

CROUP. 25 



complicates measles, small pox, scarlatina, epidemic diphtheria, and other 

 infectious disorders, will be described hereafter when treating of the 

 diseases themselves. 



DIAGNOSIS. [Even the most experienced practitioners may en- 

 counter difficulties in distinguishing between croup and laryngeal 

 catarrh with fever. The croupy cough, the aphonia, and even the 

 choking, may each and all arise during a catarrh of the chords ; 

 and the fact that these symptoms alone have been accepted as proof 

 of croup will account for the success in treatment claimed by cer- 

 tain physicians, and for the belief of parents that their child has 

 had croup several times. Inspection of the fauces must never be 

 omitted, and the presence of croup may be regarded as certain 

 when a white deposit can be seen upon the tonsils, soft palate, or 

 laryngeal walls, or when loosened bits of membrane are coughed or 

 vomited up. But the absence of croup of the fauces by no means 

 indicates the non-existence of croup of the larynx. In the hands 

 of an expert, the laryngoscope no doubt would settle the question. 

 Auscultation is unsatisfactory, for the vesicular murmur is feeble, 

 owing to the difficulty with which the air enters the lungs, while 

 the wheezing in the larynx drowns all other sounds save a few rales. 



After tracheotomy, the bronchi being then free, spots of atelec- 

 tasis or of pneumonia may be made out when large enough to cause 

 tubal respiration. When deprived of their supply of air, the oc- 

 cluded portions of lung shrink, by virtue of their elasticity, so as to 

 become quite void of air in some places. The diaphragm then sinks 

 in, and the forward edges of the lung fall asunder. Thus the heart- 

 dulness becomes abnormally wide. Pulsation of the aorta and 

 vena cava also becomes perceptible on both sides of the sternum. 

 Fever is never absent, but is rarely of very high grade.] B 



TREATMENT. Prophylaxis against croupous laryngitis requires the 

 measures already recommended for protection against laryngeal catarrh. 

 Never shut up a child permanently in its chamber because it has once 

 had an attack of croup, nor accustom it to too much clothing. Mean- 

 while, however, teach the mother not to let herself be deceived by bright 

 sunshine alone, nor to send the child out without paying attention to the 

 direction of the wind. When there is decided predisposition to croup, 

 watch the weather-cock, and keep the child from exposure to a rude 

 northerly or northeasterly wind. It is also advisable to keep the child 

 within doors after sunset. Finally, cold washing of the throat and breast, 

 provided that the skin be afterward carefully dried, is a capital prophy- 

 actic where there is predisposition to croup. 



As the real causes of croup are obscure, the ca isal indications cannot. 

 in most instances, be met. Among the laity it is considered a settled 



