CROUP. 27 



according to the age) are, moreover, of exceedingly doubtful assistance 

 in croup. In far the greater number of instances they are directly 

 hurtful. Their recommendation is, in great measure, supported upon the 

 erroneous view that hyperaemia and inflammation are identical, hence 

 abstraction of blood will allay inflammation. A really inflammatory pro- 

 cess is not interrupted by blood-letting, although it may moderate the 

 collateral hyperasmia in the vicinity of the inflamed spot ; however, if a 

 stasis of the blood take place in the mucous membrane of the larynx, 

 if its circulation be interrupted, the blood flows with greater force into 

 the vessels of the neighboring tissues, and produces in them transuda 

 tion, swelling, and oedema. 



We have shown that a part of the danger in croup proceeds froir 

 such swelling and infiltration ; hence, when we have to deal with a vigor 

 ous, blooming child (but only in such a case), we may apply a few 

 leeches to the manubrium sterni. They must never be applied over the 

 larynx, as at that point the bleeding is hard to stanch. In all case, 

 we should apply the leeches ourselves, or employ an expert to do it, 

 who can check hemorrhage. Among puny, badly-nourished children, 

 leeches are contraindicated. It is most dangerous to exhaust the 

 strength of a child, which he will require at a later stage of the disease 

 to enable him to expectorate with vigor. Blood-letting has no power 

 whatever to prevent the formation of the exudation. 



With regard to the employment of emetics, the revulsive action 

 through which they are supposed to exert an influence upon croup is 

 altogether problematic. Still less may we promise ourselves help from 

 their diaphoretic effect. They are only indicated where obstructing 

 croup-membranes play a part in producing the dyspnoea, and when 

 the child's efforts at coughing are insufficient to expel them. We 

 have stated, in describing the symptoms, that impeded expiration 

 should cause us to infer that the glottis is becoming choked by false 

 membrane. We, therefore, would lay great stress upon this symptom 

 as an indication for emetics. As the formation of pseudo-membrane 

 may take place at a very early period, an emetic, if indicated, may be 

 given early in the disease. In treating croup, preference is given to 

 sulphate of copper over tartar-emetic or ipecacuanha, and, as it seems to 

 me, with reason. Beware, however, of giving this remedy in doses too 

 small, for it may then act with uncertainty, and is much more apt to 

 operate as a poison than when used in full doses. We prescribe ten 

 or fifteen grains of sulphate of copper dissolved in two ounces of water, 

 and let the child take a large teaspoonful of it every five minutes unti 1 

 vomiting sets in. The more complete the remission after the vomiting 

 the more the membrane thrown out, so much the more reason have we 

 f< T repeating the emetic, should the peculiar dyspnoea above described 



