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Croup.It is therefore important to note the points of difference between the two, as indicating corresponding differences in the treatment required. False croup is one of the most frequent troubles of infancy. The attacks occur usually at night; the child goes to bed well, at least so far as its breathing is concerned ; though these attacks occur with especial frequency in children suffering from some of the usual indispositions, especially the bowel complaints so frequent during teething. Sometimes there is a slight degree of fever during the afternoon before the attack occurs. The mother is awakened by the child's violent coughing ; the infant is usually in a state of great agitation, gasping for breath in the intervals between a loud, hoarse, ringing cough. The effects of imperfect breathing are seen in the flushed, often bluish color of the skin, as well as in the child's violent efforts at respiration ; if the chest be exposed, it may often be observed that the spaces between the ribs are markedly depressed during the effort to take breath, indicating that there is an obstruction to the entrance of air into the lungs. After the attack has subsided spontaneously, or under the influence of domestic remedies, the trouble often recurs within an hour; indeed, the entire night may be passed in a state of alarm and anxiety, caused by the rapid recurrence of successive attacks. If the affection be simply false croup there need be no anxiety as to the ultimate recovery of the patient. That the disorder is false croup may be recognized by its sudden occurrence in a previously healthy child; by the absence of fever, which, if present at all, is observed in only slight degree, and is rarely noticeable until the attack has begun; by the suddendevelopment of the sharp barking," croupy" cough, which when once heard is never forgotten. This cough, it is true, may also occur in true croup, but in that case is not developed so suddenly. After one attack sometimes, or more frequently after several, the child recovers its usual condition, except that it betrays a certain amount of exhaustion, and usually continues to cough hoarsely at intervals during the following day. In true croup the fever continues, and the child's condition in the morning is usually worse than during the previous night. The chief element in the production of false croup is a spasm of the upper part of the air passages - technically known as the glottis. This affection is doubtless also the feature in true inflammatory croup, though but one of several phenomena which constitute the latter disease. Treatment.-The object of treatment in false croup is to relieve the spasmodic condition of the glottis, an object best attained by the application of warmth and moisture to the throat, both internally and externally. The first measure is, therefore, to procure a warm and moist atmosphere ; all windows should be closed and other draughts avoided ; the room should be heated to, and maintained at a temperature of 80 or 90 degrees Fahr., and filled with steam most readily and quickly obtained from a kettle. Meanwhile hot and moist applications should be made to the throat; either pieces of flannel wrung out in hot water or poultices of flaxseed, bread and water, or other convenient material should be applied to the throat and renewed at intervals of fifteen or twenty minutes. If the young mother have a preference for an onion poultice-as most have - that may be employed instead. The object is simply to apply heat and moisture as quickly and effectually as possible ; the benefit of the poultice lies in this quality and not in any virtue of fiaxseed or onions. The desired result may be hastened by the application of mustard plasters to the feet or by the immersion of the feet and legs in hot water with or without the addition of a little mustard. The most effectual means for avoiding the recurrence of these attacks is to maintain the high temperature and moist condition of the air for several hours. In the milder cases some of these measures may be unnecessary, but they will never be out of place. True Croup, also called fibrinous, membranous and inflammatory croup, differs from the preceding, in that there is not only a spasm of the glottis, but also the formation of a false membrane in the upper portion of the air passages. This membrane, together with the swelling of the inflamed surfaces, obstructs the entrance of the air into the lungs ; the immediate danger to the child is measured by the amount of this obstruction, and one of the aims of treatment, as will be presently mentioned, consists in the effort to remove this obstruction. True croup is distinguished from false croup by distinctive features at the commencement, during the course, and at the decline of the disease ; for our purpose it is, of course, especially important to note the differences at the commencement. It may be said in general that the onset of true croup is more gradual and of longer duration than that of spasmodic croup ; the latter may affect a child which was at bedtime apparently well, or at least devoid of fever; in cases of true croup, the child is usually evidently indisposed, often feverish, and not infrequently suffering from a cough for two or three days prior to the occurrence of the first spasm of breathing. In true croup the child is unmistakably ill; the skin is hot and dry, the mouth parched in addition to the interference in breathing; after the first paroxysm subsides, the fever and general indisposition persist; and the breathing never becomes so free as is usually the case after the first spasm of false croup. Symptoms. - Most of the symptoms of spasmodic croup are found also in the membranous disease - as would be expected since the same feature, the spasm of the glottis, is common to both. The same harsh breathing and brazen cough, the same change in the voice and difficult breathing as occur in false croup, though it is to be remembered that these symptoms do not appear usually until after one or two days of warning in the shape of general indisposition and fever. At this time there is intense thirst, and swallowing is usually accomplished without difficulty. The first spasm often occurs in true as in false croup during the night, and this may be followed in one case as in the other by successive spasms before morning. Yet in the morning if the child have membranous croup, there will be present as much or more fever than on the previous day, the breathing will still be difficult, the cough croupy and the child evidently indisposed. During the succeeding day the condition usually becomes worse ; by the end of the second or third day the disease has attained its height; the fever is now intense, the face and lips often purple, the veins distended, the voice often not more than a whisper, the child lies with its head thrown back, tossing from side to side, and evidently struggling for breath - its condition becoming more distressing during and subsequent to every fit of coughing, which usually occurs now at short intervals. At this time, although the thirst persists it can be but imperfectly quenched because swallowing is difficult. If the disease approach a fatal termination, the cough usually diminishes in force and frequency or even stops altogether ; the breathing is still more labored, the blueness increases, the hands and feet become cold, and death occurs from exhaustion or from suffocation or both. Treatment.-The appearance of any symptoms which justify a suspicion that an attack of membranous croup is impending should be a signal for calling in the services of the medical attendant; for croup is justly dreaded - by physicians as well as by others - as one of the most serious and intractable diseases. Yet it is often possible to accomplish much good during the interval that must elapse before professional aid can be obtained. The same measures recommended for relieving an attack of spasmodic croup are essential. It is especially important that the room should be kept hot, filled with steam, and all draughts avoided. One should be careful not to gratify an almost natural instinct at such a time : the struggles of the child for breath usually suggest to some one that a window should be opened to give it air. This measure, however, would defeat its own object, since the cold would simply increase the spasm in the air passage already existing. Hot applications-cloths or poultices - should be at once made to the throat. Another measure is important as soon as the signs of impaired breathing become apparent, namely, that vomiting should be provoked. A favorite and often effectual mode for inducing vomiting is the administration of warm water containing a little salt or mustard or both, yet it is often impossible to get anything into the child's stomach because of the difficulty in breathing and its consequent struggles. The quickest and most effectual way for inducing vomiting at this time is by tickling the child's throat either with a feather or with the finger. The object in promoting vomiting at this time is to secure the detachment and expulsion of the false membrane formed in the throat, and constituting the part of the impediment to the entrance of air and in securing free prespiration to lessen fever. While these measures are being taken a hot bath should be prepared, into which the child is to be placed as soon as possible. After remaining for ten minutes the patient may be rubbed briskly with a coarse towel and then warmly wrapped in flannel. These measures usually secure relief from the more pressing symptoms, the breathing becomes easier, and the child often drops off to sleep. The heat and moisture in the room and the hot applications to the throat should be continued without intermission, for repetitions of the attacks may be expected at anytime. It should also be remembered that an attack of false or spasmodic croup may be merely the forerunner of the onset of membranous croup. Causes.-The cause of false croup is usually to be found in exposure to cold draughts of air, sudden checking of perspiration. True croup often appears to be the result of the same causes. Yet it is established that membranous croup is a highly communicable disease; not that every case results from contact with a previous case of the same affection, but that every case is capable of communicating the disease to other children. Hence the necessity for care in avoiding possibilities of such exposure. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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