an that of the disease
itself. The peculiar sound is heard in two different conditions--the one
in which a child having caught cold, instead of the air-tubes alone
being affected, the windpipe, and especially its upper part, becomes
congested, and the lining membrane swollen. Partly owing to this, partly
owing to its nerve-supply being disturbed, the child breathes noisily
and hoarsely, and the cough has a peculiar metallic clangor. In the
other case there is not merely the congestion of the windpipe, the
disturbed nerve-supply, and the swollen state of the membrane; but in
connection with the influence of the special poison of diphtheria, a
deposit takes place at the back of the throat, whence it extends to the
windpipe, and in many instances even far beyond it, blocking up its
canal, and mechanically excluding the entrance of air.

To determine at once to which class a case of croup belongs is so far
from easy, that I should advise that on the first sound of voice, or
cough, or breathing resembling that of croup, medical advice should at
once be sought. I dwell on the difference between the two: the first
which has been called false croup, or better catarrhal croup, and the
second called true croup, or diphtheritic croup, in order to save much
needless apprehension to parents, in whose mind the croupy sound is
invariably associated with nothing short of that most dangerous
disease--diphtheria.

As a general rule catarrhal croup is rarely met with after the age of
six. Children in whom it occurs have either seemed quite well, or at
most have been a little ailing for a day or two with cold, and cough,
and perhaps slight hoarseness. They go to bed and fall asleep as usual,
but the cough, which does not wake them, becomes suddenly noisy,
ringing, croupy, and the breathing is speedily attended with a
long-drawn sound, half-hissing, half-ringing, and the child soon wakes
alarmed, and fighting for breath, the skin bathed in perspiration, the
face flushed and anxious. The cough, the difficult breathing, and the
struggle for air last for an hour or two, or sometimes all night long,
though they gradually subside, at any rate towards the approach of
morning, when the child falls asleep, and, but for a somewhat hoarse
sounding cough, and a look of fatigue, there are but few signs of all
that it has endured.

The attack may not return, or it may recur for two or three successive
nights, though in general with lessened severity,