Croup. (cynanche laryngitis. cynanche trachietis.)

This is usually a disease of childhood, consisting of a high degree of inflammation of the windpipe, with spasm probably of the interior muscles, and an exudation on the inner or mucus surface, with a tendency to the formation of a tough, stringy, membranaceous or viscid substance, which often adheres closely to the interior surface of the windpipe, and at times appears to cover or nearly to cover the tube for considerable length. After this membrane has been allowed to form, the case becomes extremely dangerous. It sometimes terminates fatally in a few hours, though not usually till the third or fifth day.
A predisposition to croup may no doubt be induced by a too highly stimulating diet; the excessive use of candies, mint drops, and aromatic substances, having a smart or biting taste, as pepper, spices, nutmeg, and c.; and this predisposition may no doubt be transmitted from one generation to another, so long as the habit of indulgence continues; all other notions about constitutional taint are simply absurd. What more natural than that a mother, who accustoms herself to the constant use of large quantities of allspice, or of black or cayenne pepper, or cloves, until all the mucus surfaces are burned dry and parched, and compelled to defend themselves against renewed assaults by exuding from their surface an unnatural secretion, with which they cover themselves as with a coat of mail, should transmit to her offspring a disease of those tender and delicate surfaces, upon which the poisons she is accustomed to indulge in are known specifically to act.

An attack of croup usually commences with the symptoms of a common cold; the cough at length becomes shrill or hoarse, with a ringing sound as if the air were passing through a metallic tube; breathing becomes exceedingly difficult, every inspiration of air being accompanied with a shrill sound, which has by some writers been compared to that made by a chicken when dying with the pip; if there be any expectoration it has a stringy appearance, and is exuded during a fit of coughing; the fever and restlessness are continuous, but may vary in intensity, and the paroxysms are often followed by a profuse clammy sweat, especially of the head and face. So long as the voice is sonorous, there is usually reason to hope; extinction of the sonorous character of the voice is thought to evince the existence of membraneous formations; if the pulse is hard, frequent and intermittent; the inspirations difficult and audible; the features livid or purple; the head thrown back; the cough husky; the voice whispering; the eye glassy and dull, or dilated; the danger is imminent, and recovery if not hopeless, is at least extremely doubtful.
Should the cough at length become more loose and broken, the paroxysms of coughing shorter, the sounds acquire a mucus character, and mucus be discharged to some extent with the cough, gradually becoming less strong and viscid, we have reason to hope for a favorable termination. The remedies most useful in croup have been already described in treating on the subject of laryngitis, but such is the dangerous character of this disease we shall give it a separate consideration.
So far as has yet been ascertained, Aconite, Hepar sulph., Lachesis and Spongia, are here also the most reliable, remedies. The other remedies which may become useful or necessary in the course of the treatment, are Antimonium crud., Arsenicum, Belladonna, Bryonia, Cantharis, Iodium, Kali carb., Phosphorus, Tart. emetic, Sambucus.

Aconitum napellus
is useful at the outset, to subdue the inflammatory symptoms, and the nervous spasmodic contractions, and should usually be the first remedy resorted to. It is especially indicated by the following additional symptoms: choking, strangling and suffocating symptoms, with a short, dry cough, or with constant attempts to cough, as if from uneasy sensation in the throat; convulsive, horse, croaking cough, with suffocative, constrictive spasms; hoarse, croaking voice, or tremulous and stammering, hesitating speech. The modifying effects of this remedy upon the nervous system should never be forgotten.
DOSE. – Two drops of the dilution, or twelve globules, in twelve spoonfuls of water, a spoonful to be given every fifteen minutes, in severe cases, until amelioration or change. In cases less severe, every half hour, every hour, or every two hours. After Aconite, give Spongia or Hepar sulph.
Hepar sulphur
After Aconite, especially if the skin be moist, or covered with sweat; cough and breathing more loose and free, but still a harsh or hollow cough, with hoarseness; constant rattling of mucus in the throat and chest; ineffectual endeavors to raise something from the throat; or, if the fevers continue, with frequent throwing back the head, grasping at the throat; restlessness; hot skin; rapid and difficult breathing; violent suffocative fits of coughing; husky cough, with soreness; cough, with scraping sensations and itching in the throat, at times increased to vomiting; urine when passed, pale and clear, afterwards turbid, or turbid when passed, or yellow and dark-colored; worse at night; barking cough; breathing anxious; wheezing, with attacks of suffocation, and manifest inability to breathe deeply.

DOSE. – Two drops of the dilution, or twelve globules, in half a tumbler of water, a teaspoonful to be given every two hours, or oftener, in severe cases, until amelioration or change.
Lachesis mutus
is indicated in croup by a dry, short, suffocating and croaking cough, or cough with vomiting; choking cough, or fatiguing, with inability to raise anything; cough after sleeping, or when rising up, or with flow of watery saliva from the mouth, and pains at the pit of the stomach; and if the breathing be short, rattling, croaking or wheezing; spasmodic fits of choking; convulsive spasms; difficulty of swallowing; dread of drinks, especially if there be a general appearance of bloatedness, and much tenacious mucus in the throat; neck and throat sore or sensitive to the touch, or swollen; face swollen, purple or pale, even to a frightful extent; lips swollen and discolored; rapid and feeble and sometimes intermittent pulse; cold sweat; coldness of the feet; asphyxia, with stiffness and swelling of the body; tremulous pulse, and appearance as if dying, or as if already dead.
DOSE. – One drop of the dilution, or six globules, in ten spoonfuls of water, a spoonful every two hours, or oftener, according to the severity of the symptoms, until amelioration or change.
Spongia tosta
Croup is distinguished by rattling of mucus in the lower portions of the windpipe and chest; or if there be expectoration of thick, tenacious mucus with the cough, the skin being moist, and after the more acute inflammation and dry, burning heat have been mitigated by other remedies, such as Aconite or Hepar, the breathing being still quick, wheezing, anxious and difficult; the cough barking, rough or whistling; the voice husky; or with appearance of fulness; or bloatedness of the chest, throat, face and eyes.

It would also be indicated, if the child place its hand upon the upper part of the chest, and cry after coughing; or if by any other means it should be ascertained that there are pains or burnings, or sensations as of excoriation in the chest accompanying the cough; and if the windpipe be painful, worse when touched, with constrictive sensations, or with glandular swellings; drowsiness; lassitude; out of humor. The urine deposits a greyish white sediment.
DOSE. – One drop of the dilution, or six globules, in ten spoonfuls of water, a spoonful to be given every two hours, until amelioration or change, after, or in alternation with Hepar sulph.
The above general indications, it is believed will cover nearly all cases of catarrhal, spasmodic, or simple inflammatory croup, where the attack comes on suddenly; and also a large portion of the cases which are truly membranous, and in cases not too far advanced. If the remedies above indicated, be wisely and perseveringly used, a favorable result may be anticipated; and I would here caution physicians, as well as laymen, who may use this work, against too hastily leaving our well-tried, and approved remedies, in difficult and dangerous cases, on account of the perhaps exaggerated specific virtues of some newly discovered remedy, the uses of which, although it may have done good in some given case, under a certain train of circumstances, or in some particular locality, are too imperfectly understood, to afford us indication for exact scientific prescription, as adapted to other circumstances, and other localities.
Ammonium causticum
if the voice be weak; the breathing labored and rattling; the speech interrupted; the cough violent; expectoration copious; with fits of suffocation and spasms.
DOSE. – As for Belladonna.

Arsenicum album
in the most desperate cases, and after the use of Lachesis, when the cough occurs in paroxysms, with great anguish, weakness, and prostration; coldness of the extremities; cold sweats; attacks of suffocation; stiffness or trembling of the limbs, or of the body; worse in the evening and when lying down. Or croup in persons subject to rash-like, eruptive diseases; or eruptions, with burning itchings; miliary eruptions, and diseases of the skin: scabs, or swellings of the mouth and nose, on taking cold, and c.
Belladonna
especially if following a case of scarlatina, in which Belladonna has not been used as a leading remedy; or in a case of spasmodic croup, with choking and constriction; inability to swallow; great soreness of the windpipe; and loss of voice. The cough is dry, short, hollow, and barking, excited by the least movement; with paroxysms of sneezing afterwards; worse at night, or in the evening, in bed.
DOSE. – One drop of the dilution, or six globules, in six spoonfuls of water, a spoonful every half hour, or oftener, if the symptoms appear to demand it.
Bromium
Hoarse, wheezing, fatiguing cough, having the peculiar sound which characterises croup, attended with sneezing; inability to speak, and violent fits of suffocation; mucus, rattling and wheezing; the breathing being at times slow, deep, and suffocative, at other times rapid and superficial; or labored, oppressed, gasping for air; membranous formations in the windpipe, and suffocative spasms; heat in the face; urine increased; pulse hard and slow; or accelerated.
DOSE. – One drop of the dilution, or six globules, in six spoonfuls of water, a spoonful to be given every half hour, or oftener, according to the symptoms.
Note. – The best practitioners give Bromine when required for croup, in very low dilutions; about one part to one hundred, or one to one thousand, appears most useful.

Cantharis vesicatoria
if there be oppression for breath, with sensation of excessive weakness in the respiratory organs; rattling of mucus in the chest, with cutting pains; especially where there is painful and difficult urination; scanty emission; or urine of a deep red, or of a pale yellow color.
DOSE. – One drop of the dilution, or six globules, in six spoonfuls of water, a spoonful to be given every four hours, usually in alternation with some other remedy.
Chamomilla
for catarrhal croup, attended with great restlessness; tossing about; and alternate chilliness and heat; or with redness and burning heat of the cheeks, or of one cheek; excessive nervous excitability, and fretful humor; and if the cough be dry, spasmodic, convulsive, and especially if it be excited by anger or passion.
DOSE. – Two drops of the dilution, or twelve globules, dissolved in ten spoonfuls of water, a spoonful to be given every half hour, until amelioration or change.
Cuprum metallicum
if there be violent suffocative fits, with cramps and contractions, particularly in the chest, and convulsive efforts; and especially if the cough be dry, with great weakness.
DOSE. – A drop of the dilution, or six globules, to be dissolved in six spoonfuls of water, a spoonful to be given every half hour, until amelioration, or change.
Kalium bichromicum
If the attack be slow and insidious, symptoms at first slight, becoming very gradually severe, until the sound of the air in breathing becomes shrill and whistling, even quite low down in the windpipe; cough, not frequent, but dry and hoarse, or metallic; throat red and swollen, or covered with something resembling false membrane; head thrown back; offensive breath; diminished temperature; prostration; stupor.
DOSE. – One drop of the dilution, or six globules, in ten spoonfuls of water, a spoonful to be given every half hour, until amelioration or change.

Phosphorus
may be given in croup if Hepar sulph. and Spongia fail of affording relief, and especially if there be a manifest constrictive oppression across the breast; short and difficult breathing with anguish; cough dry, shaking and convulsive, with loss of voice.
DOSE. – One drop of the dilution, or six globules, in six spoonfuls of water, a spoonful to be given every half hour, until amelioration or change.
Sambucus nigra
for catarrhal or true membranous croup, when there is an accumulation of much viscous mucus in the windpipe and throat; the paroxysms of spasmodic suffocating cough are attended with cries, tossing and anguish, and the respiration is quick and wheezing.
DOSE. – One drop of the dilution, or six globules, in six spoonfuls of water, give a spoonful every half hour, until amelioration or change.
Antimonium tartaricum
In many obstinate cases, especially if there be symptoms of paralysis of the lungs, great difficulty of breathing, face livid and cold, pulse small and rapid, or feeble and slow, great weakness and anxiety, disposition to sleep; or if there be an excessive accumulation of mucus in the chest, with paroxysms of suffocative cough, and difficult breathing; especially useful after Phosphorus.
DOSE. – One drop of the dilution, or six globules, in ten spoonfuls of water, a spoonful to be given every fifteen minutes, until amelioration or change; or it may be given every half hour, in alternation with Belladonna or Aconite.

Remark
There are large number of other remedies which have proved serviceable in croup. A knowledge of their symptomatic indications may be learned from other sources. It is believed that the above will be found sufficient for a work on domestic practice.
A disease so nearly resembling croup, as to have been termed by some Spasmodic Croup, by others, Millar’s Asthma, or Asthma of Millar, is deserving of a separate notice in this place.

It is supposed to consist mainly in a spasmodic contraction of the top of the windpipe, there being little or no evidence of membranous or even of mucus exudation. The attack commences very suddenly, the breath is drawn in with difficulty, or with a peculiar crowing or ringing noise, the face and extremities become purple, the hands often clenched, the feet and toes drawn up; the attacks recur frequently at short intervals, whilst the remissions are usually more perfect and complete, than in ordinary or true croup; little or no cough, fever, or symptoms of inflammatory disease, though in the efforts for breath, the countenance may be flushed and swollen, with an expression of extreme anxiety and distress.
The remedies usually employed are Aconite, Belladonna, and Sambucus, which may be administered according to the directions already given under the article Croup; or where the above symptoms exist, give first, Belladonna, one drop, or six globules, in six teaspoonfuls of water, a teaspoonful to be administered every five or ten minutes. If a change do not occur within one hour, and the danger appear imminent, give Sambucus in the same manner as Belladonna for one hour, and then return again to Belladonna, or give Hyoscyamus, six globules, in six spoonfuls of water, a spoonful to be administered every ten minutes or oftener, until a change is effected. After Belladonna or Hyoscyamus, Cuprum, Arsenicum, or Tartar emetic, may be indicated.
The patient, in a case of croup, should always be kept of an even temperature, in a room neither too warm nor too cold, and should be kept in the same room day and night; the air of the room should be kept perfectly clear and pure, free from all gases, vinegar, camphor and other fumigations, as well as from all odors, and strong-smelling substances. The diet should be mucilaginous, as oat-meal gruel, barley water, toast water, and c., though in some cases, broths made of the lean portions of beef or mutton, or the dark meat of chicken, from which the skin has been carefully taken, may be allowed.

In administering medicines to children, it is not always necessary to give a full spoonful of the medicine. When medicines are administered every five or ten minutes, a few drops of the dilution placed upon the tongue will always proves equally efficacious, and where there is great difficulty in swallowing, and especially if water appear to increase the spasms, a single globule placed upon the tongue at frequent intervals, with occasionally a few drops of the dilution, will be found useful and satisfactory.
Rely implicitly upon the remedies. Never on any occasion resort to fomentations, cataplasms, hot or cold baths, or other old wives’ fables, unless specifically called for by some well recognized homoeopathic adaption. Never use warm foot-baths, especially not unless the feet are hot. Let the skin be kept clean and well covered.
In severe cases of croup, physicians of the old school have recourse to tracheotomy, or to opening the windpipe for the removal of the false membrane, and also to caustic applications of the nitrate of silver, but generally with very indifferent success. Much more rational as well as homoeopathic, we should think, Dr. C. D. and his son Dr. J. Forsyth Meigs, of Philadelphia, recommend the use of Alum, which in their hands appears to have performed many extraordinary cures, although I am not aware that it has been used in homoeopathic practice. Dr. Rush recommends the free use of Calomel, and as high as three hundred grains are said to have been administered to a child in the short space of twenty-four hours. The usual allopathic treatment is by bleeding, blistering, vomiting, and the administration of Asafoetida and Opium. From such crude and undigested, as well as dangerous and heroic treatment, we turn with pleasure to the sampler and more rational, as well as safer, more efficient, and more successful treatment, which we have indicated above, confident that all persons of truly scientific minds will receive with pleasure the truths which homoeopathy alone had the power to unfold and bring to light.