Femina, A Work for Every Woman

by John A. Miller

This form of croup as its name indicates is characterized by a membrane which forms upon the surface of the inflamed mucous membrane of the larynx as an exudation, and sometimes the croupous membrane extends down into the windpipe or trachea.

This variety of croup begins just like the simple or catarrhal form only as the disease progresses the symptoms gradually grow worse, and remain persistent. It is fortunately a very rare disease and almost always fatal when it does occur. An ordinary or catarrhal croup may, when neglected, run into the membranous form and for that reason children who are croupous, no matter how light it may appear, should be carefully nursed until the symptoms have passed off. The treatment for membranous croup has been on the whole very unsatisfactory; the membrane which forms in the larynx and windpipe is the cause of suffocating the child, and the question how to remove this has never as yet been answered. Of course a great many remedies have been suggested and used but at times all have disappointed. The successful case of membranous croup that I treated many years ago was cured by giving the little patient inhalations of lime water with a steam atomizer and besides giving whisky and milk as nourishment; how much of the success in this case was due to the child’s vigorous constitution and how much to the treatment will always remain a mystery. In the commencement, the same treatment that was recommended for false croup is advisable; later on the skill of a good physician is required.

(h) Bronchitis or catarrh of the bronchial tubes is generally the cause of the ordinary cough due to exposure or taking cold. Its danger depends upon the severity of the bronchial inflammation and upon the age of the patient; the younger the child the more dangerous the disease. In older children or adults there is no connection between a bronchitis and a pneumonia, but in infants or children under two years of age who are suffering from bronchitis the tendency toward a complication with pneumonia is ever present; in fact, in children of this age, pneumonia usually begins in that way.

Cough is the most prominent symptom and it is always present from the commencement of the affection, and apprehensive of this the parents seek medical assistance. The expectoration in young children is generally swallowed after each paroxysm of cough, hence the nature of it can rarely be seen. In the first part of the night the cough is always more severe than during the day, and the paroxysms may last from half to one minute, recurring several times in the hour. Some children are less disturbed in their sleep than others, for they sleep on, notwithstanding the cough, while others always awaken, become annoyed from the disturbance and cry. These interruptions in their night’s rest reduce them in strength and flesh. Children who cough more when laid on one or the other side than when they lie on their back and who distort their face when coughing or, when old enough, complain of pain during or after coughing have something more than a simple bronchitis; they have a complication of pleurisy or a pneumonia. There is always fever and this may run very high, so that the child becomes delirious; even before the fever becomes very pronounced or the cough very annoying, their little hands and faces feel hot to the touch, indicating that they are not well.

Infants require good nursing when they are suffering from bronchitis, and it is not good to let them lie on their backs all of the time; when they have a coughing spell take them up quickly and lay them across the knees, with their faces downwards; this gives the mucus a chance to run out of the bronchial tubes and mouth which is better than swallowing it. The most important feature in the treatment of bronchitis is a warm room of even temperature night and day. If the temperature is allowed to go down during the night and the child inhales cold air into the lungs it will often bring on a relapse or aggravate the disease. When children have a cough and cold they must be kept warm in order to get well; this is no time for trying to harden them. A thermometer should be in every house and certainly in every bedchamber, so that the temperature of a room may be gauged to a certainty. In ordinary cases the temperature should not fall below seventy degrees Fahrenheit, and when the child coughs very much and the bronchitis is very bad it is best to keep the temperature of the room around eighty degrees night and day for several days, and as the patient improves, it is advisable to gradually drop to seventy.

The application of oil and spirits of turpentine is advisable in all cases of cold in the chest; it does good and one can hardly explain how and why. For the cough an infant can take with great advantage three or four drops of syrup of ipecac together with the same amount of paregoric, every four hours; older children take larger doses in proportion. When scrofula or tuberculosis is at the bottom of the bronchitis, a reliable preparation of cod liver oil emulsion should also be administered.

(i) Pneumonia is the technical term for inflammation of the lungs or lung fever. It consists of an inflammation, involving the air cells and smallest air tubules of the lungs; in other words, it is an inflammation of the substance or tissues of the lungs.

It is altogether a more serious affection than bronchitis, and in very small children exceedingly dangerous. The inflammation may affect either a small circumscribed portion of the lung, lobular pneumonia, or it may compromise an entire lobe or all the lobes of the lung, and is then called lobar pneumonia. Pneumonia is dangerous in proportion to the extent of lung tissue involved and the symptoms become correspondingly aggravated. The disease occurs extremely often in children, but it is altogether different from that which occurs in the adult. In children it is of a bronchial nature, that is, the ordinary bronchial catarrh has a tendency to extend to the very small bronchial tubes (capillary bronchitis), thence into the air cells of the lungs. In this variety of pneumonia the lungs do not become inflamed in their entirety, but here and there patches of lung tissue become the seat of lobular pneumonia. In the nursling, catarrhal pneumonia is an extremely frequent affection and I believe that it is principally due to the carelessness and promiscuous bathing of infants to which I have already referred. In foundling hospitals this disease destroys a great many children, and the chief cause has been attributed to their lying both night and day in a horizontal posture.

It has been statistically proven that many more children suffer from the disease in winter than in summer, and further, that in those parts of the lung that are inflamed the bronchial tubes which lead to them are also found to be inflamed. This relation of catarrhal pneumonia to bronchitis may be accounted for by the play of a mechanical force and thus illustrates the relation of cause and effect. The secretion of bronchitis not being expectorated, gravitates into the region in which the inflamed bronchial tubes terminate, namely, the air cells of the lungs, and by irritating and blocking or filling the air cells, a catarrhal pneumonia is developed.