12 DISEASES OF CHILDREN. 



windpipe of children is narrower than that of adults, and hence it is that any 

 tendency towards inn animation of it is so much to be dreaded. It has been thought 

 by many that croup is the same disease as diphtheria the only difference between 

 them being, that in croup the larynx alone is affected by the false membrane, while 

 in diphtheria the membrane grows on other parts as well as the soft palate and 

 uvula, and also on the "swallow," or pharynx. If a child has croup i.e., if the 

 membranous innammation is limited to the larynx it is not usual for the disease to 

 spread to other members of the family ; but in diphtheria the case is far otherwise, 

 and nothing is more common than for it to attack the members of a family by 

 turn. This is the chief difference between the two, and although this difference is 

 an important one, and one which alone would be sufficient to place them in different 

 categories, still, the points of resemblance are so many that for all practical purposes 

 croup may be considered as diphtheria of the windpipe. Croup seems to be favoured 

 by hereditary tendencies, and it is one of those diseases which are apt to fall witli 

 undue severity on certain families through many generations. Exposure to cold, 

 too, seems to be a great exciting cause, and the spring and winter are the seasons in 

 which the disease is most prevalent. Unhealthy domestic arrangements, such as 

 imperfect drainage, exposure to emanations from sewers, and low-lying situations, 

 seem also in some degree to predispose towards croup. It must be said, however, 

 that it is not a very common disease, and the experience even of medical men of 

 large practice among children does not include very many cases of this fatal malady. 

 The child usually goes to bed tolerably well, or perhaps it has complained or its 

 friends have noticed that it has a slight cold, or speaks a little hoarsely. There is also 

 some heat of skin, and perhaps a little thirst and headache. Having gone to bed with 

 110 symptom that could cause alarm, it may wake in the night with all the torments 

 of fully-developed croup. The windpipe may be tender to the touch, but this is not 

 usually the case. The child struggles for breath, and clutches at its throat in an 

 agony of terror. There is a loud, clanging, peculiar cough, and the noise of the 

 breath passing and re-passing through the obstructed air-tube is high-pitched and 

 hissing. The expression is anxious, the eyes suffused, the face purple, the whole 

 body bathed in perspiration, and the voice whispering and hoarse. The child seems 

 on the very point of suffocation, when the paroxysm subsides, and it becomes quiet 

 again and tolerably comfortable. It must be borne in mind that these paroxysmal 

 increases of suffocation are due to spasmodic narrowing of the windpipe excited by 

 the innammation. The remission of the symptoms is due to the subsidence of the 

 spasm, and not to the removal of the membrane, which is the fons et oriyo of the 

 trouble. These paroxysms last variable times from half a minute to half an hour. 

 The liability to their occurrence is much greater during the night than during the 

 day ; and the parents, who see their child lying tranquilly throughout the day, or 

 without any great evidence of suffering, arc ;pt to be buoyed up with the delusive 

 hope that the disease is subsiding : but when with the return of night the spasm 

 returns, and returns probably with increased severity, this hopefulness is cruelly 

 dissipated. The urgent difficulty of breathing is usually attributable to the spasm, 

 but occasionally the growth of membrane may be so great as absolutely to obstruct 

 the opening of the windpipe. The amount of obstruction present is judged of 



