CROUP: This is a common malady of early childhood. Scrofulous and plethoric children are most subject to it. Many children have it every winter. Candies, cakes, greasy mixtures; fried foods, excesses of Milk, bread, cereals, sugar, syrups, etc., tend to produce this condition.

Formerly croup was divided into membraneous and nonmembraneous or simple croup. Membraneous croup is now regarded as diphtheria. Dr. Trall thought the two croups differed only in degree and said "in the former case the exudation which forms on the mucous lining of the wind pipe (trachea) concretes into a membraneous covering, and in the latter case, the excreted matter is expectorated without consolidation."

The differences in the behavior of the two exudates show a big difference in their characters, and points to differences in their causes. Simple croup is of a catarrhal nature and results from carbohydrate plethora; membraneous croup is of a serous nature and is the result of protein poisoning. Protein poisoning is more virulent than starch poisoning.

Croup is a catarrhal inflammation of the larynx with swelling of its mucous lining. It is a very alarming condition but not serious It usually comes on about midnight, appearing quite suddenly and manifesting itself by a sharp, dry, hoarse barking cough. In severe cases it is difficult for the child to breathe, the child making an apparently superhuman struggle for breath, and there is often a temporary high fever. To be awakened about midnight from a sound sleep and find your child, whom you had put to bed apparently in the best of health, struggling for its breath, with shrill wheezy inspirations, perhaps blue in the face, and coughing almost constantly, is enough to frighten any parent. It dues not matter how frequently one sees croup, it never fails to produce a feeling of apprehension and terror.

However, the condition soon passes off, the child goes to sleep, and by morning seems as well as ever, giving one the impression that the whole experience was a horrible nightmare.

An overloaded stomach almost always precedes an "attack" of croup. Breathing the hot dry air from stove or furnace, tends to produce the condition. Many cases would never occur if bed rooms were properly ventilated and stoves kept out of them. Where a stove is in the room a pan of water should be placed on it to keep the air in the room moist.

Croup is always the result of wrong feeding and bad hygiene. The fattest children are the ones who have the croup most. It does not result from cold or exposure or wet feet and similar bugaboos. No child need never have the croup.

CARE OF THE PATIENT: Children who are prone to have croup frequently are overfed on bread, potatoes, beans, cereals, sugar, syrups, jellies, jams, cakes, pies, milk, etc., and are housed in poorly ventilated homes. When the diet is changed and the home ventilated, the croup disappears, never to return. These children should not be permitted to overload their stomachs at night, nor at any other time, for that matter.

There is no treatment which can do any good during an "attack." Hot baths or warm cloths applied to the chest are the least harmful of the palliative measures in use, but even these are unnecessary and not curative. The "attack" only lasts a few minutes and the real treatment should consist in the reordering of the life and habits of the child so that there will not be subsequent attacks. The ancient rule laid down by Galen that recurring affections are to be treated during the intervals rather than during the "attacks," should be our guide in croup.

If a child has an attack of croup, stop all food at once and either give nothing but water or water and orange juice or grapefruit juice for three full days. This is especially important since an occasional case of croup, which turns out to be the early stage of a fatal diphtheria, would probably never have been fatal if feeding had been stopped at the first signs of trouble. It is also necessary because croup usually lasts about 3 days, the "attacks" coming on only at night. There may be almost no hoarseness in the morning and during the day, until late in the afternoon, when he again becomes croupy.

Hot mustard baths, wine of ipecac, syrup of ipecac, paregoric, emetics, warm enemas, inhalations of chloroform, turpentine vapors, moist inhalations and adenoid operations are among the medical measures in use. None of these are of value, although they may do much harm, not the least of which is the fact that they teach parents and children to rely on these things for palliation rather than on hygiene for permanent cure. They build the sick habit and lead us away from a sense of personal responsibility.