CROUP, a specific inflammatory affection of the larynx
Crousz. and trachea (windpipe), giving rise to a peculiar secretion which concretes as soon as it is thrown out, and forms a false membrane which blocks up the air tube, and produces rapid death by suffocation. This disease is peculiar to children from a few months old to the age of 12 years; and is most common in damp low-lying situations, in the neighbourhood of the sea, of marshes, or of rivers. It makes its appearance suddenly during the night. The child goes to bed apparently in perfect health. After he has been asleep for a few hours he is heard to give an occasional cough of a peculiar ringing character, as if he had coughed through a brass trumpet. The cough rapidly becomes more frequent, with an increasing difficulty of breathing, accompanied by a peculiar crowing and wheezing noise at each inspiration; the voice becomes rough and hoarse, the child restless and feverish, the face flushed, and with an excited anxious expression; he complains of uneasiness in the throat, and says he is choking. The difficulty of breathing rapidly increases, and great efforts are made by the child to dilate the chest in order to get breath; the air is drawn into the lungs with extreme difficulty, as if by a piston, and through a very narrow aperture, and the crowing sound is audible at a considerable distance. Sometimes these symptoms, if not very severe, subside after midnight, to return the next night; but if severe, unless the child be promptly relieved, the disease will rapidly terminate fatally.
As soon as the disease is noticed, the child ought to be put into a hot bath, and kept there for ten minutes, or even until slight faintness is experienced. Simultaneously, or while this bath is getting ready, an emetic ought to be administered; and by far the best for this purpose is the sulphate of copper, in doses of two or three grains, dissolved in a little hot water. If this be not at hand, an emetic of ipecacuan or of antimony may be substituted; and in any case the emetic should be repeated at intervals of half-an-hour or an hour, according to circumstances, till the child is somewhat relieved. Immediately after the vomiting is over, calomel in half-grain or one-grain doses should be given every second hour till the symptoms yield, and the breathing becomes free and natural. In very severe cases it is useful to blister the throat; and by far the most efficacious and speedy way of accomplishing this is to rub the nitrate of silver over the whole course of the windpipe. Blood-letting, in all its forms, is a dangerous remedy (though very generally recommended), as, unless it removes the disease at the moment, which it very rarely does, it increases the tendency to the formation of the false membrane in the windpipe. (J. S.—K.)