14 DISEASES OF CHILDREN. 



paroxysms are of less duration, and it is generally accompanied by peculiar con- 

 tractions of the fingers and toes, which are not observed in true croup. Laryngismus 

 is almost limited to those of rickety constitution, while true croup attacks con- 

 stitutions of all kinds, and respects none. 



The treatment of croup must be rational, and we must be careful not to do too 

 much and so weaken the child who requires all its strength to battle with its disease. 

 It used formerly to be the fashion to apply leeches to the neck over the windpipe, 

 and to dose the sufferer pretty freely with calomel and tartar emetic, or antimonial 

 wine ; but this is seldom considered necessary nowadays, and any attempt to cut 

 short the disease by strong measures is, we think, to be deprecated. It is very 

 useful to begin with an emetic, and a tea-spoonful of ipecacuanha wine may be 

 administered with advantage. The act of violent coughing which usually accom- 

 panies vomiting may have the effect of dislodging some of the membrane in the 

 larynx. The parts should be kept warm and moist. Poultices may be applied to 

 the throat, and the child may with advantage inhale the steam of hot water. The 

 bed should be provided with curtains, and the steam from a kettle provided with a 

 long tube from the spout may be conducted between them. The bed should be 

 of a large size, and the curtains not too thick, so as to avoid overheating the 

 patient, and producing weakness. Some physicians are accustomed to repeat the 

 emetic, and always keep one at the bedside to administer when a dangerous 

 paroxysm supervenes. It is necessary to give a sufficiency of the most nourishing 

 food. The strongest soups, milk and wine, or brandy and water, may be given with 

 no stinting hand, but great care must be taken not to overload the stomach, nor to 

 give anything which shall make too great a demand on the digestive power. 



If the child is in urgent danger of dying of suffocation, it is necessary to open the 

 windpipe by the operation of tracheotomy. This is always a very serious proceeding, 

 but serious as it is there should be no hesitation in consenting to its performance, 

 for it assuredly gives the child a chance of life. It must be remembered that the 

 windpipe of the child is blocked with a membranous exudation which it has failed 

 to remove by the act of coughing ; that it is not only impossible but inadvisable 

 even to attempt to remove the membrane through the mouth by inserting forceps 

 into the windpipe; but it is certain that if some plan be not devised for getting 

 air past the obstruction into the lungs, death must inevitably result. The operation 

 of tracheotomy consists in making a small cut into the windpipe below the 

 obstruction, and inserting a tube through which the child is enabled to draw air 

 into its lungs. The operation is one which to the uninitiated seems terrible, and 

 during its performance the child had better be left entirely to the care of the 

 medical attendants and nurse, who are accustomed to perform and witness operations 

 of all kinds. In many cases it is quite safe to give a little chloroform to lessen 

 tin.; sufferings, but even if this be not thought advisable, the friends will find some 

 consolation in the fact that the sensibility of the little patient has been so deadened 

 by the suffocative process to which it has been subjected that it will feel but little, 

 and beiiu;- quite unconscious of what is going to he done to it, it is saved all the 

 terror of apprehension which so increases the sufferings of adult patients. If the 

 operation be successful, the relief afforded by it is one of the most gratifying 



