The approach of this terrible disease fills the mother's heart with alarm, for she has learned to dread its fearful ravages, and to rightly look upon it as the scourge of infancy. The ringing, brassy cough, which characterizes the disease, is so peculiar, that once heard it is never forgotten. It generally attacks children between the age of one and five years, although it sometimes occurs at a later period, or even when the child is not more than four or five months old. It consists of an inflammation of the mucous membrane of the larynx or windpipe, the inflamed surface secreting a kind of thick lymph, which narrows the passage for the admission of air, and at length a false membrane may he formed, which almost or entirely chokes up the passage, causing the child to die from suffocation. Our object in the treatment, is of course to remove this secretion, which is filling the windpipe and choking the child, by dissolving it, or causing it to be thrown up, at the same time breaking up the inflamed state of the organ, thereby checking its diseased secretions.

Diagnosis

Preceding an attack of croup, there is generally more or less fever, cough, huskiness of voice, and other catarrhal symptoms. These symptoms may only last a few hours, and do not usually continue longer than twenty-four hours. These symptoms increase towards evening, or the attack may come on without any premonitory symptoms, the child suddenly awakes out of a sound sleep by a sensation of suffocation, with a hoarse, ringing cough, hurried respiration and great distress. The cough resembles slightly the crowing of a cock, or the bark of a dog; it has a peculiar ringing or brassy sound, like air passing through a brazen instrument. The paroxysms of coughing become more frequent and spasmodic, until breathing is almost suspended. It is with great difficulty the child can breathe, and its flushed face, sometimes bedewed with sweat, its clenched hands, arms tossing about, removing all covering from the chest, and its look of intense agony, show the violence of its struggles for breath. The pulse is quick, the skin hot, the face livid and swollen, the eyes injected and almost seeming to start from their sockets, the child restless, and tossing from side to side, in the vain hope of obtaining relief by a change of position.

There may be a partial remission of symptoms during the day, returning again at night with renewed violence. All the symptoms are now fearfully aggravated. The voice is whispering and almost suppressed, the respiration extremely difficult and accompanied with a hissing noise. The convulsive struggles for breath are fearful, the head is thrown back, the face livid, cold sweat-drops stand on the forehead, respiration becomes more and more difficult, until at length with signs of convulsive suffocation, or falling into a state of stupor, it dies. The mother who has watched with bitter agony the fearful struggles of her child, breathes a sigh of relief as the last breath is drawn, and as the look of anguish changes to the sweet calm of death, she knows that suffering is over, and her little one is at rest.

The above is a description of the more severe attacks of croup, but they are often of a lighter character. There is a kind of croupy cough, which is sometimes mistaken for croup, and unnecessarily alarms the friends, as it is unattended with immediate danger, but if not cured may end in inflammation of the lungs. In real croup, as we have before said, the child is almost always attacked at night, is -aroused from its sleep by violent spasmodic cough, is restless, and shows unmistakable signs of suffering; in a few moments however, it may again drop to sleep. In croupy cough the breathing may be labored, and the voice husky, but the child shows no indication of suffering, and the cough seldom fairly arouses it from sleep. As we have before said, there may be a slight remission of symptoms during the day, but even in the milder forms of croup, care should be taken not to expose the patient for three or four days, as the attacks are liable to return.

Treatment

If premonitory symptoms are present, such as slight fever, hoarse cough, etc, Aconite and Spongia should be alternated one hour apart. If however in the evening the symptoms assume the distinct form of croup, or the attack commences suddenly with the barking, ringing, or suffocative cough, about as much crude Tartar Emetic (Stibium) as can be placed on a five cent piece should be mixed with a tumbler of water, and a teaspoonful given in alternation with Spongia ten or fifteen minutes apart until relieved. A warm bath at the same time would be beneficial, or the application of cloths to the neck, wrung out in cold water and covered with dry flannel. After the violence of the paroxysm has subsided, and the cough is less ringing but of a more moist or loose character, Spongia and Hepar-s may be alternated one hour apart. If at night the violent paroxysm should return, the same treatment should be repeated.

Iodine is a valuable remedy in almost all stages of croup, and will often produce a decided effect, when other remedies fail. When the remedies enumerated above seem still indicated, but fail to produce the desired effect, one drop of the first dilution of Iodine maybe given every half hour, until four or five doses have been taken.

At length the disease, if unchecked, becomes very violent, and there are plain indications of the formation of the false membrane. The countenance wears a look of intense agony, and the breathing and cough are almost suffocative. It is evident, that unless speedy relief is obtained, death will soon close the scene. Bi-chromate of Potash and Bromine are here the prominent remedies.

Caustic Ammonia

When the voice is deep and weak, speech fatiguing and interrupted, great secretion of mucus in the bronchia, violent cough, with copious expectoration, especially after drinking; rattling, labored, or stertorous breathing; suffocative fits and spasms in the chest.

Bromine

Hoarse, wheezing and fatiguing cough, sometimes with sneezing and suffocative fits; respiration accompanied with mucous rattling; wheezing; breathing slow and suffocative, or hurried and superficial, labored, painful, oppressed; gasping for air, and strong indications of suffocation.

Bi-Chromate Of Potash

This is an invaluable remedy in cases of membranous croup. Hoarse, dry and crowing or whistling cough; respiration accompanied with a whistling sound; the nose filled with mucus; evident signs of pain about the throat; great restlessness of the child; cough gradually subsides, breathing becomes more and more difficult, and the spasmodic efforts for breath, the tossing about from side to side, the look of intense agony, the flushed face and starting eyes, the nose and sometimes the mouth filled with mucus, all give clear indication of the rapid formation of the false membrane, and unless relief be obtained, the certainty of speedy death.

Hepar-s. and Spongia will generally complete the cure, with the addition, perhaps, if much soreness is present, of Phosphorus.

Dose

Bi-chromate should be given a powder of the first trituration once in fifteen or twenty minutes.

If Bromine is given, a drop should be put in a tumbler filled with water, and if the mixture seems too strong, a portion of it may be thrown away. The tumbler may be then filled up and a teaspoonful given once in twenty minutes or half an hour.

With the other remedies where the amount of the dose has not already been given, two drops of the tincture should be mixed with a tumbler half full of water and a teaspoonful given at a dose; or a powder taken dry on the tongue.

Diet And Regimen

During the attack, the diet should consist of arrow-root, or gruels, or perhaps milk and water. Cold water may also be taken, if much thirst is present