still further reduced the functional energy of the respiratory organs, a viscid matter rises in bubbles, and one of these bubbles, like a tenacious membrane, closes the tube of the larynx. Suffocation results, and, in the ensuing struggle for life, Nature has a very slim chance to prevail. In our Northern States alone, five or six thousand perish thus every year—killed by domestic contrivances as surely as the prisoners of Surajah Dowlah were killed by the architectural arrangements of the Black Hole. If the physician is only called in the last stage of the deliquium, inflammatory croup constitutes one of those exceptional cases where artificial causes of disease have to be met by artificial remedies. The far-gone exhaustion of the patient, a thin, expiring pulse, would indicate that tracheotomy, or the opening of the windpipe, offers the only hope of salvation. A violent, suffocating, and spasmodic cough would indicate that the expulsive efforts of Nature require the aid of a swift emetic—tartar or ipecacuanha.
But, if the symptoms of danger are heeded in time, croup is as curable as a common catarrh. As soon as the characteristic cough betrays the condition of the windpipe, the patient—infant or adult—should be reduced to two meals, the last one not later than four hours before sunset. Flesh-food, greasy made-dishes, narcotic drinks, as well as all kinds of alcoholic stimulants, should be strictly avoided. Before night the bed should be removed to a cool and carefully ventilated room. Families who have no alternative should not hesitate to open every window for at least fifteen minutes, and in the mean while compromise with their prejudices by carrying the child to the next neighbors, rather than bring it back before the air of the bedroom has been thoroughly purified. A draught of very cold air might possibly excite a cough that would precipitate the crisis of the disease, though by no means lessen the chances of a lucky issue. But more probably fresh air, whether cold or cool, would so re-enforce the remedial resources of Nature that the inflammation would subside in the course of a few days.
If in spite of such precautions a strangling-fit should occur at night, the child should be immediately raised to a half-upright position, by making the weight of the body rest on the knees, with the head slightly inclined (face downward), the elbows back, and the hands resting against the hips the position which a person would instinctively assume in the endeavor to aid an expulsive effort of the lungs. Between the paroxysms ease the chest by a quick forward-and-backward movement of the arms, and by persistent friction with a wet brush, applied to the neck and the upper ribs. Under the influence of these stimulants, combined with the invigorating tendency of fresh air, the organism will employ all its resources to the best advantage and soon relieve itself by a sort of retching cough. If the difficulty has not been aggravated by the use of "croup-sirup," the patient will rest at ease for the remaining hours of the night. A week may go by with-
