oup_ quickly show themselves at the
outset of the disease. Sometimes a sore throat, a short, dry cough, and
a slight harshness of breathing, usher in the affection; in other
instances, that which first attracts attention is hoarseness in the cry
or tone of the voice, attended with, or quickly followed by,
feverishness, thirst, and dulness, or fretfulness; while in another
class of cases the disease suddenly developes itself without any
noticeable premonitory signs. In all these cases the characteristic
symptoms of the disease commonly make their appearance at night. The
child's sleep is disturbed by a peculiar clanging cough, which, when
once heard, will ever afterwards be remembered and easily recognised.
The skin becomes hot and dry, the breathing difficult, the cough more
frequent, and the child is soon awakened, frightened, and struggling for
breath. With flushed face and staring eyes, the little sufferer starts
up, grasping the throat with the hand as if seeking to remove some
encircling pressure which is choking it. Each drawing in of the breath
is attended with a hissing sound, the redness of the face and neck
increases, and speech becomes impossible. This attack may pass off in a
few minutes, or be prolonged, with varying degrees of intensity, for an
hour. Almost invariably, however, it is followed by a period of relief,
in some instances so complete as to deceive the anxious relatives into
the belief that the disease is over and the child safe. This false
confidence is, unfortunately, generally soon rudely dissipated by a
return of the attack in all its first violence.

The disease attains its height by the end of the second, or at the
latest the close of the third day. The fever is now the hottest, the
tongue becomes white, the face and forehead red and covered with
perspiration, the lips at times purple, the veins of the neck and
temples distended, the countenance distressed, and the voice whispered
or suppressed. The cough is now also most frequent and noisy; its
peculiar sound has been compared to that made by a fowl when caught in
the hand. The thirst is great, but swallowing difficult. The child often
inserts its fingers in the mouth as if trying to clutch something which
closes the air passages. These symptoms may either increase to the rapid
exhaustion of the patient or take a favorable turn. One of the first
evidences of the latter is a change in the character of the cough,
which, although it may not l