L8 AFFECTIONS OF THE LARYNX. 



la the bodies of croupous children we may almost always find intense 

 hypersemia of the aings and bronchial mucous membrane, bronchial ca 

 tarrh with copious secretion, oedema of the lungs, and not uncommonly 

 croup of the bronchi, spots of pneumonia, atelectasis, with both vesicular 

 and interstitial emphysema. It will be shown, hereafter, that such con- 

 ditions are in a great measure the necessary consequences of laryngeal 

 croup. 3 



SYMPTOMS AND COURSE. In many instances prodromata give warn- 

 ing of the attack. The child is cross and feverish ; is hoarse, and coughs 

 with suspicious tone. Such symptoms alone, however, may be of little 

 moment, being quite as indicative of the approach of an insignificant 

 laryngeal catarrh, as of the onset of one of the most fatal disorders of 

 childhood. Even thus early, however, an observant physician may dis- 

 tinguish between the two. In all cases examine the fauces forthwith, 

 although the child dd not complain of difficulty in swallowing. 

 Should we find them swollen, and spotted here and there with small, 

 firm, white patches, we have before us the signs of incipient croup, 

 while the same symptom, accompanied by persistent sneezing, and by a 

 profuse flow from the nose, is equally characteristic of laryngeal catarrh. 

 A further diagnostic point is found in the predisposition of the individual. 

 If a child habitually grows hoarse and coughs with a bark upon taking 

 cold, but never exhibits other sign of croup ; if his brothers and sisters 

 show no tendency toward the disease, we may feel less concern for him, 

 than for one who already has suffered an attack, or who has lost a 

 brother or sister by this malady. These prodromata may precede the 

 attack itself by one or two days. They are absent, however, in very 

 many cases, the disease setting in suddenly and unexpectedly in all its 

 terrors. Late in the evening, generally, or in the middle of the night, 

 the child is roused from his sleep with a harsh, hoarse, inaudible voice, 

 the deep, soft note of which breaks into shrill, piercing discord, as the 

 swollen vocal chords, already frequently coated by exudation, come for an 

 instant into contact. The cough, which was short and sharp in the 

 beginning, soon becomes harsh, hoarse, and is no longer barking, except 

 when, upon a violent expiratory effort, the air in its exit stretches the 

 chords, and causes them to bulge. At last the cough loses all sound. 

 We see the child cough and speak ; we hear nothing. 



Besides these symptoms, which are, and indeed must be, entirely 

 identical with those of catarrh of the larynx, and which owe their origin 

 to the thickening and relaxation of the vocal chords, from incipient 

 palsy of the muscles by which they are stretched, and to the exudation 

 which coats them, there is dyspnoea, a persistent, perilous dyspnoea, char- 

 acteristic of croup, and rarely seen in catarrh of the larynx, and onlj 

 then a& a transitory symptom. This dyspnoea, which proceeds from nar 



