en designated
as croup. But two of these are worthy of consideration here. These are
_true_ or _membranous_ croup, in which a false, semi-organized membrane
is formed, and _spasmodic croup_. Both may result fatally, but the
former is much the more dangerous.

MEMBRANOUS CROUP is supposed to originate in the trachea, from which, as
it progresses, it often extends upward to the larynx, and downward to
the bronchial tubes. It is the result of severe inflammation of the
mucous membrane, and is characterized by the formation of a false
membrane, which covers or lines the inner surface of the true structure
(see Fig. 1). It is formed of a coagulable, semi-fluid exudation from
the mucous membrane. On being brought to the surface and into contact
with the inspired air, this substance grows thick and tough, or
leathery, as we find it. It is the obstruction in the respiratory canal
which this foreign matter causes that gives rise to the labored
breathing, and the ringing, brassy cough, together with the crowing or
whistling inspiration characteristic of croup. Before recovery can take
place this membrane must be detached and expelled. The cough is nature's
effort to accomplish this work.

The formation of this adventitious membrane in the larynx is attended
with more danger than when it is confined to the trachea. In most cases
in which the disease has had a very speedily fatal termination, an
examination has shown that the larynx was its chief seat.

SYMPTOMS. True croup is generally preceded by what is known as "a cold."
The child coughs, sneezes, and is hoarse. It is the hoarseness and the
peculiar _character_ of the cough which indicate the tendency to croup.
This has been already described. In addition, the child is restless,
fretful and feverish. The disease makes rapid strides. Finally the cough
ceases to be loud and barking, and is very much suppressed; the voice is
almost gone; the face is very pale; the head thrown back; the nostrils
dilated and in perpetual motion, the pulse at the wrist very feeble,
great exhaustion, more or less delirium, and, finally, death comes to
the relief of the little sufferer. Convulsions sometimes occur in the
last stages, and soon terminate fatally.

TREATMENT. No time should be lost in commencing treatment. Hot
fomentations should be applied to the throat and upper portions of the
chest. The free inhalation of steam should be employed early. The
following treatment has been found very