The CROUP is a disease peculiar to children, and generally fatal, if
care is not taken in the commencement. It commonly approaches with
the usual signs of a catarrh, but sometimes the peculiar symptoms
occur at the first onset; namely, a hoarseness, with a shrill ringing
sound both in speaking and coughing, as if the noise came from a
brazen tube. At the same time there is a sense of pain about the
larynx, and some difficulty of respiration, with a whizzing sound
in inspiration, as if the passage of air was diminished; which is
actually the case. The cough is generally dry, but if any thing is
spit up, it is a purulent matter, sometimes resembling small portions
of a membrane. There are also a frequent pulse, restlessness, and an
uneasy sense of heat. The inside of the mouth is sometimes without
inflammation, but frequently a redness, and even a swelling exist.
Sometimes there is an appearance of matter on them like that rejected
by coughing.
_Remedies._
As soon as possible a brisk emetic should be administered for the
purpose of freeing the patient from the coagulable lymph which is
already secreted. Topical bleeding, by means of leeches, should
immediately succeed, and the discharge be encouraged. As soon as it
diminishes, a blister, sufficiently large to cover the whole throat,
should be applied, and suffered to lie on for thirty hours or longer.
The steam of warm water should be inhaled, and the bowels should be
evacuated by calomel.
As soon as the emetic has operated sufficiently, opium may be
administered, by which means the breathing will in general be soon
relieved; but should it become more difficult in the course of a few
hours, the emetic is to be again repeated, and after its operation
the opium again employed. This practice is to be alternately used
till the patient is out of danger, which will, in general, be in the
course of three or four days. The child should be kept nearly upright
in bed.
Children, until the age of six years, are liable to be attacked by
BILIOUS FEVER, which is gradually developed, by irregularity in the
bowels, which are either too costive, or too much relaxed.
On its first appearance, the child becomes peevish and fretful, his
lips are dry, his hands hot, accompanied by shortness of breath,
pains in the head, and quickness of pulse, which beats from 110 to
112 in a minute; he shows an unwillingness to stir or speak, starts
in his sleep, and has a loathing for food. The stools have often
a mucous and slimy appearance; some children are affected with
delirium, others dull and stupid, and many are for a time speechless.
Several slight accessions of fever take place in the course of the
day, during which the child is usually drowsy; in the intervals
of these paroxysms he appears tolerably well, though, at times,
unusually peevish.
These symptoms are more or less prevalent for eight or ten days,
when suddenly a more violent paroxysm of fever will ensue, preceded
by a shivering fit, and sometimes an incessant vomiting of bile. The
pulse rises to 140; the cheeks are flushed, the child’s drowsiness
increases, and when awake, he resorts to picking at the skin of the
nose, lips, and eyes, to a most painful degree.
This species of fever is mild at the commencement, slow in its
progress, and very uncertain in its event. The desire for food is
destroyed, and the child will take neither aliment nor medicine. The
stools are changed from their natural appearances, being sometimes
black, and smelling like putrid mud; and at other times they are
curdled, with shreds of coagulable lymph floating in a dark green
fluid.
_Treatment._
The first thing, is to cleanse the stomach by a few grains of
ipecacuanha, and soon afterwards to administer some active purgative.
For restoring the healthy secretions of the bowels, nothing is
so efficacious as small and often repeated doses of calomel and
scammony, (¾ of a grain of the former to 1¼ of the latter,)
followed up after some hours by a solution of Epsom salts in an
infusion of senna, or by a dose of castor oil. When the stomach is
very irritable, small quantities of chalk mixture, with a few drops
of laudanum, are to be given alternately with the above-mentioned
purgatives.
If the head is much affected, leeches should be applied to the
temples, and if the stomach will not retain the medicine, from three
to six leeches should be applied to the upper part of the belly, or
right side; and after this a blister, if necessary. The warm bath
will prove useful after the stomach and bowels are properly cleansed.
_Tonic Powder._
To obviate debility, when the fever has abated, the following
tonic powder is recommended.
Mix together 2 drams of powder of cascarilla,
24 grains of rhubarb, and
1 scruple sub-carbonate of iron.
Divide this into 24 papers, one to be taken morning and
evening.
_Regimen and Diet._
The child should likewise be sent into the country as soon as
possible, and be allowed every reasonable amusement, to dissipate the
peevishness which is an invariable consequence of a severe attack of
this disease. The diet, for a time, should be light and nourishing;
as jellies, isinglass and milk, veal broth, and beef tea. The drink
may be whey, and toast and water.