CROUP.
Although this disease is said to be more severe in Europe than in our own country, and more frequent in our northern than in our southern States, most American mothers, in all parts of the country, know and dread its alarming and often fatal attacks. It is a disease of childhood, but not of early infancy, being rarely met with under the first or after the tenth year of life.
Children who have once had this affection are very liable to another attack upon exposure to any of the causes which excite it. It has been noticed also that croup runs in certain families, and not unfrequently, children of a ruddy complexion and of a fleshy and apparently vigorous appearance are those most subject to it.
Among the causes of croup, which should be specially guarded against by mothers of croupy children, are checking of the perspiration, sudden alterations in the dress, change of climate, and even in some cases a residence at the sea-side. Croup also often follows measles, and at times is epidemic.
The unmistakable symptoms of croup quickly show themselves at the outset of the disease. Sometimes a sore throat, a short, dry cough, and a slight harshness of breathing, usher in the affection; in other instances, that which first attracts attention is hoarseness in the cry or tone of the voice, attended with, or quickly followed by, feverishness, thirst, and dulness, or fretfulness; while in another class of cases the disease suddenly developes itself without any noticeable premonitory signs. In all these cases the characteristic symptoms of the disease commonly make their appearance at night. The child's sleep is disturbed by a peculiar clanging cough, which, when once heard, will ever afterwards be remembered and easily recognised. The skin becomes hot and dry, the breathing difficult, the cough more frequent, and the child is soon awakened, frightened, and struggling for breath. With flushed face and staring eyes, the little sufferer starts up, grasping the throat with the hand as if seeking to remove some encircling pressure which is choking it. Each drawing in of the breath is attended with a hissing sound, the redness of the face and neck increases, and speech becomes impossible. This attack may pass off in a few minutes, or be prolonged, with varying degrees of intensity, for an hour. Almost invariably, however, it is followed by a period of relief, in some instances so complete as to deceive the anxious relatives into the belief that the disease is over and the child safe. This false confidence is, unfortunately, generally soon rudely dissipated by a return of the attack in all its first violence.
The disease attains its height by the end of the second, or at the latest the close of the third day. The fever is now the hottest, the tongue becomes white, the face and forehead red and covered with perspiration, the lips at times purple, the veins of the neck and temples distended, the countenance distressed, and the voice whispered or suppressed. The cough is now also most frequent and noisy; its peculiar sound has been compared to that made by a fowl when caught in the hand. The thirst is great, but swallowing difficult. The child often inserts its fingers in the mouth as if trying to clutch something which closes the air passages. These symptoms may either increase to the rapid exhaustion of the patient or take a favorable turn. One of the first evidences of the latter is a change in the character of the cough, which, although it may not lessen in force or frequency, becomes lower in tone, less dry, and finally moist.
The treatment should be most prompt, active, and energetic. Few diseases require, for the safety of the patient, such quick and efficient aid at the outset. Prepare at once sufficient hot water for a bath, and make a fire in the room. In the meanwhile, immerse the child's arms in some hot water, and apply cloths, wrung thoroughly dry from it, to the throat. Give the child a tea-spoonful of powdered alum in a little syrup, molasses and water, or honey. Repeat the dose in a quarter of an hour if full vomiting be not excited by the first tea-spoonful. So soon as the warm bath is ready (the water should have the temperature of 98° Fahrenheit), place the child in it, and keep up the heat of the bath by the occasional addition of hot water. Have hot towels in readiness to dry the skin completely, and a warm blanket in which to wrap the patient. See that the temperature of the room is raised to about 66° Fahrenheit, and that it does not fall below this. Moisten the air by putting a kettle of boiling water on the fire and diffusing the steam from it by means of a long roll of paper fixed to the spout.
The warm bath and the emetic will usually relieve the breathing; but no matter how complete this relief may appear to be, nor how quietly the little one may sleep, it must be carefully watched all night, so that the first return of unfavorable symptoms may be promptly treated. In all instances also, however favorably the case may progress, the patient must be confined to bed for several days, and the temperature of the room, and the moisture of the air, carefully maintained, as directed for the first treatment of the attack. If the child has had previous attacks, or if the weather be cold and inclement, it should be kept in this warm moist atmosphere for two weeks. Were these precautions known and heeded we should have to lament fewer fatal cases of croup.
Of course in this, as in all other serious diseases, skilled medical advice should be secured as quickly as possible. We have given the above directions, not only for those so situated that they cannot secure medical aid, but also for all others, in order that no valuable time may be lost in commencing the treatment, that the efforts of the physician may be intelligently seconded and carried out, and that the importance of promptness at the outset, and prolonged care during convalescence, maybe impressed upon every mother who consults these pages.