Croup is an acute laryngitis of childhood, usually occurring between the ages of two and six years. The nervous element is more marked than in adults, so that the symptoms appear more alarming. The trouble frequently arises as part of a cold, or as a forerunner of a cold, and often is heralded by some hoarseness during the day, increasing toward night. The child may then be slightly feverish (temperature not over 102° F., usually). The child goes to bed and to sleep, but awakens, generally between 9 and 12 P.M., with a hard, harsh, barking cough (croupy cough) and difficulty in breathing. The breathing is noisy, and when the air is drawn into the chest there is often a crowing or whistling sound produced from obstruction in the throat, due to spasm of the muscles and to dried mucus coating the lining membrane, or to swelling in the larynx. It is impossible to separate these causes. The child is frightened, as well as his parents, and cries and struggles, which only aggravates the trouble. The worst part of the attack is, commonly, soon over, so that as a rule the doctor arrives after it is past. While it does last, however, the household is more alarmed than, perhaps, by any other common ailment.

Death from an attack of croup, pure and simple, has probably never occurred. The condition described may continue in a less urgent form for two or three hours, and very rarely reappears on following nights or days. The child falls asleep and awakens next morning with evidences of a cold and cough, which may last several days or a week or two.

The only other disease with which croup is likely to be confused is membranous croup (diphtheria of the larynx), and in the latter disorder the trouble comes on slowly, with hoarseness for two or three days and gradually increasing fever (103° to 105° F.) and great restlessness and difficulty in breathing, not shortly relieved by treatment, as in simple croup. In fifty per cent of the cases of membranous croup it is possible to see a white, membranous deposit on the upper part of the throat by holding the tongue down with a spoon handle and inspecting the parts with a good light.

Croup is more likely to occur in children suffering from adenoids, enlarged tonsils, indigestion, and decayed teeth, and is favored by dry, furnace heat, by exposure to cold, and by screaming and shouting out of doors.

Treatment. Place the child in a warm bath (101° F.) and hold a sponge soaked in hot water over the Adam’s apple of the throat, changing it as frequently as it cools. Hot camphorated oil rubbed over the neck and chest aids recovery. If the bowels are not loose, give a teaspoonful of castor oil or one or two grains of calomel. The most successful remedies are ipecac and paregoric. It is wise to keep both on hand with children in the house. A single dose of paregoric (fifteen drops for child of two years; one teaspoonful for child of seven years) and repeated doses of syrup of ipecac (one quarter to one half teaspoonful) should be given every hour till the child vomits and the cough loosens, and every two hours afterwards. The generation of steam near the child also is exceedingly helpful in relieving the symptoms. A kettle of water may be heated over a lamp. A rubber or tin tube may be attached to the spout of the kettle and carried under a sort of sheet tent, covering the child in bed. The tent must be arranged so as to allow the entrance of plenty of fresh air. Very rarely the character of the inflammation in croup changes, and the difficulty in breathing, caused by swelling within the throat, increases so that it is necessary to employ a surgeon to pass a tube down the throat into the larynx, or to open the child’s windpipe and introduce a tube through the neck to prevent suffocation.

The patient recovering from croup should generally be kept in a warm, well ventilated room for a number of days after the attack, and receive syrup of ipecac three or four times daily, until the cough is loosened. If ipecac causes nausea or vomiting, the dose must be reduced. The disease is prevented by a simple diet, especially at night; by the removal of enlarged tonsils and adenoids; by daily sponging, before breakfast, with water as cold as it comes from the faucet, while the child stands, ankle deep, in hot water; and by an out of door existence with moderate school hours; also by evaporating water in the room during the winter when furnace heat is used. When children show signs of an approaching attack of croup, give three doses of sodium bromide (five grains for child two years old; ten grains for one eight years old) during the day at two hour intervals and give a warm bath before bedtime, and rub chest and neck with hot camphorated oil.