from the manner in which the lungs heave in breathing. The worst degree of the disease is called the BOWEL HIVES, from the great motion of the abdominal muscles in respiration.

It has been called suffocatio stridula by Dr. Home, and cynanche trachealis by Dr. Cullen. Professor Frank calls it trachitis, and Dr. Darwin considers it as a pleurisy of the windpipe. By the two latter names, the authors mean to convey the correct idea, that the disease is the same in its nature with the common diseases of other internal parts of the body.

It is brought on by the same causes which induce fever, particularly by cold. I have seen it accompany, as well as succeed, the small-pox, measles, scarlet-fever, and apthous sore throat. In the late Dr. Foulke it succeeded acute rheumatism. The late Dr. Sayre informed me, he had seen it occur in a case of yellow fever, in the year 1798.

It sometimes comes on suddenly, but it more frequently creeps on in the form of a common cold. Its symptoms are sometimes constant, but they more generally remit, particularly during the day. It attacks children of all ages, from three months to five years old. But it occasionally attacks adults. It generally runs its course in three or four days, but we now and then see it protracted in a chronic and feeble form, for eight and ten days.

Dissections show the following appearances in the trachea. 1. A slight degree of inflammation. 2. A thick matter resembling mucus. 3. A membrane similar to that which succeeds inflammation in the pleura and bowels, formed from the coagulating lymph of the blood. 4. In some cases the trachea exhibits no marks of disease of any kind. These cases are generally violent, and terminate suddenly. The morbid excitement here transcends inflammation. Similar instances of the absence of the common signs of disease after death, occur in other parts of the body. Where the cynanche trachealis has appeared in the high grade which has been last mentioned, it has been called spasmodic. Where the serous vessels of the trachea have been tinged with red blood, it has been considered as inflammatory. Where a liquid matter has been found in the trachea, it has been called humoral; and where a membrane has been seen adhering to the trachea, it has received from Dr. Michaelis the name of angina polyposa. But all these different issues of the cynanche trachealis are the effects of a difference only in its force, or in its duration: they all depend upon one remote, and one proximate cause.

In the forming state of this disease, which may be easily known by a hoarseness, and a slight degree of stertorous cough, a puke of antimonial wine, tartar emetic, ipecacuanha, or oxymel of squills, is for the most part an immediate cure. To be effectual, it should operate four or five times. Happily children are seldom injured by a little excess in the operation of this class of medicines. I have prevented the formation of this disease many hundred times, and frequently in my own family, by means of this remedy.

After the disease is completely formed, and appears with the usual symptoms described by authors, the remedies should be

1. Blood-letting. The late Dr. Bailie of New-York used to bleed until fainting was induced. His practice has been followed by Dr. Dick of Alexandria, and with great success. I have generally preferred small, but frequent, to copious bleedings. I once drew twelve ounces of blood, at four bleedings, in one day, from a son of Mr. John Carrol, then in the fourth year of his age. Dr. Physick bled a child, of but three months old, three times in one day. Life was saved in both these cases. Powerful as the lancet is, in this disease, its violence and danger require that it should be aided by

2. Vomits. These should be given every day, or oftener, during the continuance of the disease. Their good effects are much more obvious and certain in a disease of the trachea, than of the lungs, and hence their greater utility, as I shall say hereafter, in a consumption from a catarrh, than from any other of its causes.

3. Purges. These should consist of calomel and jalap, or rhubarb, and should always follow the use of emetics, if they fail of opening the bowels.

4. Calomel should likewise be given in large doses. Dr. Physick gave half a drachm of this medicine, in one day, to the infant whose case has been mentioned. I have never known it excite a salivation when given to children whose ages rendered them subjects of it, probably because it has been given in such large quantities as to pass rapidly through the bowels. Its good effects seem to depend upon its exciting a counter-action in the whole intestinal canal, and thereby lessening the disposition of the tracheal blood-vessels to discharge the mucus, or form the membrane, which have been described.

5. Blisters should be applied to the throat, breast, neck, and even to the limbs.

6. Dr. Archer of Maryland commends, in high terms, the use of polygola, or Seneka snake-root, in this disease. I can say nothing in favour of its exclusive use, from my own experience, having never given it, but as an auxiliary to other remedies.

7. I have seen great relief given by the use of the warm bath, especially when it has been followed by a gentle perspiration.

8. Towards the close of the disease, after the symptoms of great morbid action begin to decline, a few drops of liquid laudanum, by quieting the cough which generally succeeds it, often produce the most salutary effects. They should be given in flaxseed, or bran, or onion tea, of which drinks the patient should drink freely in every stage of the disease.

The cynanche trachealis is attended with most danger, when the patient labours under a constant and audible stertorous breathing. The danger is less, when a dry stertorous cough attends, with easy respiration in its intervals. The danger is nearly over, when the cough, though stertorous, is loose, and accompanied with a discharge of mucus from the trachea.

An eruption of little red blotches, which frequently appears and disappears two or three times in the course of this disease, is always a favourable symptom.

I once attended a man from Virginia, of the name of Bampfield, who, after an attack of this disease, was much distressed with the stertorous breathing and cough which belong to it. I suspected both to arise from a membrane formed by inflammation in his trachea. This membrane I supposed to be in part detached from the trachea, from the rattling noise which attended his breathing. He had used many remedies for it to no purpose. I advised a salivation, which in less than three weeks perfectly cured him.

Since the general adoption of the remedies which have been enumerated, for the cynanche trachealis, instances of its mortality have become very uncommon in the city of Philadelphia.