It is needless to dwell upon spasmodic croup. It scares the family and may lead to unnecessary dosing, but seldom does any additional harm. If it is not related to Aconitum (with fever), or Spongia (sudden attack at night), at a glance, I study up the similar medicine.
Membranous croup, pseudo-membranous laryngitis, croupous laryngitis, has killed many a victim and demands careful attention. The exudation upon the mucous surface is fibrinous. Although rated with diphtheria, it differs from diphtheria in that it has no penetrating odor and leaves no scar.
It tries a physician’s nerves to see a child perish under the torture of membranous croup. He may in consequence err in judgment and do too much, and thereby lose a case that might otherwise have been saved.
Aconitum has been a potent weapon in my hands when there were fever, hot, dry skin, thirst, fear and restlessness. From numerous cases I select the worst one for illustration. After a struggle lasting twenty-four hours, the attending physician had said to the family that there was no chance whatever for the little boy. He welcomed their suggestion to call me in, and expressed a wish to be free of responsibility. The prospect was most discouraging. Membrane covered the throat and invaded the larynx. The symptoms first named above were all present. I made a solution of Aconite two-hundredth, and began to give it every fifteen minutes. After two hours of this there seeming to be a slight amendment, the doses were placed twenty minutes apart, and so on. It was about sunset when we began. About eight o’clock the next morning the patient was evidently improving, and the medicine was given every hour. I had ordered every dose myself and now took a recess. Subsequently the same plan of abatement of doses as improvement was seen was followed. After two days of this work the cure was complete.
Antimonium tartaricum has often been indicated in my practice. The demand for it is so definite that none should fail to comprehend. Face cold, bluish, covered with cold sweat, pulse frequent, voice soundless, sawing respiration, rattling respiration, as if the air passages were full of mucus, without expectoration; larynx painful to touch, great prostration, beginning paralysis of pneumogastric nerves. Aggravation in the morning. Tartar emetic has helped me out with some desperate cases having the foregoing peculiarities. If it has been indicated and failed to cure, then nothing else, not even tracheotomy, has been of any use.
Belladonna is often needed in spasmodic croup. It is also occasionally the remedy in the more serious malady. It serves me best for a sensitive nature, with hot head, large pupils, flushed face, dry and hot skin, full and sharp pulse, dry, barking cough, swollen red tonsils, patches of exudation on fauces. Aggravation 3 p. m. Midnight attacks.
Hepar sulphuris calcareum has a loose, rattling, choking cough, worse in the morning [compare ant. t.]. My cases have more frequently demanded Hepar by virtue of a hoarse, dry, barking cough. The child cries when coughing. Whistling respiration. Swelling of neck in region of trachea. Worse before midnight. Boenninghausen says worse in east and north wind. Dunham confirms this statement as for Germany, and reminds us that the American west and north-west wind corresponds with the other of Germany. The west and northwest wind (dry and cold) has figured in all my Hepar cases. When indicated, this remedy is mighty.
Kali bichromicum. Dyspnoea, hoarse, rough cough, breathing sounds as if the air were passing through a metallic tube. Often needed in the worst cases of membranous croup and diphtheritic croup. (See Diphtheria.)
Lachesis. Occasionally needed in true croup. Patches on fauces. Larynx painful to touch. I have always insisted upon having a number of the grand, general characteristics of Lachesis shown by the case, before giving it in this disease.
Phosphorus has been of most assistance to me when hoarseness persisted and the disease exhibited a tendency to relapse after most of the work had been done by other remedies. Others have had cases that needed phosphorus from the start. Then the tout ensemble was that of a typical phosphorus patient.
I no longer do tracheotomy upon short necked, fat children having membranous croup, unless solicited to do it. Aside from the difficulties attending the operation upon such patients — and they are not to be despised — tracheotomy has disappointed me after faithful trial. It gives temporary relief, but the disease nevertheless extends downwards. The system shows more and more the effects of poison, and the patient succumbs to asphyxiation or exhaustion. Of course, I have not operated until driven into a corner. “Just so,” says my surgical friend, “I operate earlier and save a number.” “Exactly,” say I “but a good proportion of such cases as you operate upon I cure with the indicated remedy, and without operation. Shall we compare statistics of the sums total?”
Intubation was hailed as a great boon and I have no desire to belittle its claim, but I observe a falling off in enthusiasm for it and an increasing catalogue of detraction. I have never done intubation, and do not own a set of tubes. I am, perhaps, too apathetic, but it is not easy for me to understand why intubation should save a desperate case that tracheotomy cannot save. Did some say “begin early?” I thought so. It is not a strong argument with a Hahnemannian. Since learning the futility of tracheotomy in the specified class of subjects, I also wish to be allowed to begin early with the similar medicine. My percentage of cures is greater than it was formerly. If operation must be early or fail, let me rely upon the more mighty early prescription.