Croup. A strong solution of the Nitrate of Silver (gr.xx., Aq. Dest. fj.) was first employed as a local application in this disease, by Prof. Mackenzie,§ of Glasgow, in 1825; more recently, it has been successfully employed by Drs. Horace Green, Kesteven, Blakeman, and Bryan. The last physician || employed a stronger solution (ij. - 3j., Aq. Dest. fj.)- A small piece of sponge, attached to a stick of whalebone, is to be dipped in the solution, and the tongue being depressed by the handle of a spoon, it is to be applied freely, for a few seconds, to the larynx. Great immediate relief and subsequent cure are stated to have followed its application in several cases. The employment of the Nitrate instead of the solution, not only in Croup, but in all Laryngeal and Pharyngeal Inflammations, is recommended by Dr. Peron-neau, of Paris. Dr. Hatin¶ also employed it in many cases, and in the majority with decided advantage. An assistant is directed to place the child on his knees; with one hand he fixes the hands, with the other he holds the head firmly. The operator places himself in front, holding in his left hand an instrument to keep the mouth open, and depress the tongue. In the right hand he holds a porte-pierre, bent like a sound, containing a piece of the caustic projecting some lines. The tongue being depressed, the tube containing the Nitrate is passed into the posterior fauces, and rapidly passed over all points for a second or two. The operation is to be repeated twice; the second almost immediately after the first. It is said to afford almost immediate relief. Moist warm air diffused through the chamber, and the application of hot water externally to the throat, greatly aid the above measures, and should never be omitted. In Functional Aphonia, arising from paralysis of the vocal cords, Dr. Gibb has found the application of showers of solution of Nitrate of Silver to the larynx, in the form of spray, attended with the best results.*

* Ann. deTherap. 1846.

Dublin Med. Press, Feb. 1850.

Dict, of Pract. Med. vol. i. p. OS.

§ Edin. Med. Journ. April, 1S25. || British Record, Deo. 1, 1848. ¶ Rev. Medicate, Oct. 1837.

344. In Diphtheritis, the local application of a solution of the Nitrate is strongly advised by Dr. West, Mr. S. D. Brown, and others. Mr. Brown advises that the solution should not be of a less strength than 3j. to fj. or fij. of water. Its use has been extended with reputed benefit to some forms of Bronchitis, Hysterical Cough, and Aphonia. Trousseau and Belloc, Dr. Ebert, and others, strongly advocate the use of the Nitrate (gr. iij., Sugar 3j., in impalpable powder) by the means of insufflation. (See Part II.) Dr. Horace Green employs in-jections of the Nitrate into the bronchi in certain cases, but the practice seems to be not devoid of danger even when practicable. In Diphtheria, the application of the solid Nitrate to the throat has been advised; but the practice is condemned by Dr. Ranking, § who advises either a twenty-grain solution of the Nitrate or a gargle of Hydrochloric Acid.

345. In Cynanche Maligna,Prof Mackenzie|| speaks highly of the efficacy of applying a solution of Argent. Nit. (gr.xx. - Aq. fj.) to the mucous membrane of the throat. It may be applied with a camel's-hair brush, once or twice a day, according to the severity of the symptoms. It is stated to be very valuable in these cases.

346. In Hypertrophy of the Tonsils, the application of the solid Nitrate is advised by Mr. Cusack.¶ It is to be applied to successive portions of the surface, so as to produce a succession of small eschars. By this means a cure is effected in about six months.

347. In Aphthous Ulcerations of the Mouth, the Nitrate, applied in substance to the ulcers, is spoken of by Dr. Symonds** as an efficient and most decisive remedy.

348. In Ptyalism, Dr

Symonds states that, in his experience, the best local application is the Nitrate of Silver, either in substance or in a strong solution (3j. - Aq. fj.), applied, by means of a small camel's-hair pencil, or sponge, to the gums.