48 PRACTICE OP MEDICINE. 



hard, and the countenance flushed ; the child is either dull or in ex- 

 cited spirits ; there is generally more or less pain in the head. In 

 other cases, in addition to these symptoms, those of common catarrh 

 are present ; in some instances, the cough may be slightly resonant, 

 but the respiration is not stridulous. 



Second stage. — The duration of the catarrhal stage is very va- 

 riable ,• it may continue but for two or three hours, or may last as 

 many days, when the inflammatory stage sets in. The fever now 

 increases rapidly ; the respiration becomes difficult and sonorous ; 

 the cough may be either loud, dry, and clangous, as if passing 

 through a brass tube ; or it may resemble the barking of a young 

 puppy. The inspiration is dry, hissing, and slow, and produces a 

 sound similar to that which would be caused by forcing a piston 

 down a dry pump. In most cases, the sympathetic fever runs very 

 high; the skin is hot and burning; the pulse is frequent and hard; 

 the face flushed, sometimes covered with perspiration ; the bowels 

 are constipated ; and the urine is scanty, highly coloured, and gene- 

 rally albuminous. The head is now commonly thrown backwards; 

 and the child, either by its speech or attitudes, expresses a feeling 

 of anxiety, with pain and constriction about the trachea and larynx, 

 which are often tumefied externally. These symptoms, with the 

 exception of the hoarseness of the voice, quickness of the pulse, 

 peculiar cough, and sibilous inspiration, evince distinct remissions 

 during the day. 



Third stage, — The cough, which was at first dry, or attended 

 with a scanty muco-sanguineous expectoration, now becomes husky 

 and suffocative, and is frequently attended with abortive eflforts to 

 excrete what is felt in the trachea ; the sense of suffocation is in- 

 creased, and the fits of coughing are accompanied by the expectora- 

 tion of a glairy mucus, containing shreds of the adventitious mem- 

 brane. As the disease advances, there is total absence of any dis- 

 tinct remissions ; the pulse becomes accelerated, small, weak, and 

 irregular; and the cough is less frequent, less audible, but suffo- 

 cative. If a fatal termination is approaching, the patient tosses 

 about in great distress ; seizes on objects around him, and grasps 

 them convulsively for a moment ; throws his head back ; seizes his 

 throat, as if to remove some obstacle to respiration ; makes forcible 

 efforts to expand the lungs; and, after a variable duration of such 

 sufferings, seldom above twenty hours, dies, either with signs of con- 

 vulsive suffocation, or those of complete exhaustion of vital energy. 

 Such is the course of the severe form of croup, when left to nature, 

 or when unchecked by treatment. 



In some slight forms, hoarseness, with a hard, ringing cough, 

 succeeded by a crowing or stridulous inspiration, present chiefly in 

 the night, and remitting during the day, are the only symptoms ; the 



