CROUP.
Laryngisums Siridalus (a true spasm of the glottis usually occurring in rickety children) has its treatment detailed under its own heading. Mem branous Croup or .11. Laryngitis, formerly known as True Croup, is now universally regarded as of diphtheritic nature, and its treatment will be discussed under Diphtheria. The present article deals solely with the treatment of spasmodic croup—an affection whose pathology is that of a slight catarrhal inflammation of the larynx, which induces spasm of the laryngeal muscles in young children, coming on suddenly, generally during the night, and manifesting itself in lividity and dyspncea with hoarse cough and crowing.
The affection, though more sudden and alarming than true diphtheritic laryngitis, yields speedily to simple treatment. A smart emetic, 5 grs. of the powder or i teaspoonful of the wine of Ipecacuanha, should be given every 15 or 20 minutes till free vomiting is produced. Some physicians prefer Tartar Emetic a gr.) or the old-fashioned Mercuric Sulphate or Persulphate in I-gr. doses.
The purely local emetics, as Zinc Sulphate, Alum, Copper Sulphate, or Mustard, are contra-indicated, as they possess no after nauseating ex pectorant action.
The following mixture is more valuable than either of its active ingre dients when given alone. It is suitable for a child one year old.
1 . Vini A ntintonialis histi 1pecacuanha Syrujii Scillce 5iv.
Aqua Destillatce ad 3ij. 111isce.
Fiat mistbira. Signa.—" A teaspoonful every 15 minutes till vomiting occurs, then half a teaspoonful every 2 or 3 hours whilst the cough lasts." Though the laryngeal spasm rapidly subsides after the establishment of free emesis, it will be found wise to continue the use of expectorants for a few days, to keep the child well clad and confined to the sick room, the atmosphere of which should he warm and moist, and due precautions should be taken against future attacks, which are apt to be easily induced by even mild attacks of catarrh from exposure to cold and damp.
Whilst awaiting the action of the emetic, the child may be plunged into a warm bath containing a spoonful of mustard, and after being rubbed dry and placed between blankets a hot poultice may be applied round the throat, or Graves's method may be tried of applying a sponge squeezed out of very hot water, and kept in close contact with the laryngeal and tracheal region, and renewed every few minutes till thorough reddening of the skin be produced.
Nitrite of Amyl may be inhaled in urgent cases where swallowing is difficult.
When the laryngeal cough and hoarseness do not pass rapidly off there is sure to he a catarrhal condition of the membrane, and steam inhalations or the bronchitis kettle should be used, and it is needless to say that the serum treatment should be undertaken without delay if there be even a suspicion of diphtheria. The nares should be examined for adenoids when the attacks recur in older children; exposure to cold and damp must be avoided. Hutchinson recommends a small dose of Antipyrine or Chloral at bed-time for a few nights after the seizure as a preventive of future attacks.