On Croup.

266 in them. This affection often coincides with anterior herpetic eruptions, and many patients are troubled’ with acne. Singers are subject to it, together with a thickening and redness of the membrane. In most cases, the disease advances slowly; when arrived i at a certain stage it causes great inconvenience. It frequently commences with a slight cough, without expectoration, and is generally unattended to. When the secretion becomes abundant, then it becomes troublesome. The affection is marked by a feeling of constriction in the fauces; the patient exerts himself to expel masses of mucus, which are found over the entrance of the air passages; he desires to drink a little water to allay the uneasiness or pain, which it will effect for a few moments. In slight cases, on depressing the tongue with a spoon, from two to ten little red points, of the size of a millet-seed and round, may be seen disseminated over the reddened mucous membrane. In a more advanced stage, these round points become discoid, or ovoid, and glistening; ’ and in the most intense degree, we see the diseased parts pro- i jecting in the form of pillars, or projecting columns, from the sides; and lastly, these transverse folds may so entirely ’i occupy the pharyngeal mucous membrane as to leave but a few small isolated patches of it in a normal state. The alteration of the follicles, however, is not always in relation ’, with the intensity of the symptoms; for the latter depends ’I much on the susceptibility or irritability of the patient. It is not uncommon to see the follicles covered over by I, a thick, adhesive mucus, which must be removed before their i condition is brought into view. The progress of this affection is ’, essentially chronic; it will often spontaneously disappear; at other times will yield to very simple treatment; but sometimes also is very refractory, resisting all modes of cure. I I Speaking and singing aggravate the malady. The cough attending it is guttural; it does not come from the chest, nor do the pellets of mucus, which are expelled in small quantities. The latter are small globular masses, of the size of a small pea, very adhesive, and semi-transparent; in ’, the morning they are sometimes strewed with minute greyish- I ’ black points, consisting of inhaled carbon. The voice is generally somewhat altered; and as a similar change occurs in phthisis, some alarm may be created; but then the absence of the peculiar features of the latter disease will remove all disquietude on that score. The voice becomes soon worn out, and reading or speaking aloud soon involves the necessity of ceasing. Sometimes, owing to a piece of tenacious mucus, the patient is obliged to wait before he can articulate the smallest word. Singers perceive they have lost one or two notes, that the clearness of their voice is lost, as also its sweetness of tone. The diagnosis presents no difficulty, unless the susceptibility of the patient be so great as to preclude examination, or render it very difficult, when care must be taken not to confound this condition of the follicles with the common normal hypertrophy of the mucous membrane and follicles, which is often present in advocates and singers, and which demands no treatment. Cauterization is the most effectual and ready mode of treatment, but it is sometimes difficult to limit. Nitrate of silver, or dilute nitric acid on a sponge, may be used for the purpose. Caustics, however, should not be used in the first instance; gargles of borax and alum should be previously tried, and will in most cases relieve, if not permanently cure. The sulphurous waters of the Pyrenees and of Enghien, particularly the latter, have often proved useful-one or two glasses being used in a morning, gargling, and then gradually swallowing. In summer, douches to the neck may be used as adjuncts. Reading aloud must be avoided, as also much talking, and the diet must be regulated. Acrid and irritating aliments must be refused, and care should be taken to masticate thoroughly parts of hard substances, as crust, which may mechanically irritate the pharynx. mucous

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rarely general, but mostly circumscribed, and among the exciting causes, cold is the most common. The symptoms generally begin by functional lesions ot the voice, respiration, and deglutition, cough, &c.; then come the organic lesions, as inflammation, the production of false membranes, and the participation of the system at large, manifested by fever, cyanosis, &c. In most cases the disease is ushered in by premonitory symptoms, as uneasiness, anorexia, cough, &c. The characteristics of the cough, although not conclusive, are nevertheless worthy of remark; it is hollow and almost cavernous; thus it may continue for several days, then it suddenly becomes less deep, loses all moisture, and gets dry, sonorous, and metallic. It may come even to simulate the barking of a dog, and often resembles ventriloquism. Aphonia is an invariable phenomenon, for the crowing inspiration can hardly be called a voice; it is merely a sharp sound accompanying the cough. As to the dyspnoea in croup, it is characterized by modifications of the usual respiration-in such a way that the inspirations become relatively longer, and the expirations shorter. The inspiration resembles the noise of a saw dividing stone, the expiration is blowing. Respiration is always rapid in croup, and dyspncea often verges into suffocating fits. Auscultation rarely allows us to distinguish are

whether the false membranes have reached the bronchi, the larynx, or trachea. There are, however, exceptions, and the so-called valvular flapping is sometimes heard. The expectoration may be merely mucous, or contain shreds of false membranes. The engorgement of the submaxillary glands is far from being so constant as has been mentioned by authors; whilst fever is alwavs present, and the quickness of the pulse in proportion with the heat of the skin. The exterior bearing of the patient is very remarkable; there is a certain expression of calm mixed with anxiety, which is manifested by the position of the head and the expression of the features. The dcubitus is variable, lateral between the fits, but dorsal when they come on, and the head has a tendency to be thrown backwards, with an arching forward of the neck. The respiratory muscles act more distinctly than in ordinary circumstances, but very regularly. The cyanosis is not an early symptom; it is a phenomenon pointing to slow asphyxia; it is seldom absent. The fits of suffocation which are almost pathognomonic symptoms, are always preceded by alteration of the voice, of the cough, and of respiration. The child, when near an attack, begins to be more heavily oppressed; the breathing becomes louder, and the patient gets restless; he tries to put his head in the most convenient situation for inspiration, which is getting difficult; he suddenly sits up in the bed, even springs up, falls back again, however, and takes hold of projecting objects, and is, in fact, thrown into a state of utmost anxiety. Inspiration takes place with a sort of scream, and expiration is sometimes normal, and sometimes longer than usual, taking place at every fourth inspiration. We omit the pathological anatomy of the disease, and will conclude with the differential diagnosis which the author has treated with care. He says,-In spasm of the glottis the voice is natural; there are no cough, no laryngo-tracheal hissing, no fever, and no false membranes; the fit consists in convulsive respiration, and lasts, at most, a few minutes. (Edema of the glottis is much more rare than croup; inspiration is difficult and hissing, and a tumour may be felt on the Asthma has only a few symptoms of croup. When false croup is slight, it is easy to distinguish it from true croup; but when it is serious and complicated, all the characters of actual croup should be borne in mind. Simple laryngitis offers less characteristic fits, the cough is feeble, but not metallic. Croup, as is well known, is one of the most dangerous diseases of youth; out of thirty-seven cases which the author reports, three only were cured. The author promises another paper on the treatment of the disease and on tracheotomy, an account of which we shall make a point of giving to our readers.

epiglottis.

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On Croup. FurunculustreatedwithArsenic. M. VAUTHiER, for some timeinterne" of the Hopital des We find in " Casper’s Wochenschrift"that Dr. SCHWEICH, Enfants Malades, has published in the June number of the Archives de Médecine, a paper on the pathological history of struck with the great efficacy of Fowler’s solution in cutaneous croup. This disease, says the author, seems to occur less in affections, has just tried it with great success against those the winter, and most in the spring and beginning of the furuncles which, by their number and rapid succession, besummer. Although it may attack persons of any age, it is come so very annoying. He gave four drops morning and nevertheless rare before the second and after the seventh evening; when one drachm of the fluid has thus been taken, year, the greatest frequency existing in children from threehe gives five drops; and after the third drachm, six drops a day. If, during the treatment, the boils appear again, to five years old. Sex and temperament seem to have little influence; but the children who suffer from croup have they heal very rapidly, along with the ecthymatous pustules generally been labouring beforehand under cough, eruptive which so often accompany them. Fowler’s solution has been fevers, or hooping cough. Epidemics of croup in large towns just as efficacious in acne.

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