22 AFFECTIONS OF THE LARYNX. 



to recall to mind the scene of terror of the previous night. But be- 

 ware of buttling too great hopes upon these remissions. The coming 

 night may bring with it a repetition of the same symptoms, and the 

 greatest danger to the life of the child. The continuance of fever, even 

 if only moderate, and, above all, the presence of pseudo-membrane in 

 the pharynx, should excite the greatest solicitude. 



Sometimes the croup exhibits this rhythmical type throughout its en- 

 tire duration, bad nights following upon tolerable days ; in fatal cases, 

 the remissions becoming more and more incomplete, and the nocturnal 

 exacerbations growing more and more formidable. In other instances, 

 which are far more dangerous, the symptoms of croup run a continuous 

 course from the beginning. The remission expected in the morning 

 fails to appear, and death may ensue in the course of two or three 

 days. 



When, instead of abating, the malady tends to terminate unfavor- 

 ably (an event but too common in croup), the scene changes. The 

 flushed face of the child grows pallid, the lips lose their color, the eye, 

 which hitherto has been gazing anxiously about it, assumes a drowsy 

 expression. Quite frequently spontaneous vomiting sets in, while the 

 emetics which we administer remain without effect, and the child grows 

 insensible to sinapisms and other cutaneous stimulants. The respira- 

 tion becomes diminished, and now the whistling sound of inspiration 

 often ceases ; the child lies exhausted in a half-slumber ; the symptoms 

 of croup seem gone. It seems to have no more dyspnoea, until, upon 

 awakening from sleep, or after coughing, it involuntarily attempts to 

 draw a long breath. Then the glottis closes ; the child, once more in 

 danger of suffocation, springs up, props itself up with its hands, looks 

 desperately around it, anew makes violent efforts to draw breath, and 

 finally sinks back again exhausted, and falls into a state of semi-somno- 

 lence. (In young animals in which the par vagum nerves have been 

 cut, we observe precisely these phenomena. Respiration almost free as 

 long as they breathe quickly ; respiration impeded in the highest degree 

 the moment they attempt to draw a deep breath a condition easily un- 

 derstood after the above explanation.) 



These changes in the child's condition are a result of gradual blood- 

 poisoning by carbonic acid, overcharge of the blood with this gas form- 

 ing one of the main sources of danger from this disease. 



The above-described train of symptoms is by no means due to en- 

 gorgement of the brain and its meninges (as has been generally assumed), 

 nor is a child with croup ever cyanotic from impeded respiration alone, 

 excepting when, in the act of coughing, the flow of blood within the 

 jugulars is arrested by compression of the contents of the thorax. A 

 child vith cr'Mip cannot be otherwise than pale at this stage of the dis 



