This is a complaint usually attended with much danger, and which requires such prompt treatment that the parents should never-unless from circumstances absolutely compelled-depend upon their own skill and treatment. In many cases, the success of the treatment and the safety of the patient depend so much upon the promptitude with which the case is treated, that if there is a well qualified medical man within reach he should be at once summoned.

This is a disease almost peculiar to infancy and childhood; it commences variously. Not unfrequently the child is affected for some time with the symptoms of common Catarrh, and perhaps fever, before those peculiar to Croup are developed. Very often a croupy cough and some hoarseness precede the attack for some hours or even days; and this state of things, though always suspicious, sometimes passes away spontaneously, without the occurrence of the fully formed disease. Often these symptoms have continued for a longer or shorter time, or, sometimes without warning of any kind, the child is attacked with a paroxysm of coughing and shortness of breath. In the majority of cases this occurs in the night, and more frequently in the early part of it than towards morning. The paroxysm differs greatly in severity in different cases, sometimes being slight, and at other times violent and alarming.

The child usually starts out of sleep with a peculiar, dry, sonorous, ringing cough, sounding, according to Cheyne, as though it came through a brazen trumpet; but, in fact, comparable to nothing else in nature, and to be appreciated only by being heard. When once heard it will always afterwards be remembered and easily recognized. So characteristic is it of this disease that, when met with in other affections, as sometimes happens, it is called the croupy cough.

If the child attempts to speak, the voice is usually more or less rough and coarse, though very rarely quite extinct or whispering. The distress of the child during the paroxysm is often very great; he sits up or tosses himself about in bed, supports himself on his hands and knees, or lies on his back with his head extended; puts his hand to his throat as if to remove some difficulty there, or holds them out imploringly for aid from his attendants; and, as if conscious of threatened suffocation, has upon his countenance an alarmed and anxious expression. Sometimes, when able to speak, he complains of pain or tightness in his throat; but his voice and his piteous attempts to cry are often stifled by the cough, and increase the violence of the paroxysm. At first, the countenance is usually flushed, the skin warm and the pulse frequent; but, unless the paroxysm subsides, especially when it is very severe, the elects of the impeded respiration soon begin to show themselves. The lips assume a purplish or livid hue, the face becomes pale, the extremities cool, the pulse very frequent, feeble and irregular, and a condition takes place approaching to asphyxia, during which the spasm relaxes, and the air is again allowed to enter the lungs more freely. The violent symptoms are now moderated, and the paroysm gradually subsides, so that the child falls to sleep, and upon awaking is found to be greatly relieved. In some extraordinary cases, complete and fatal asphyxia may take place before the spontaneous subsidence of the paroxysm.

There is, however, a worse form of the disease than this, in which a lining or false membrane is formed in the inside of the windpipe which gradually chokes the patient. In this case the symptoms of the last stage occasionally come on very early, even within twenty-four hours from the commencement of the attack. More frequently, however, they are postponed for three or four days, and sometimes considerably longer. This stage is characterised by excessive difficulty of respiration. With complete suppression of the voice, and a tight and dry cough, the inspiration is wheezing and sonorous, so that it may be heard at a considerable distance. The child uses his utmost efforts to expand the chest, and the respiratory muscles are thrown into almost convulsive action. The shoulders rise, the breast heaves, the nostrils expand and contract, the head is thrown backward. The force of the respiratory effort is sometimes so great as to rupture the air-cells of the lungs, and even to make a rent between the rings of the windpipe. The child appears in an agony of distress. He throws himself about in bed, or jumps up and runs to the window for air, his face bearing meanwhile a most anxious, alarmed, and imploring expression. At length, the powers of the system fail, the pulse becomes exceedingly quick and feeble, the skin cool and bathed in sweat, the cheeks pale and cold, the lips livid. The brain and heart cease to act, and the patient sinks gradually and quietly away, or the nervous system rouses itself for a last struggle, and death takes place in the midst of convulsions. Not unfrequently, however, the patient is cut off at an earlier stage by suffocation in one of the paroxysms. Instances of recovery from the last stage are very rare. The duration of the disease varies from less than a day to one or two weeks.

The most common cause of the disease, in all its forms, is cold, or cold combined with dampness. The disease is said to prevail most in moist places. It is frequently brought on by the sudden passage from hot to cold air, and in infants, is probably often produced by sleeping in very cold chambers, after having been all day in hot rooms. Irritating substances inhaled into the lungs have sometimes caused it.

The disease is not positively confined to any period of life, but it is exceedingly rare in adults, and is seldom seen in very early infancy. From one to seven years is the age at which it is most prevalent, although cases are not very uncommon at any period before puberty. The disease sometimes appears to run in families, and males seem more liable to it than females. Vigorous and fleshy children, with rosy complexions, are said to be most frequently affected.

Treatment

The treatment must be prompt. As quickly as possible get water heated, and put the child into a bath, as hot as it can bear it, up to the neck; keep it in for ten or fifteen minutes, then wrap it up in warm flannel. While the water is heating, give the child an emetic. (There are certain things that every family should keep in the house, and Powdered Ipecacuanha or Ipecacuanha Wine and Antimonial Wine are two of them.) If the child is young, say two or three years old, a teaspoonful of Ipecacuanha Wine or Antimonial Wine may be given it every ten minutes till it begins to retch, and then it may drink a little lukewarm water occasionally till the vomiting is free. If attended to in time, these means will generally give relief, and all that will be necessary afterwards will be to repeat the warm bath occasionally, guarding carefully against cold, and a dose or two of Castor Oil or Senna Tea. When Ipecacuanha or Antimonial Wine is not obtainable, thin mustard will act as a substitute; it may be worked off, like the other emetics, with warm water, but it is rather too rough an emetic for a young child. If the warm bath and the emetics do not at once moderate the symptoms, it is best to send without delay for medical advice.