may continue in a less urgent form for two or three hours, and very rarely reappears on following nights or days. The child falls asleep and awakens next morning with evidences of a cold and cough, which may last several days or a week or two.

The only other disease with which croup is likely to be confused is membranous croup (diphtheria of the larynx), and in the latter disorder the trouble comes on slowly, with hoarseness for two or three days and gradually increasing fever (103° to 105° F.) and great restlessness and difficulty in breathing, not shortly relieved by treatment, as in simple croup. In fifty per cent of the cases of membranous croup it is possible to see a white, membranous deposit on the upper part of the throat by holding the tongue down with a spoon handle and inspecting the parts with good light.

Croup is more likely to occur in children suffering from adenoids, enlarged tonsils, indigestion, and decayed teeth, and is favored by dry, furnace heat, by exposure to cold, and by screaming and shouting out of doors.

Treatment. Place the child in a warm bath (101° F.) and hold a sponge soaked in hot water over the Adam's apple of the throat, changing it as frequently as it cools. Hot camphorated oil rubbed over the neck and chest aids recovery. If the bowels are not loose, give a teaspoonful of castor oil or one or two grains of calomel. The most successful remedies

A

are ipecac and paregoric. It is wise to keep both on hand with children in the house. A single dose of paregoric (fifteen drops for child of two years; one teaspoonful for child of seven years) and repeated doses of syrup of ipecac (one-quarter to one-half teaspoonful) should be given every hour till the child vomits and the cough loosens, and every two hours afterwards. The generation of steam near the child also is exceedingly helpful in relieving the symptoms. kettle of water may be heated over a lamp. A rubber or tin tube may be attached to the spout of the kettle and carried under a sort of sheet tent, covering the child in bed. The tent must be arranged so as to allow the entrance of plenty of fresh air. Very rarely the character of the inflammation in croup changes, and the difficulty in breathing, caused by swelling within the throat, increases so that it is necessary to employ a surgeon to pass a tube down the throat into the larynx, or to open the child's windpipe and introduce a tube through the neck to prevent suffocation.

The patient recovering from croup should generally be kept in a warm, well-ventilated room for a number of days after the attack, and receive syrup of ipecac three or four times daily, until the cough is loosened. If ipecac causes nausea or vomiting, the dose must be reduced. The disease is prevented by a simple diet, especially at night; by the removal of enlarged tonsils and adenoids; by daily sponging, before breakfast, with water as cold as it comes from the

faucet, while the child stands, ankle deep, in hot water; and by an out-of-door existence with moderate school hours; also by evaporating water in the room during the winter when furnace heat is used. When children show signs of an approaching attack of croup, give three doses of sodium bromide (five grains for child two years old; ten grains for one eight years old) during the day at two-hour intervals and give a warm bath before bedtime, and rub chest and neck with hot camphorated oil.

CHAPTER III

The Lungs and Bronchial Tubes

Meaning of Bronchitis-Symptoms and Treatment-Remedies for Infants-Pneumonia-Consumption the Great Destroyer— Asthma-La Grippe.

COUGH (occurring in Bronchitis, Pneumonia, Consumption or Tuberculosis, Asthma, and Influenza or Grippe).-Cough is a symptom of many disorders. It may be caused by irritation of any part of the breathing apparatus, as the nose, throat, windpipe, bronchial tubes, and (in pleurisy and pneumonia) covering membrane of the lung. The irritation which produces cough is commonly due either to congestion of the mucous membrane lining the air passages (in early stage of inflammation of these tissues), or to secretion of mucus or pus blocking them, which occurs in the later stages.

Cough is caused by a sudden, violent expulsion of air from the chest following the drawing in of a deep breath. A loose cough is to be encouraged, as by its means mucus and other discharge is expelled from the air passages.

A dry cough is seen in the early stages of various respiratory diseases, as bronchitis, pneumonia, pleurisy, consumption, whooping cough, and with irritation

from enlarged tonsils and adenoids (see p. 61) occurring in children.

Irritation produced by inhaling dust, or any irritation existing in the nose, ear, or throat may lead to this variety of cough. The dry cough accomplishes no good, and if continuous and excessive may do harm, and demands medicinal relief.

Bronchitis.-Cough following or accompanying cold in the head and sore throat generally means bronchitis.

The larynx or lower part of the throat ends just below the "Adam's apple" in the windpipe. The windpipe is about four and a half inches long and three-quarters to an inch in diameter, and terminates by dividing into the two bronchial tubes in the upper part of the chest. Each bronchial tube divides and subdivides in turn like the branches of a tree, the branches growing more numerous and smaller and smaller until they finally end in the microscopic air sacs or air cells of the lungs. The bronchial tubes convey air to the air cells, and in the latter the oxygen is absorbed into the blood, and carbonic acid is given up. Bronchitis is an inflammation of the mucous membrane lining these tubes. In cough of an ordinary cold only the mucous membrane of the windpipe and, perhaps, of the larger tubes is inflamed. This is a very mild disorder compared to inflammation of the smaller and more numerous tubes.

In bronchitis, besides the ordinary symptoms of a