CROUP. 49 



respiration and pulse being but little disordered in the intervals, and 

 the febrile symptoms not very acute. 



Physical signs, of croup. — Croup is to be recognised by the sud- 

 den hoarseness, with fever, followed by the characteristic croupy 

 cough, dependent on albuminous exudation from the mucous mem- 

 brane of the trachea and bronchi. When the disease extends to the 

 bronchi, the respiration about the sternum, which is naturally 

 bronchial, becomes sibilant and whiffling; but it is sometimes diffi- 

 cult to distinguish from a similar rhonchus which generally, also, has 

 its seat in the trachea. The clearest physical sign of inflammatory 

 tracheal croup is, the detachment and expectoration of the albuminous 

 concretions formed in the air-tubes. 



Morbid appearances. — The mucous membrane lining the larynx, 

 upper part of the trachea, and sometimes even the larger divisions of 

 the bronchi, exhibits a greater or less degree of swelling and red- 

 ness ; it is sometimes covered by a false membrane^ of a pale yellow 

 or grayish colour, the thickness of which is greater in the larynx 

 and trachea than in the bronchi. The false membrane of croup cor- 

 responds exactly with the form of the canal which it covers ; its 

 consistence is about that of boiled white of egg, but this usually 

 diminishes towards its extremities, so that it becomes sometimes, in 

 these situations, scarcely more solid than the thick phlegm of catarrh. 

 The false membrane is sometimes separated from the mucous mem- 

 brane by a viscid or puriform fluid ; at others, it adheres more or 

 less intimately, according to the degree of inflammation, and also 

 its proximity to the glottis. Those who die of croup generally ex- 

 hibit a high degree of congestion of the lungs, and also of the cere- 

 bral vessels. 



Treatment. — The medical man is seldom called in during the 

 first stage of this disease, as the symptoms are often so slight as not 

 to attract much attention. When, however, the child is seen in this 

 stage, by judicious interference, the attack may be either cut short, 

 or very much modified in its subsequent severity. The patient 

 should be confined to his room, all stimulating diet forbidden, and an 

 antimonial emetic immediately prescribed. After the vomiting, the 

 child should be kept in bed, the bowels ought to be freely acted 

 upon, tepid diluents should be given, and small doses of ipecacuanha 

 be persisted in. A hot poultice may also be applied to the throat. 



But when the inflammatory stage has become developed, the treat- 

 ment must be bold and decisive, for the life of the patient depends 

 on what is done within the first six or eight hours of this disease* 

 If croup be not accompanied by a stronglyrmarked asthenic diathesis, 

 or does not occur in very young infants, the treatment of this stage 

 ought to commence with one or two bleedings from the arm. Some 

 authorities in this country recommend the abstraction of blood from 

 the jugular vein. In very doubtful cases, and where the disease has 



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