This section is from the book "Hartmann's Theory Acute Diseases And Their Homoeopathic Treatment", by Charles J. Hempel. Also available from Amazon: Theory of acute diseases, and their homoeopathic treatment.
§ 199. Croup, angina membranacea, polyposa, cynanche strenua, stridula, exsudatoria, laryngitis exsuda-toria.
* This liability to inflammation of the respiratory organs, frequently arises from a constitutional nervous debility, and should be treated with the tincture of Aconite, even when there is no synochal fever. See my "Essay on the present condition of the Homoeopathic School." - Hempel.
Croup is one of the most dangerous diseases of children, which appears only very seldom after the eighth year, and is more frequent among boys than girls. This disease has a distinct precursory stage. It generally commences as a simple catarrh or catarrhal fever, with coryza, cough, hoarseness, frequent sneezing, chilliness, heat, weariness, drowsiness, lachrymation, peevishness, heaviness in the head, etc. Hoarseness generally is a dangerous symptom among little children, particularly when attended with rough cough. These symptoms increase until the eighth day. Suddenly, generally at night, the children start out of their sleep with a feeling of anguish, occasioned by a sense of suffocation. This attack lasts more or less long, after which the children go to sleep again. After the lapse of from three to twenty-four hours, another attack takes place, with apparently slight symptoms, a little hoarseness, rough cough, oppression of breathing, and moderate but continuous fever. In many cases the children, though perfectly well the day previous, wake suddenly about midnight with pain in the larynx, sudden alteration of voice, panting, wheezing, respiration somewhat resembling the crowing of a little cock, or the braying of an ass, with considerable dyspnoea and violent fever. The noise during respiration is occasioned by the spasmodic constriction of the glottis, which does not admit of the air being expelled except by fits and starts and with great exertions. During this difficult breathing the face of the child turns red, the conjunctiva is injected, the pulse hard and full. All these symptoms sometimes appear to give way completely towards morning, but soon reappear with redoubled violence. The hoarse voice assumes a rough, shrill sound, and frequently passes from the highest pitch to the lowest bass. The croup-cough is violent, short, shrill, barking; afterwards it becomes crowing, hollow, and rough; at first dry, at a later period frequently moist, with expectoration of a tenacious, jelly-like, sometimes blood-mixed mucus: the cough comes on by paroxysms, and is excited by drinking, crying, talking, and deep inspirations. After such an attack is over, the children seem to be quite well, and even go to sleep quietly. The continuance of the feverish pulse, however, shows that this rest is only apparent. The breathing is anxious, hurried, by fits and starts; when the paroxysms of cough are very violent, the child is sometimes on the point of suffocating. The patient experiences more or less pain in the larynx or trachea, which is aggravated by contact. On looking into the mouth, the tonsils and fauces appear red, the epiglottis looks aedematous and swollen. Little by little the paroxysms of cough increase in violence; the breathing becomes more and more difficult, hissing, rattling, as if from a fluid in the trachea, the sawing respiration being heard even at a distance. The patients lie with their necks stretched, and sometimes grasp at them during the attack. The orthopnoea becomes excessive; at every inspiration the larynx descends towards the sternum, during an expiration it is raised towards the jaw. Under these circumstances, vomiting frequently sets in, with discharge of membranous, tubular masses. If the pulse become quick, small, thready, if the rattling breathing increase, and the breathing be effected by means of the abdominal muscles, if the face become bloated and blue, and the children bend their necks backwards, or sink into a sopor from which they are only roused by the paroxysms of cough, the danger of apoplexy is very near.
Croup is generally seated in the larynx; the tracheal croup is much less frequent, and the bronchial croup is distinguished from the other kinds by a rather stertorous than wheezing respiration, by an absence of distinct remissions, by constant dyspnoea, and by the rattling noise which is perceived all through the chest by means of the stethoscope.
§ 200. Etiology: Croup is more frequent in the north than south. In some families croup seems to be hereditary. It is sometimes occasioned by sudden exposure to cold, when the thoracic organs are heated by running, crying, etc. According to Schoen-lein, croup may likewise arise by metastasis from whooping-cough, from a simple catarrhal affection, or it may be occasioned by the measle-contagium, which will lead, in some individuals, to the formation of croup, instead of developing the measle-eruption. Croup appears most frequently in the first part of spring and in the latter part of the fall. As an epidemic disease, it may occur in every season.
The prognosis depends upon the nature of the epidemic, upon the age and individuality of the patient, and particularly upon the periods when the physician is called to the patient. The prognosis is more unfavorable when there is considerable exudation with little expectoration; when symptoms of suffocation, ner-vous paroxysms, convulsions, coma, etc., have set in, there is scarcely any hope.
§ 201. When the disease is preceded by a catarrhal stage, the remedies indicated for a catarrhal fever, (see § 29, etc., and § 196,) may be employed. A keen observer will however perceive that this apparently simple catarrh is of a peculiar kind, that the cough is spasmodic, hollow, hoarse, attended with wheezing or rattling. In this case, the following remedies should be thought of: Hyoscyam., Bellad., Cina, Chamom., China., Ipec, Nux vom., Puls., Drosera. If the cough should have the croup-sound, without inflammation or swelling being present, Hepar sulph. c. will prove very serviceable. In one case I have removed a metastatic cough with the croup-sound, by a few doses of Cupr. met., second trituration; (the patient was a full-grown girl.)
If the disease should set in suddenly, with synochal fever and evident symptoms of inflammation of the larynx, Aconite should be employed in repeated doses, until the nervous and vascular irritation, the burning heat, thirst, the hurried breathing, are removed. Aconite is sometimes sufficient to cure the disease. If the wheezing, quick, anxious, difficult breathing, and a hollow, hissing cough, with pain in the region of the larynx, etc., should set in from the commencement.
Spongia should be used immediately; in 24 hours the danger is generally over. If after this lapse of time, the cough should still have the peculiar croup-sound, the breathing should still be hissing, or if there should still be danger of suffocation, Hepar s. c. is then to be employed.
I have frequently cured croup with Hepar sulph. c, without first giving Aconite or Spongia. The disease was then epidemic, and attacked, for the most part, scrofulous subjects. In some sporadic cases, where the membrane was already formed, a solution of Iodine, third attenuation, in alternation with the second attenuation of Aconite, giving three drops every half hour, the patients were cured slowly but certainly. Iodine always deserves consideration when scrofulous or leucophlegmatic individuals are attacked by the disease.
If the disease should not yield to the aforesaid remedies, or if the height of the paroxysm should be characterized by spasmodic symptoms, Sambucus, but more frequently Moschus, is of great use, and sometimes alters the character of the disease so as to render one of the other remedies available.
In some cases of croup, an obstinate hoarseness with slight catarrhal croup remains after the disease is cured. This hoarseness seems to arise from a lameness of external laryngeal, and its branch, the recurrens, and yields most frequently to Phosphorus.
Merc, Hep. sulph., Rhus t., Drosera, Mangan., are sometimes of use for the last mentioned difficulty, but they scarcely ever do more than palliate the trouble. Arnica and Belladonna are much more available, or frequently and rapidly repeated doses of Hepar s.
Now-a-days most physicians treat croup with alternate doses of Hepar s. and Spongia.