CROUP. 47 



Morbid appearances. — The mucous membrane lining the larynx, 

 and particularly the glottis and epiglottis, is red and injected; this 

 appearance is either in spots, or diffused to a greater or less extent. 

 It is also somewhat tumefied, and presents a viscid or puriform fluid 

 on its surface. When the disease has been protracted, the redness 

 disappears, and the membrane becomes thickened ; small ulcerations 

 are occasionally observable in these cases, particularly at the sides 

 of the glottis. 



Treatme7it. — In the earliest stage of this disease bleeding should 

 be employed, and repeated, if it be requisite. Where bleeding is 

 performed, it should not be carried to syncope. Leeches may be 

 applied to the sides of the throat, or cups to the nucha. Warm 

 fomentations are also of great service. Calomel, opium, and tartar 

 emetic may also be given, but if the disease does not yield, trache- 

 ototny is the only resource. Blisters to the throat are inadmissible 

 in the early stages. 



Before giving a prognosis, and performing the operation, it is re- 

 quisite to ascertain what is the state of the lungs ; for the chance of 

 success from opening the trachea will be much less, if the lungs are 

 diseased. 



Sometimes the disease affecting the glottis is not so much acute 

 inflammation, as (Edema, the result of a low degree of vascularity. 

 Tracheotomy and purgatives are the chief resource. 



CHRONIC DISEASE OF THE LARYNX 



May consist o^ chronic infiammation and thickening: o{ ulcera- 

 tion, common, and syjjhilitic, disease of the cartilages, and morbid 

 groivths. Ulceration is very common in consumptive patients. 



In cases of chronic inflammation or ulceration, attended with 

 husky voice, and irritating cough, and tenderness, the regular appli- 

 cation of a few leeches, the very gentle administration of mercury ; or 

 sometimes sivabbing the upper orifice of the larynx with solution of 

 lunar caustic, may be of use. But if dyspnoea and choking cough 

 increase, the safest plan is to open the larynx, whereby spasm of 

 the glottis is prevented, and the part being at rest is more likely to 

 get well. 



CROUP. 



Symptoms. — Three stages of this affection have been noticed 

 by the best authors — 1st, the invading, or catarrhal; 2d, the de- 

 veloped, or inflammatory ; 3d, the stage of albuminous exudation, 

 with threatening suffocation. 



First stage. — In the catarrhal stage there are slight febrile symp- 

 toms, consisting chiefly of alternating chilliness and heat, and in 

 more acute cases the skin becomes hot, the pulse accelerated and 



