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Gen. VII. The writers on croup have given but one form of it,
· been described under the name of LARYNGISMUS STRIHitherto er. DULUS. Properly speaking, however, there are two forms, roneously an acute and chronic, under which the present species
shows itself, and which may thus be distinguished as va-
Sense of suffocation keen, and · Acute croup. constrictive; chiefly seated
in the larynx; respiration sonorous; voice harsh ; cough ringing; great restlessness;
terminating in a few days. Chronica.
Sense of suffocation obtuse and Chronic croup. heavy; chiefly seated in the Bronchial polypus. chest; cough severe, but in
termitting ; extending to some
weeks or months. Los try The disease, in both varieties, usually commences with the common symptoms of a cough or catarrba but essentially consists in a peculiar inflammation that spreads through different parts or even the whole range of the windpipe, from the larynx to the minutest ramifications
of the bronchiæ. In this extensive sense, the tube was bronchus
called brunchus by the ancients; and I have hence preformerly, and on the ferred the term bronchlemmitis to that of trachlemmitiss or
membranous inflammation of the trachea, as such a term casion.
would imply a limitation of the inflammatory action to the upper part of the bronchus alone, to which it is not
confined in either of the forms before us... . « E. Bronch- The FiRST VARIETY, importing the COMMON or ACUTE lemmitis acuta CROUP, the suffocatio stridula of Dr. Home, who has Common or the merit of having earliest called the attention of meroup. dical practitioners to it as a distinct disease, though it
extends thus widely, usually commences in the larger parts of the tube; during which a peculiar effusion is secreted, that readily assumes a membranous form, and lines, not only the trachea above its divarication, but
also its minutest branches, though the larger parts of the Gen. VII. tube are first affected. When chemically examined the E. Bronchsecretion appears to consist chiefly, if not entirely, of the lemmitis gluten, or coagulable lymph of the blood, diluted with a its serosity, and copiously combined with that peculiar acute croup. substance of the blood, detected by the labours of mo- Peculiar dern chemistry, which, from its essential tendency to like secre
concrete into a fibrous, and even a membranous texture, tion. 'has received the name of fibrin.
'By what means the mucous secernents throw forth this peculiar effusion on this peculiar occasion we know not. It is said by some writers to be secreted on no other occasion, and by no other organ; but this is un
Sometimes questionably a mistake. There are few practitioners,
secreted in perhaps, of accurate observation, who have not found it other parts discharged at times from the intestinal canal; of which I of the have already given examples under DIARRHEA tubularis; in which, as in croup, there is an inflammatory affection of the morbid organ, and a spasmodic constriction of the
passage. 3'In reality the effusion, distinct from the inflammation formation of that gives rise to it, is not essentially different in its polypi. principles from what occurs in genuine polypus, or that of the nostrils, and those polypous concretions which are
Whence often to be found in other cavities: and hence Dr. Mi- croup has · chaelis and some other writers have given to the disease been named
angina poly'the name of angina polyposa *: a term, however, inconve- posay inient, and indeed, inaccurate, since angina, as commonly but incorunderstood, imports inflammatiom of the fauces accom
rectly. panied with difficulty of swallowing, neither of which are necessary or even accidental symptoms of bronchlemmitis. "
Disease :... This disease appears in the present day to exist in known in most parts of the world, and in the American States is most parts of
the world at - called hives, supposed by my distinguished friend Dr. Hosack to be a corruption of the term heaves, and pro
distinctly noticed till
within the • De Anginâ Polyposā. Auctore Christ. Fred. Michaëlis. 12mo. Argentor.
and in the
GEX. YIL, bably so named from the heaving or violent efforts of the
Spec. VI. „E. Bronche muscles of the chest and abdomen which take place in lemmitis breathing during its course. It is hence extremely singuCommon or lar that till within the last century it should either not have acute croup. had any existence or not have been definitely noticed or
described by medical writers: for Dr. Cullen appears to be perfectly correct in referring to Dr. Home as the first
person who has given any distinct account of it*.' Its attack on It is also not a little singular that children should be children not chiefly subject to its attack, at whose age fibrin is not pe counted for. culiarly abundant, and whose blood contains compara
tively but a small proportion of azote, which in fibrin is so large a constituent. These are among the many curiosities which the prying eye of physiology has yet to follow up: and much has it to accomplish before it will
be able to explain them. Rarely at- Dr. Cullen asserts that acute croup seldom attacks tacks them in after twelve
infants till after they have been weaned; and that there years of age, is no instance of its occurring in children above twelve
years of age. As a general rule this remark holds, but the disorder is by no means unfrequent to infants at the breast, of which I had one example not long ago : and it has been found occasionally in persons cono siderably above twelve years of age. Those who have once had it are more susceptible of it than before, though, the susceptibility gradually wears off as they grow older. It is found equally in midland regions and on the coast; but perhaps more frequently in low, marshy grounds, than in drier uplands. There is no unequivocal instance of its being contagious, though it seems to have been oca
casionally epidemic. Description. It commences usually with a slight cough, hoarseness,
and sneezing, as though the patient had caught cold and was about to suffer from a catarrh. And to these in a day or two, succeed a peculiar shrillness and singing of the voice, as if the sound were sent through a brazen tube. "At the same time”, says Dr. Cullen, who has
* De Suffocatione Stridula,
well described the progress of the disease, “there is a Gen. VII.
SPEC. VI. sense of pain about the larynx, some difficulty of respi- «E. Bronchration, with a whizzing sound in inspiration, as if the pas- lemmitis sage of the air were straitened. The cough which at- Com tends it is sometimes dry; and if any thing be spit up, acute croup. it is a matter of a purulent appearance, and sometimes films resembling portions of a membrane. Together with these symptoms, there is a frequency of pulse, a restlessness, and an uneasy sense of heat. When the internal fauces are viewed they are sometimes without any appearance of inflammation; but frequently a redness, and even swelling appear : and sometimes in the fauces there is an appearance of matter like that rejected by coughing. With the symptoms now described, and particularly with great difficulty of breathing, and a sense of strangling in the fauces, the patient is sometimes suddenly cut off.”* To which I may add that the countenance exhibits great distress; the head and face are covered with perspiration from the violence of the struggle; the lips and cheeks are alternately pale and livid.
Whence the The essence of croup consists in the secretion of this da viscid and concrete lining, which is perpetually endan- the disease : gering suffocation. Dr. Cullen does not dwell sufficiently upon this symptom; but ascribes the danger principally to spasmodic action, and represents the accompanying fever, which, on his hypothesis, is also a spasmodic action, to be very considerable; but spasm whether was with him, as we have already seen, a favourite doc-" trine, and his judgement was often warped by it. Dr. Marcus of Bamberg in Bavaria, who regards all fevers as inflammation of some organ or other, and as entirely OF
mation : seated in the arterial system, regards croup also as a local inflammation alone, utterly independent of spasm, which neither exists here, nor in fevers of any kinds and attributes the danger to this symptom solely: which is the more extraordinary as he regarded croup to be a disease identic with hooping-cough, in which the spasm
Gen. VII. or convulsion is the most prominent symptom. That
E. Bronci- there is some degree of spasmodic action, however, as lemmitis well as of fever, is unquestionable, though neither are
mmon or very considerable; and the locality of the disease as acute croup. well as the peculiar character of the inflammation, suffiboth of
ciently distinguish it from catarrh, in which there is also present. some inflammation of the mucous membrane of the
trachea, though of a common kind, and rarely limited to this organ. In children, however, it frequently treads close upon catarrh, measles, hooping-cough, and any other disease that has debilitated the powers of the lungs: for as Dr. Michaelis observes, whatever tends to weaken or produce any degree of irritation in the lungs so as to occasion a preternatural secretion into that organ, may be considered as a predisposing cause of croup. Pro
fessor Dupuy of the Veterinary School at Alfort, gives Communi an instance of its having been communicated in a village, cable to dogs.
in which it was epidemic, to a dog, brought under his care from a mistaken idea that the dog was suffering from hydrophobia. During the progress of the disease he had the shrill, ringing voice of children labouring under it; and speedily died of suffocation. On opening the body, a false membrane was found in the larynx, of à reddish colour, which extended to the bronchiæ; and
the lungs were filled with an abundant serous effusion. The cure
The cure demands a prompt and active attention; and must depend upon remov- must depend not so much upon searching into and coring the recting the remote cause, or even counteracting the membranous
spasm, as in counteracting and removing the membrawhich chiefly nous secretion, which is every moment in danger of proendangers suffocation.
ducing suffocation; and especially in children, in whom the natural aperture of the glottis is much smaller in proportion than in adolescents; and occasionally not more than a line and a half in breadth.
There is in the patient a perpetual effort to remove Copious this solid secretion by coughing; but the cough is for bleeding.
the most part dry and ineffectual, and nothing more than
• Bibliotheque Medicale, Août, 1822.