(Membraneous Laryngitis, False Croup.).
**Aconite is always the remedy in the beginning of croup, be it spasmodic or membranous in character. The child is suddenly aroused out of sleep gasping for breath. There is a most anxious distressed countenance, hot skin and much restlessness and tossing about. The cough is of the driest kind, loud and barking, no expectoration. If however, the remedy be continued a little while a little expectoration will appear and with it relief. Crop brought on by exposure to dry, cold winds calls for **Aconite. The remedy should not be stopped too soon; if so the trouble will return the following night. The breathing is loud, especially the inspiratory effort.
**Ferrum phosphoricum often acts well in the beginning of croup. It may be distinguished from **Aconite by the absence of anxiety and restlessness so characteristic of the latter drug **Aconite croup comes on very suddenly.
**Veratrum viride is also a very useful remedy at commencement. The anxiety of **Aconite is absent.
**Spongia is the great homoeopathic croup remedy, but it always comes in after **Aconite. The breathing is harsh, sawing and hard as if the patient were breathing through a sponge. Hard barking ringing cough with scanty expectoration; in fact, it seems to get tighter and tighter every minute and almost threatens suffocation. It is worse before midnight, and it is especially well indicated in light complexioned children with blue eyes. It corresponds m;ore closely to the spasmodic form of croup than to the membraneous.
Hepar Sulphur. [Hep]
This is the third of the great croup trinity, and it follows **Spongia well. It has the same croupy sound, but there is a certain amount of moisture to it; it has a ***”loose edge.” It comes on after dry, cold winds, the breathing is whistling and there is great sensitiveness to the cold air. There must be ****some looseness of the cough to indicate **Hepar; in fact, the child is apt to have choking fits with the cough. In the membraneous form of croup it is useful when there are pains going from the throat to the ears and expulsion of pieces of false membrane. Boenninghausen treated croup almost exclusively with these three remedies. His method was to give five powders; first, he gave a powder of No.1 **(Aconite) in water so as not to make the patient cough; he waited two hours and if necessary gave powder No.2 **(Aconite) and followed after two or three hours, if necessary, with No.3 **(Spongia). The others, No. 4 **(Spongia) and No.5 **(Hepar), were given if necessary, but he always waited two to four hours between the doses. Hardly one in a hundred received all five powders, and he treated, it is said, over 400 cases without losing one. All this emphasizes the value o;f these remedies in croup. In false croup give **Hepar as soon as the child during the day, commences to cough hoarsely. It will avoid the nocturnal attacks.
Perhaps the next remedy in order is **Bromine. Its indications are a deep, hoarse voice, and every attempt at inspiration produces coughing; the breathing is hoarse, rasping and whistling and there is rattling in the larynx, and when the child coughs the larynx sounds full of mucus. With **Bromine the child is suddenly roused out of sleep as if choking and a drink of water often relieves the spasmodic condition. The sensation as if some of the membrane were loose in the larynx giving rise to this rattling, is very characteristic of this drug. There is also marked prostration.
**Antimonium tartaricum has this rattling lower down than **Bromine. (lower)
**Bromine follows **Hepar well when **Hepar is unable to remove the exudation. Great suffocation so that the child wants to be carried from room to room is a good indication. **Bromine follows **iodine well. Preparations of Bromine soon decompose, so it becomes necessary to have them made fresh; prepare with distilled water, one drop of pure **Bromine to six ounces of water. The higher homoeopathic attenuations never deteriorate nor lose their power.
Kali muriaticum. [Kali-m]
Clinically, **Kali muriaticum has been found a very useful remedy in croup. It corresponds to croupous exudations, it has expectoration of gray fibrinous slime or phlegm from the mucous membrane. The cough is dry, hard and croupy, harsh and barking. It forms with **Ferrum phosphoricum the principal tissue remedy treatment of croup.
This is a remedy little used or thought of in croup. It has some good symptoms, however. It is useful for membranous croup when it extends downwards, and one of its characteristic symptoms is intense soreness along the trachea and upper part of the chest. The patient does not want anything to touch him because the chest is so sore.
**Ammonium causticum is considered by some specific in membraneous croup.
Iodine, in its provings, not only presents all the symptoms peculiar to croup, such as hoarseness, dry, rough, deep cough, painful larynx, whistling respiration, sensation of obstruction in larynx, but in the record of poisonings we have the formation of pseudo-membrane on epiglottis, vocal chords and the parts of the larynx beneath them. Experienced teaches that its curative actions is all the more favorable the firmer the consistency of the morbid product is, hence **Iodine is less indicated for mucous than for membraneous formations. It may be employed in all stages of croup. Given in the beginning, it may cut short the attack, and after the exudation has taken place it diminishes this either directly by absorption, or by rendering it more fluid it become more easy to expectorate; and when exudation has existed for some time and the patient is exhausted it has the effect of rousing the organism to general reaction.
The special indications for its use are the dry, short, barking cough with wheezing, sawing respiration, dyspnoea and imminent suffocation. The cough may have lost the peculiar metallic tone and become muffled and indistinct. There is constant desire to change position, and it acts especially well in dark-complexioned children. Use the Ix dilution, three drops every fifteen minutes. Croup caused by long continued damp weather, with more fever than with **Bromine, are good indication for **Iodine. It comes in after **Hepar when in spite of that remedy the exudation forms itself into membrane. Some practitioners pin their faith to there remedy in the Ix dilution, especially when the case is a severe one.
Kali bichromicum. [Kali-bi]
This remedy is suitable to children with short, fat necks, and it is indicated in true membraneous croup. The cough is metallic, the fauces and tonsils are red and swollen, breathing is labored and the larynx is sensitive. The child has smothering spells and awakens choking. The formation of a thick membrane takes place, and the tendency of the disease is to extend downward, becoming croupous bronchitis. There is violent wheezing, and the expectoration is of tough and stringy mucus. It offers the most hope of removing the false membrane. Cowperthwaite places this remedy before all others in membraneous croup.
When the spasm o;f the throat is very severe, **Lachesis will sometimes be indicated.
**Mercurius proto-iodide has been successful in certain cases and if diphtheria is suspected **Mercurius cyanatus.
This remedy may be useful in croup. There is the formation of a false membrane with dryness, burning and swollen feeling in the throat and a wheezing, whistling croupy cough. Dryness and burning are the keynotes of **Sanguinaria.