325 



CROTONIC ACID. 



CROUP. 



320 



useful in aiding in the expulsion of the tape-worm, when proper 

 anthelmintic medicines have been prescribed. The powerful impression 

 which it makes on the intestinal canal renders it useful in some cases 

 of dropsy. It is in most instances proper to combine it with castor oil, 

 almond emulsion, or an alkali, to lessen its acrimony. 



The seeds are employed in India, " and are used in the form of pills, 

 commonly called Jamalgota pill*. The natives usually separate the 

 embryo, and combine the albumen of the seed with catechu or pepper." 

 (Royle.) Where the embryo is not extracted before using, even one 

 seed has proved fatal. As the embryo seems to possess the greatest 

 acrimony and purgative power in the Jatropha Careen, this is removed 

 by the inhabitants (Europeans) of the East Indies, and one seed may 

 then be eaten with comparative safety ; but a seed not so treated is 

 then offered to an inexperienced person, and, if eaten, followed in 

 many instances by serious consequences, a very mauvaise plaisanterif. 

 The oil diluted with five parts of olive oil, or seven of oU of turpen- 

 tine, is occasionally employed as a liniment to bring out a pustular or 

 vesicular eruption, and to act also as a rubefacient; but this also 

 requires caution. 



CROTONIC ACID.. An unimportant oleaginous acid obtained 

 from croton oil. Its vapour is irritating to the eyes, and the acid 

 itself is poisonous. Its composition is unknown. 



CROToNIXE. A doubtful alkaloid, said to be found in the seeds 

 of the croton tiglium. 



CROUP, a specific inflammation of the air tubes, giving rise to a 

 peculiar secretion, which concretes almost immediately it is formed, 

 producing a false membrane, which lines the affected parts. It has 

 been shown [CATARRH] that the mucous membrane which lines the 

 air passages is subject to two different kinds of inflammation, each pre- 

 senting distinctive characters. In one the inflammation produces a 

 secretion which does not concrete, constituting all the varietes of bron- 

 chitis, catarrh, &c. In the other the inflammation produces a secretion 

 which consolidates almost the moment it is formed, giving rise to the 

 various phenomena which constitute the peculiar disease denominated 

 croup. 



That the inflammation which terminates in the formation of the 

 secretion peculiar to croup is of a specific nature, is argued, first, 

 because it uniformly terminates in the production of this peculiar 

 secretion ; and, secondly, because this secretion is obviously not de- 

 pendent on the intensity of the inflammatory action, since the pheno- 

 mena characteristic of inflammation are often less acute in croup than 

 in catarrh. It has been conjectured that catarrh depends upon inflam- 

 mation of the secreting follicles of the mucous membrane, and that 

 croup depends upon inflammation of the capillary arteries of its tissue, 

 a conjecture which is probably correct, though in the present state of 

 our knowledge it must be regarded merely as a conjecture. As the 

 inflammation, however, presents in the essential phenomena characters 

 o different, it is convenient to distinguish the one from the other by 

 distinct names, and accordingly the former is termed catarrhal, and 

 the latter plastic inflammation. 



The false membrane, the result of plastic or croupal inflammation, 

 moulds itself to the part inflamed ; it does not extend beyond the in- 

 flamed portion of the mucous membrane ; it varies in thickness from 

 half a line to a line ; it is of a white or whity-brown colour ; it has the 

 rence of boiled white of egg, and its firmness is always greatest 

 where it is thickest. When it is raised from the mucous membrane, 

 the latter is always found to be reddened and swollen, but rarely to 

 the degree common in catarrh. 



This morbid secretion is most, commonly poured out on that portion 

 of the windpipe which constitutes the larynx ; hence in general the 

 larynx forms the peculiar and proper seat of croup ; but the site oi 

 this adventitious membrane is by no means confined to the larynx ; it 

 often extends above to the glottis and epiglottis, and below to the 

 bronchial tubes. When, as happens in the great majority of cases, the 

 adventitious membrane is confined to the larynx and epiglottis, it pre- 

 sent* the characters just described ; but when it extends into the 

 bronchial tubes it becomes modified in its appearance. It is then 

 generally " formed into a single cylinder, but occasionally into a series 

 of tubes inclosed within each other in the closest contact, and forming 

 altogether a solid body, of a thick and tolerably firm structure, and in 

 the exact form of the tube from whence it has been abstracted. Upon 

 making a transverse section of this polypifonn substance, concentric 

 lamina; are very apparent. It adheres but slightly to the mucous 

 surface, and may easily after death be drawn out entire, presenting a 

 complete mould of a large bronchial tube, with all its subdivisions 

 down to its minutest ramifications." 



Though in the croup the deposition of the adventitious membrane 

 is commonly confined to the larynx, yet other parts of the mucous 

 membrane in the immediate neighbourhood of the larynx are some 

 times the seat of plastic inflammation, terminating in the formation o: 

 a precisely analogous morbid secretion. Occasionally " small yellowish 

 grey spot* appear upon the fauces, surrounded by the mucous mem 

 brane, highly and darkly reddened. These spots enlarge, coalesce, am 

 form a continuous false membrane, of the colour and consistence o 

 the buffy coat of the blood, lining the throat more or less completely 

 Sometimes it is seen to cover the posterior half of the tongue, so tha 1 

 its anterior part might be elevated by a probe in a membranous form 

 occasionally, though not often, it passes down the oesophagus even 



nto the stomach, but much more frequently it extends into tlie lung, 

 jroducing all the symptoms of croup. When plastic inflammation is 

 seated in the fauces, it gives rise to a disease called Cynanche Maligna, 

 or gangrenous sore throat, so named from the supposition that the 

 spots on the fauces consist of gangrenous sloughs ; but more careful 

 observation has demonstrated that they consist of an adventitious 

 membrane. Nevertheless, gangrene does occasionally, though very 

 rarely, co-exist with the deposition of a fictitious membrane, that is, the 

 lse membrane is deposited over a gangrenous surface." [DIPTHEEIA.] 

 The most striking and characteristic symptoms of croup of course 

 depend on the consequences that result from the obstruction to the 

 free passage of the air to the lungs, that is, impeded respiration and 

 change of the voice. The respiration is impeded in proportion to the 

 quantity of adventitious membrane that is formed, and the consequent 

 degree in which the calibre of the air-tube is diminished ; in propor- 

 tion to which must of course be the diminution in the column of air 

 admitted to the lung. The air-passage in the progress of the disease is 

 often obstructed to such a degree as to produce a most painful feeling 

 of suffocation, attended with all the signs that denote the imminent 

 danger of suffocation, and death is constantly occasioned by the nar- 

 rowing of the air-tube to such an extent as actually to produce suffo- 

 cation. In milder cases, when not impeded to this extreme degree, 

 the respiration is still always difficult, anxious, and distressing. The 

 edges of the circumference of the inferior extremity of the adventitious 

 deposit being loose, mucous, and soft, frequently adhere to each other, 

 so as to close up the tube, and require a strong effort of inspiration to 

 overcome the temporary obstruction. " I have seen," says Dr. Davies, 

 " a slight film of pseudo-membrane traversing the upper part of the 

 larynx suffocate an infant almost instantly. The dyspnoea becomes 

 always great when the concretion separates, and if it be not quickly 

 expectorated, often destroys the patient immediately." 



Owing to the diseased condition of the air-tubes, the acts of respi- 

 ration and of coughing produce peculiar sounds. The inspiration is 

 sonorous and ringing, as if the sound were formed and resounded in a 

 brazen tube. Sometimes it is dry and hissing, resembling the sound 

 produced by a piston forced through a dry pump, or by a crowing 

 noise similar to that emitted by a chicken in the pip. The croupal 

 cough is a peculiar, loud, clangous, ringing sound, which has caused it 

 to be almost universally compared to the crowing of a cock. The 

 voice partakes of the same character, being shrill and hoarse. 



The fever excited in the system by this local inflammation is com- 

 monly acute and intense. The skin is burning hot ; the face flushed, 

 sometimes covered with perspiration ; the eyes prominent, injected, or 

 watery; the carotid arteries throb powerfully; the jugular veins are 

 tumid, and the pulse at the wrist is frequent, hard, and wiry. Some- 

 times, on the contrary, the febrile symptoms are of a low or asthenic 

 character ; the skin cool, and of a dirty pallid colour ; the pulse fre- 

 quent, but exceedingly feeble ; the breath f cetid, and the general- pros- 

 tration extreme. 



As the disease advances, the restlessness and anxiety of the patient 

 increase ; the hand is constantly applied to the throat, which is often 

 slightly tumified externally, and sometimes painful to the touch ; the 

 respiration becomes more and more difficult, the cough convulsive and 

 exhausting, the countenance bloated, and the cheeks and lips either 

 livid or exceedingly pale. In this stage the pulse becomes small, weak, 

 and irregular, the eyes sunk, the skin cold and clammy, the voice lost, 

 or capable only of a whisper ; the head is constantly tossed back ; the 

 throat often seized as if to remove an obstacle to respiration ; violent 

 efforts are made to expand the lungs, and death at length puts au end 

 to a state of intense suffering, either by convulsive suffocation, or by 

 the subsidence of the restlessness and violence into a state of profound 

 lethargy and stupor. 



Croup, as has been stated, is almost peculiar to infants. It may 

 occur at any period from the second mouth after birth to puberty ; 

 and the younger a child is, after it is weaned, the more liable it is to 

 the disease. It is most apt to occur in the sanguineous temperament 

 and the full habit. It often seizes a child not perfectly recovere^from 

 a previous illness, and is liable to a recurrence at distant intervals on 

 exposure to causes which ordinarily produce only common catarrh. 

 Yet it occasionally occurs in the adult, generally as a consequence of 

 its extension from the fauces to the larynx. It is chiefly prevalent in 

 the neighbourhood of large bodies of water, running or stagnant, salt 

 or fresh, and especially among the ragged and half-starved children of 

 the poor, who five on the sea-coast, or near the banks of rivers or 

 canals. But it also occasionally prevails in other situations as an 

 epidemic, especially during the continuance of north or easterly winds, 

 after heavy and long-continued falls of rain. 



There is perhaps no disease to which the human body is subject the 

 progress of which U so frightfully rapid. In a few hours after the 

 attack, the morbid secretion is often formed to such an extent, as to 

 prove inevitably mortal ; yet the inflammation of which it is the result 

 might have been checked by immediate, vigorous, and judicious treat- 

 ment. It is therefore of the last importance that those who have the 

 care of infants and young children should be familiar with the first 

 signs of the approach of this dreadful malady. Of these a graphic 

 description has been given by Dr. Cheyne, who had abundant expe- 

 rience of the disease in situations in which it is but too prevalent. 

 After having pointed out the importance of attending to the first 



