Aconite. If the child has a truly synochal fever; is very restless, with much oppression of the chest and anxiety. It can scarcely cough, the suffering is so intense.
Belladonna. Face very red, and eyes injected. The child moans with every breath. Its skin imparts a burning sensation to the hand.
Bryonia. The child cannot bear to be moved, the least movement so greatly increases its sufferings. Dry and parched lips; mouth dry; constipation, feces hard and dry as if burnt, usually of a dark color.
Lycopodium. Decided flapping, or fan-like motion of the alae nasi, they dilate widely and extremely and then contract alternately.
Mercurius. Much fever; thirst; salivation; a profuse perspiration which affords no relief.
Phosphorus. Particularly in tall and slender children; cough violent, sounding dry or loose, panting respiration; hoarse towards evening.
Sulphur. In cases attended with pustular eruptions; skin rough, and scaly; and other indications for this remedy.
Calcarea, and Hepar, should also be studied, the former in very fat children especially.
CROUP.– CYNANCHE LARYNGEA, OR TRACHEALIS.
Croup is an especial disease of little children, and it by no means spares young infants. Strictly speaking, it is an inflammatory affection of the mucous membrane, first of the larynx, and subsequently of the trachea also. Under the general name of croup are popularly included tow distinct forms of disease; one the inflammatory, or the true croup; the other the spasmodic of spurious croup. The inflammatory, or membranous croup of gradual in its onset and insidious in its character; and unless arrested by the appropriate medication it is pretty certain to terminate fatally. The spasmodic, or false croup, is not attended with formation of false membrane; and though much more sudden and violent in its onset, it is far less dangerous in its nature. The true, membranous croup has an element of persistence and the great hoarseness may remain for a long time unabated, as well as the other symptoms; and give the physician much anxiety about the ultimate result, even when improvement is actually taking place as rapidly and favorably as possible. And in no other disease is the triumph of Homoeopathy over Allopathic practice more evident or more grateful than in this. Three- fourths of the cases of membranous croup confessedly perish under Allopathic treatment, and no small proportion of those of the spasmodic variety; while those who survive, especially an attack of true croup, have been so barbarously treated, with blisters, cups, leeches, purgatives, emetics, et id omne genus, that they remain for a long time enfeebled. In the Homoeopathic practice on the contrary, a case of croup is very seldom lost, even of the membranous variety, and never, we think, save from want of attention and care on the part of the nurse, failure to call in the physician before the disease has too far advanced, or failure on the part of the physician himself to administer the remedy required by the exigencies of the individual case.
Etiology. Croup is developed in constitutes predisposed to this disorder, by a variety of causes which in other persons might have resulted in simple catarrh, or pneumonia. The most frequent cause, however, is exposure to cold and damp. We remember an exceedingly obstinate case of croup occurring in a little boy, in consequence of his sitting playing in the damp snow. It has been remarked by the physicians of Edinburgh, that the croup occurs, among the poorer classes, in that city, most commonly on a Sunday or Monday, and they account for it by the fact that the cottage floors are usually washed on Saturday afternoon, and remain very damp. We remember a remarkable case of croup which resulted from a leak in the roof, by means of which the moisture penetrated the ceiling of the child’s sleeping chamber, after a heavy rain in winter, and rendered damp the papering of the walls in the corner where his bed was placed. Particular states of the atmosphere and wind sometimes seem to favor an epidemic development of croup; and this may be in dry cold air, as well as in the wet.
Symptoms. The membranous croup may begin with simple hoarseness, followed by an occasional hoarse cough, which to uneducated ears has no particular significance; but which to the initiated announces the preliminary stage of this much-dreaded disease. In some cases related by Allopathic writers, the children thus affected were stated to be already past all hope of recovery, while yet able top play about the room! This hoarseness may continue and the hoarse cough become more frequent, for two or three days before the illness of the child becomes so obvious as to seriously alarm the parent. But usually towards evening these cases become very much wore; but the next day the child seems so much better, the fond mother allows herself to think the danger is passed. But the second and the third night soon undeceive her; when, if unarrested by the Homoeopathic remedy, the gradual but sure development of the false membrane threatens to destroy her child with suffocation.
In many cases of true membranous croup, however, the symptoms are much more severe from the first. The child, after, retiring to rest, suddenly awakes from his sleep, with difficult and wheezing respiration, and frequent paroxysms of loud, ringing cough; his skin is intensely hot, his face flushed, and his voice hoarse and indistinct. In general, these symptoms after a short period gradually abate; the respiration becomes more free, the patient falls asleep again, and on awaking in the morning, with the exception of some degree of hoarseness and a slight cough, present no symptoms of any serious disease; the pulse however will, in general, be found to be more frequent than natural, and the cough more hoarse and resonant.
On the ensuing evening the respiration becomes against suddenly difficult, loud and wheezing, and the cough convulsive and ringing; the patient experiences a sensation of impending suffocation, and carries his hand to his throat, as if to remove the cause of his suffering. His face becomes swollen and flushed, his pulse hard and frequent, and his voice hoarse and almost inaudible. These symptoms become more and more intense, unless the progress of the disease is arrested by appropriate medication; while the remissions become shorter and less distinct. The cough loses its acute ringing sound, while the loud wheezing respiration of the patient is heard beyond the apartment he occupies. The dyspnoea becomes excessive; the patient is in a constant state of agitation; his face is swollen and livid; his lips purple, and his forehead covered with large drops of perspiration. The skin becomes cool, the pulse small, feeble and extremely rapid; the thirst is often intense. By the cough, assisted sometimes by vomiting, a quantity of thick, ropy mucus, and even fragments of the false membrane are expelled. If a tubular portion of the false membrane is thrown off, great relief may result.
In the spasmodic or non-membranous form of croup, these symptoms from the first are much more violent still; and the onset of the disease is correspondingly sudden. The patient who retired to bed, apparently in perfect health, is suddenly awakened from sleep with a violent fit of loud, ringing cough; his respiration is loud, wheezing and oppressed, and attended with a feeling of immediate suffocation. As in the former variety, the difficulty of breathing and cough occur in paroxysms, which as the disease advances become more and more frequent, until there is no longer any remission. While the attack, by its suddenness and violence, announces no small degree of danger, still it gives some reason to hope the case is rather one of the spasmodic than of the membranous form of croup. In the more advanced stages of croup the evidences of the formation of the false membrane become too positive to be denied. Still the same great symptoms of hoarseness, peculiar ringing cough, and loud wheezing or sibilant (hissing) inspiration, and dyspnoea, appear in both varieties of croup; in different degrees of intensity according to the severity and more or less advanced stage of the case.
A brief recapitulation of the symptoms of croup, that is of those common to both forms, will enable the physician the better to recognize the disease and to select the simile for each case.
The hoarseness, which comes on gradually in the membranous croup, and more suddenly in the inflammatory variety, in either form remains during the remission. The alteration of the voice gives what is recognized as the croupy tone; but this sounds very differently in different cases. Sometimes it resembles the crowing of a cock, or the barking of a dog; in some cases it is hollow and deep; in others screeching, lisping or wheezing; in others again the voice is entirely suppressed as the disease advances, and in some rare instances, from the very first.
The cough also has various sounds; it may be violent, short, shrill, hacking, afterwards crowing hollow and harsh; it may be simply hoarse; or sound as if the child were coughing into an empty pot or metallic tube. In general the cough is dry; and it is followed by the peculiar sonorous, loud-sounding, or hissing inspiration. As the disease advances, the cough acquires a husky or even muffled sound, which would indicate the effusion of coagulable lymph.
