Page:The American Cyclopædia (1879) Volume V.djvu/521

 CROUP 517 in the case of patients who are in a comatose state. Externally applied, it produces inflam- mation of the skin and a pustular eruption suffi- ciently resembling that of smallpox to deceive Croton tiglium. a careless or inexperienced observer. It is sometimes used as a counter-irritant. A pseudo croton oil has been obtained from the seeds of jatropha curcas, curcas purgans, or the physic- nut tree, and also from croton pavana. CROUP. Under this name a medical writer in Scotland, Dr. Francis Home, in 1Y65, de- scribed an affection in children of the wind- pipe or the upper portion of the air tubes (larynx and trachea), involving liability to death from suffocation, and characterized by a peculiar ringing, metallic cough. He applied also to the affection the classical name suffoca- tio stridula ; and the term cynanche trachealis has been used by writers in the same sense. The name croup has been in popular use ever since the date of Home's writings, and em- ployed also by physicians, to denote diseases in the windpipe giving rise to more or less suffo- cation, together with the peculiar cough just referred to. " The hives " is a popular term formerly much in vogue in this country, hav- ing the same meaning. Writers, however, who came after Home, pointed out the fact that suffocative symptoms, accompanied by the croupal cough, occur in connection with different forms of disease in the same situation. The late Prof. John Ware of Boston was the first to indicate clearly the different affections embraced under the name croup. They are as follows: 1. A spasmodic affection of certain muscles of the windpipe (larynx), occurring independently of inflammation. This affection has been distinguished as spasmodic croup. Its distinctive features are a sudden attack, generally at night, suffocation apparently being imminent, and the peculiar cough very strik- ingly marked. This affection, though from the violence of the symptoms apt to occasion great alarm, is devoid of danger. After a period varying from a few minutes to several hours, complete relief is obtained, no symptoms of disease within the windpipe remaining. A frequent cause of the attack is indigestion. 2. An affection which, in like manner, involves spasm, the symptoms of suffocation together with the cough being wholly due to the spas- modic condition; but, in addition, there is a slight or subacute inflammation of the mem- brane lining the larynx and trachea. The in- flammation does not invest the attack with any danger. Relief is obtained, but a little cough remains, with perhaps some hoarseness. Prof. Ware distinguished this affection as catarrh al croup. 3. An acute inflammation of the mem- brane lining the windpipe, the proper nosolo- gical name for which is acute laryngitis. The inflammation is essentially the same as in the ordinary acute inflammatory affections of the mucous membrane in other situations, and, by way of distinction from the unusual variety to be presently noticed, it may be called simple acute laryngitis. The swelling of the mem- brane gives rise to more or less obstruction to the passage of the air in breathing ; but spasm is also an element in this form of disease, caus- ing paroxysms of increased difficulty in breath- ing, accompanied by croupal cough. Simple acute laryngitis in children proves fatal in only a small proportion of cases. It is less serious in the child than in the adult, owing to the fact that in the latter it is apt to give rise to serous effusion beneath the mucous membrane, the obstruction, and consequent danger of suf- focation, being thereby increased. Prof. Ware distinguished this form as inflammatory croup. 4. The form to which par excellence the name croup is applied, which it is customary to call "true croup," and the three other affec- tions different varieties of " false croup. 1 ' In true croup the mucous membrane lining the larynx and trachea is inflamed. The disease is therefore laryngitis ; but the inflammation has a striking peculiarity which distinguishes it from a simple acute laryngitis, viz. : an exuda- tion, that is, an effusion of fibrine which co- agulates upon the mucous surface and forms a layer like a membrane, called a false mem- brane. The presence of this false membrane is a cause of obstruction in addition to the swelling of the mucous membrane ; hence the greater persistent difficulty in breathing and danger from suffocation in true croup, as com- pared with the three varieties of false croup. The disease proves fatal in a very large pro- portion of cases, and the suffering from the want of breath is very great. In distinction from simple acute laryngitis, the affection is called by a variety of names, such as mem- branous or pseudo-membranous, fibrinous, plas- tic, exudative, and diphtheritic laryngitis or croup. The production of an analogous false membrane is the distinctive characteristic of the disease now known as diphtheria. (See DIPHTHERIA.) Diphtheritic laryngitis is de-