Prognosis. — Ordinary types of ea tarrhal croup are never fatal. In very rare instances in which the catarrhal ele ment predominates and is very severe, the prognosis may be grave. In other words, catarrhal croup is rarely or never fatal, while severe catarrhal laryngitis with spasm may be a dangerous disease.
Treatment. — Preventive treatment consists in the removal of all evident exciting causes, such as enlarged tonsils and adenoid growths, and in the relief of indigestion. Exercise in the open air is important, but the child must be prop erly clad, and all exposure should be avoided. Screaming and excessive use of the ITOICC while at play during damp and stornay weather should be prohibited. Anwmic and delicate children should re ceive proper constitutional treatment. Relief of the paroxysms may be sought by external application and medical treatment. A large, hot poultice over the throat and chest will do much to relax the spasm. A large bath-sponge saturated with water as hot as the child can bear and applied to the throat is almost as effective as a poultice and is more readily managed. Vigorous rub bing with hot, camphorated oil is also efficacious. The use of the croup-kettle and tent will sometimes prove more ef fectual in stubborn cases than any other measure. The steam seems to be the effective agent, but is somewhat aided by the addition of volatile substances, par ticularly creasote in small amount.
Among drugs, ipecac, opium, and anti pyrine have proved most efficacious in my experience. If there is acute indi gestion, emesis through the use of ipecac will sometimes check the attack perma nently. In other cases emesis is not usu ally followed by complete and permanent relief. The wine of ipecac is more pronipt and effective in its action than the syrup. Opium I have found the most efficacious drug in checking spasm. One full dose, adapted to the age of the child, may be given, but the ipecac may be repeated several times. It is not best to produce vomiting. During recent years I have used chiefly tablet tritu rates of brown mixture, the active princi ples of which are opium and antimony. Antipyrine is an extremely effective drug in most cases, but sometimes fails to (rive material relief. The best results
are seen from its use when the catarrhal element is slight and the spasmodic ele ment marked. lt is a comparatively safe drug for use among children. Two grains may be given at two years, half the dose to be repeated in one hour if necessary. Aly most common plan of treating the paroxysm is as follows: After evacuation of the stomach and bowels in case of indigestion or constipa tion, a hot sponge or poultice is applied to the throat and a full dose of antipyrine and brown mixture (mistura glycyr rhizm comp.) is administered, the latter in the form of tablet triturate. If no relief is manifest in forty-five minutes, a second dose is given, while a few 10 drop doses of wine of ipecac are given in the interval.
Relief of the muscular spasm can be accomplished very effectually by spray ing the mucous membrane of the throat with a 2-per-cent. solution of cocaine. A. O. Stb»pson (Med. and Surg. Re porter, Mar. 27, '97).
Coal-oil, in doses of 15 to 30 drops on sugar, or syrup, every fifteen or thirty minutes, according to age and severity of the case, is of great value. It may also be used with turpentine and lard, on throat and chest. Caspar Q. West (Med. Brief. June. '07).
On the following day cough or bron chitis is treated by the use of brown mixt ure given in doses indicated by the symptoms and the age of the child. They may be increased in frequency as night approaches. Antipyrine is very effective in preventing recurrence on the following nights. Two grains adminis tered in the afternoon and again in the evening will alone frequently prevent the attack. It can, however, be given in addition to the usual cough-mixture.
Creosotal used in croup, with pro nounced success. In one ease a com plicating pneumonia was checked at its onset and a favorable change in the croup itself brought about over night. Two sitnilar cases also improved rap idly, while some of those treated with sermn died. In psettdocroup a dose suf ficiently large to cause the character istic odor about the breath and per spiration must be given; when the fever falls, smaller doses are employed for some time to prevent a recurrence. L. Lasansky (Deutsche med. Weitsch., Nov. 13, 1002).