FALSE CROUP. 15 



testimonies to the value of the surgical art which it is possible to witness. The 

 child, who a few moments previously had been struggling for breath in an agony 

 of tiTror, with a face purple from suifocation, suddenly finds that air can be drawn 

 without difficulty into its lungs. The agony vanishes, the natural complexion 

 returns, the child is able probably to take nourishment, and after some expressions 

 <>f satisfaction it commonly falls into the caresses of "Nature's soft nurse." 



Unhappily, the relief afforded by tracheotomy does not always secure the recovery 

 of the child. There are still rocks ahead of which the friends should be well aware. 

 Th*> most common cause of death after tracheotomy is bronchitis or inflammation 

 of the lungs, and the best method of guarding against this is to exercise great care 

 that the air of the room in which the child lives is kept properly warm and 

 moist. Ordinarily, the air which we breathe is warmed by passing through the 

 hot cavities of the mouth or nose, which is not the case when the air is admitted 

 to the lungs through a tube in the throat, and it often happens that bronchitis 

 is set up or kept going by the irritation of cold air striking on the lungs. 



Sometimes the child dies of exhaustion after tracheotomy. This is often the 

 case when the operation has been too long delayed, which is a common result of 

 the reluctance of the friends to give the necessary permission for its performance. 

 The child has been so weakened by disease that its power of recovery is too 

 slight to allow of its receiving any advantage from the operation ; but even in 

 such cases the sufferings are very much lessened, and the friends are spared the 

 spectacle of a helpless child dying in the greatest agony. If tracheotomy lias 

 l>een performed, great care must be taken that while the child is wearing the 

 tube in its throat it be kept scrupulously clean. The tube should be washed or 

 changed every day, and the edges 'of the wound should be carefully cleansed of 

 all discharge which may accumulate round them. If the operation be successful, it 

 Avill be found that as recovery advances the obstruction in the windpipe diminishes ; 

 and if the patient be taught to close the orifice of the tube with the finger, or 

 if the tube be closed for it, it may be able to cough up the portions of false 

 membrane as they loosen and separate. When the child is able to breathe when 

 the orifice of the tube is stopped, i.e., when the child is able to draw air through 

 the top of the windpipe and past the tube, the tube may be removed, and in a 

 very few days the opening which was made for its insertion will heal and close. 



During convalescence from croup, great care must be taken that the child is 

 not exposed to cold, for the exposure of the scarcely-healed windpipe to the cold 

 air may bring about spasm, and perhaps a return of the trouble. 



During an attack of croup, the child should be kept separated from its fellows, 

 so that no risk of contagion may be run ; and it should not be allowed to mix a.irain 

 with its companions till every croupy symptom has disappeared. Sea air is of great 

 service in restoring the strength after croup, as after other exhausting diseases, but 

 our south coast with its moist balmy breezes should be selected in preference to the 

 more cold and bracing climate of the east. 



In!*,- f'rnt/p is of two kinds. Many children, especially between the ages of 

 about four and twelve, when they catch cold are liable to suffer in their throats. 



