i;ot r. 13 



ly the degree to wliich the chest sinks in dining the attempts to draw the breath. 

 In health, the chest walls bulge out during the act of inspiration ; but if the entrance 

 to the windpipe (the glottis) be obstructed, they fall in, and the degree to which 

 they do so is a measure of the amount of obstruction. The sinking in of the chest is 

 always considerable during the attacks of spasm, but in the intermediate periods it 

 may not be noticeable, and the inference we draw is that the amount of membrane 

 present is not great; but if in the intervals between the spasms the chest walls 

 recede, we conclude that the obstruction is considerable, and our apprehensions are 

 consequently serious. It is not usually feasible to see the membrane in the throat. 

 This is only possible by means of the laryngoscope, an optical instrument for 

 illuminating and reflecting an image of the windpipe ; but it is not advisable to use 

 it on children suffering from croup, lest the excitement may bring on a spasm. 

 On simply looking into the throat, we may see that it is red and perhaps swollen, 

 and if we can catch a sight of the tip of the epiglottis the lid covering the top of the 

 windpipe we may see that it too is in the same condition. If any false membrane 

 is seen on the palate or the back of the mouth, the case would be spoken of as one 

 of diphtheria, and not croup. Occasionally children cough up great pieces of the 

 membrane, which resemble tough pieces of moistened wash-leather. This is usually 

 followed by relief; but the membrane often grows again, and in a few hours the 

 child's condition is as bad as ever. The disease, if it terminates fatally, usually does 

 so by the end of two or four days ; but if the child survive, and live into the second 

 week, the chance of its recovery is greater. Occasionally we may find the glands 

 along the side of the neck enlarged. 



The complications of croup are all referable to the lungs. It is very usual to 

 have some bronchitis, and if this bronchitis be caused by the growing downwards 

 into the lung of the false membrane, it is necessarily of a very serious kind, and very 

 often results in collapse of great portions of the lung, i.e., the lung emptying of air 

 and not being able to get filled again. Pneumonia, or inflammation of the lung 

 itself, is a very serious complication, and one which is very generally fatal. 



It is not easy to foretell the result of an attack, of croup, but the disease when 

 once established is but too often fatal. Very young children recover less often than 

 older ones, so that the older the child the better is his chance of recovery. It is 

 said that croup is especially fatal when it follows measles. The presence of any of 

 the complications, especially pneumonia, is very serious. It should be borne in 

 mind that children occasionally die quite suddenly in croup, apparently from the 

 shock caused by sudden closure of the windpipe. A second attack is said to be less 

 likely to be fatal than a first; but it is somewhat doubtful if true croup ever recurs, 

 and whether these so-called second attacks are not merely attacks of ordinary (not 

 membranous) inflammation of the larynx to wliich spasm is superadded. 



Croup has to be distinguished from the cibove-mentioned simple inflammation of 

 the larynx, with which it is not unfrequently confounded. The disease of all others, 

 however, which is most often mistaken for croup, is the so-called false croup, or 

 faryngisvwa atridtilmt, which is quite a different disease, and wliich consists of 

 spasm of the windpipe alone, without any inflammation of any kind. The noises 

 in the tin oat in laryiigismus very closely resemble those of true croup, but the 



