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♦ 
C R 0 U P
ITS SPECIFIC  REMEDY
HENRY JJIGAND, M. D.
29/fk
        BOSTON:
OTIS CLAPP,  SCHOOL STREET,
     NEW YOEK, WILLIAM RADDE.
   PHILADELPHIA, C. L. RADEMACHER.
           1846. 
 WF
l'S4rt
         BOSTON:
PRINTED BY FEEEMAN AND BOLLES,
      DEVONSHIRE STREET. 
PREFACE.
   These few pages are given to the public, with the
sincerest wish of the author that, by the publication  of
a remedy used so successfully in the treatment of croup,
every physician, and every father and mother, might be
induced  to  use this remedy in similar cases, and thus
save the lives of  thousands of children, the pride and
hope  of  parents, .who, without this remedy, cannot be
saved from a most horrid death.
   The author is  a foreigner; and the deficiencies  of
this little pamphlet the reader will kindly  excuse, and
attribute  the same to his not very extensive knowledge
of the English language.
Boston, June,  1846. 
CONTENTS.
		Page
I.	Introduction, ....	5
II.	What is Croup, ....	. 7
III.	Nature and Seat of Croup,	7
IV.	Causes of Croup, ....	. 9
V.	How to prevent Croup,	10
VI.	Course and Symptoms of Croup,	. 11
VII.	Diagnosis, ....	13
VIII.	Prognosis, .....	. 14
IX.	Treatment by Cold Water,	14
X.	Utensils, &c, necessary for the Operation,	. 15
XL	How to apply the Water,	15
XII.	Phenomena during and after the Operation, .	. 17
XIII.	Diet and Convalescence, .	22
 
INTRODUCTION.
  For sixty years physicians have been endeavoring to dis-
cover a remedy for the cure of croup.  Almost every  drug
of the shops has been tried over and over again ; and among
all these not one has attained such a celebrity as calomel.  A
great many doctors have believed this preparation of mercury
a specific against this disease ; some even have pronounced
it the  best and the never-failing remedy.  However, every
physician of the old school now knows that children who are
laboring under a higher degree of croup, can, neither by small
nor large  doses of this poison, nor  by any other drug,  be
saved from  suffocation.  As croup commonly commences
with very slight symptoms, parents do not call for the aid of
a physician till the disease has reached a remarkable  height,
or, till paroxysms of suffocation commence.  In such an ad-
vanced stage of croup, allopathic treatment is of no avail,
and  the  application of vesicatories, leeches, emetics and
calomel, which are administered in rapid succession, are only
additions to the increasing  pain and distress, from which
these unfortunate children already suffer so intensely.
  Homoeopathic physicians  have treated  this disease  with
more success, by the administration of aconite, belladonna,
hepar, spongia, &c.; yet even  this treatment has, in  a great
many cases, proved unsuccessful; and it would be ridiculous
to recommend  or try either the one or the other kind  of
treatment,  when we  have   an  almost specific remedy for
croup — a  remedy so  simple,  and  yet  so powerful.   This
remedy is  cold water.   I, and many other physicians in this
country, and in Europe, have applied cold water in all stages
of croup ; and every one who has tried it  has become  con-
vinced that by it the life of thousands of children could  be
                 2 
6
saved, who without it must  undoubtedly suffocate.   Thirty-
three cases  of real croup have been reported lately by an
eminent  surgeon in Germany, which were treated  by him
with cold water exclusively, and of which he lost only two.
Is there a physician in the  world, who  can say that among
thirty-three  cases of croup  he has lost only two 1   Almost
daily are  children attacked by this fatally terminating dis-
ease. The word " croup" fills the heart of every mother with
the greatest anxiety;  and physicians owe  it to their  con-
science and humanity, after hundreds of  cases  have  been
treated so successfully by this remedy, to give it  a  trial.
Yet, fathers and mothers, should the physician hesitate to
apply this all-healing balsam,  and is the life of your  child
dear to you, do not  hesitate to apply the water yourselves.
Pills, calomel, and other poisonous things, only increase the
pain and sufferings  of your poor child, and hasten it to the
grave.  The operation with water  is very  simple, and the
necessary materials are  in the hands of every body;  only,
apply it strictly according to the prescriptions which I shall
give to you in the following  pages. 
CROUP.
  Croup is  a Scottish word, which signifies compres-
sion, and is applied to denote an acute inflammation of
the mucous membrane of the larynx, trachea and bron-
chial tubes.   This disease is characterized by a rapid
formation of a false membrane in the above-mentioned
canals.  The  name  "croup"  is transferred into all
languages; however,  other  names  are  also used, by
different writers, for the disease called croup.  Baillou
calls it " Affectio  orthopnoica ;" Michaelis, " Angina
membranacea ;" Albers, " Tracheitis infantum; " Hufe-
land, " Angina laryngea exsudatoria," &c.   The  time
of the  origin of this disease  is  unknown ;  though Mr.
Hagen thinks it appeared first since coffee was used as
a dietetic article.

            NATURE AND SEAT  OF CROUP.

   Croup is  of an  inflammatory nature.   It is well
known that membranous concretions are formed upon
spots of the skin, where a vesicatory has been applied ;
also, upon serous and mucous membranes which become
inflamed ; and, in  almost all post mortem examinations
of croup cases, the mucous membrane of the larynx has
been  found reddened, and  full of minute apertures.
Nevertheless, there have been, and are probably  yet,
physicians, who  deny  the   inflammatory  character of
croup, and call it a catarrhous and spasmodic affection. 
8
Catarrhous affection is at the same time  an inflam-
matory affection ;  and a  closer consideration of this
opinion would be  out  of  place.  Regarding the spas-
modic affection, they think it a contraction of the glot-
tis, by  which the  passage  of  air is  prevented.   As  a
proof of the correctness of this opinion,  they refer  to
cases, in  which dyspnoea  existed in  a high  degree,  or
suffocation had taken  place, though no  foreign body
was found after death,  and sufficient space was left for
the passage of the air.  These facts, however, are no
proof; for, by the inflammation of the glottis and the
passage of air through this narrow space, or the exist-
ence of a false membrane, the sensitiveness and irrita-
tion is  raised, and a spasmodic affection  is the  conse-
quence.   The contraction and spasmodic constriction
need not be so intense  as we at first  might  imagine, in
order to produce the horrid feeling of suffocation, which
is one of the characteristic symptoms of croup ;  for the
inflammatory swelling of the mucous  membrane is alone
sufficient  to  produce obstruction of  a canal, which, in
children, is only half as large as in adults.   It is true,
there are cases on record in which  no redness of the
canals was noticed, and no false membrane existed after
death ; but, in  all cases  of sudden  inflammation, does
not the  redness  of the  affected part disappear after
death ?   Or, if expectoration of the false membrane had
taken place previous to death, does  not this give suffi-
cient proof that inflammation had existed  ?   Moreover,
could it not  have  been another disease, very similar to
croup ?   Hereby it is obvious that neither  by the symp-
toms nor by the results of pathological anatomy, can any-
thing be  found which confutes the inflammatory nature
of croup.   But the question arises here, Whether croup
shows  itself  as a pure,  simple  inflammation, or as  a
peculiar  kind;  and whether  every inflammation of the
larynx must be considered as croup ?
   Every laryngitis, in  which we notice a tendency to
form a false membrane, gives sufficient evidence, by  its
symptoms, its causes and course, to be  distinguished 
9
from simple laryngitis ; wherefore it has been separated
from the latter by  the name  "croup."  It is  not  the
larynx alone, however, in which this false membrane is
formed ; we find it also in the trachea and bronchial
tubes; and, therefore, we have a laryngeal, a laryngo-
tracheal, and laryngo-bronchial croup.   Bronchial and
tracheal inflammation never exists without participation
of the larynx, while the latter is found inflamed without
affection of the former organs.
   Some writers, in France  and Germany,  think  the
croup a morbid affection of the blood and the nerves of
the affected organs. The disease of  the blood they
prove by the plastic lymph noticed in the same after
venesection ; the affection of the nerves, by a kind of
asthma preceding real croup, also by the great anguish
and restlessness in  the beginning of the disease, and the
peculiar cough.
CAUSES OF  CROUP.
  Croup is a disease of children.  Only a few cases are
on record where adults had been attacked by the same.
Nursing  children are  less liable to this disease,  than
weaned  children from the second up to  the  seventh
year.   Plethoric, fat  children, with auburn hair, who
were  always healthy,  are  attacked very  suddenly by
this disease, and die  by suffocation, a few  hours  after
commencement of the same.   Not unfrequently it ap-
pears epidemic; without spreading  so  rapidly as an
exanthematic disease, or as hooping-cough.  In the ma-
jority of cases, we find it sporadic, without contagion.
Many children are at once  taken by this disease, in
countries where  the  air  is kept  moist  constantly by
stagnant waters, and especially near the sea-shore, where
north and east winds prevail.   This, however, gives no
proof of a  contagious character.   Children who  take
cold suddenly, or who are exposed to a  draught of air
when warm, also boys who, with their head and  neck
uncovered, when very warm, expose themselves to the
            . 2* 
10
cold air, or run against the wind, talking and screaming
very loud, are liable to croup.  This disease is rare in
summer,  and  in southern  more  unfrequent  than in
northern  regions.  Moist air is  considered as  a* cause,
although the greatest part of croup cases is  noticed in
dry seasons.   Other predisposing causes are, a  too nu-
tritious diet, animal food, and heating  liquids — coffee,
tea and wine.

              HOW TO  PREVENT CROUP.

   In order to  prevent this  disease,  children should
become accustomed to the changes  of weather in all
seasons ; to a cold, hot, dry and moist  atmosphere ; to
north and south winds ;  avoiding, however, every sudden
change from warm to cold.  They should not be dressed
too  warm, and  especially the neck should be covered
lightly ;  for  nothing  favors  the susceptibility for this
disease more  than wearing fur around  the  neck.   The
wearing  of flannel upon the naked  skin is also  per-
nicious.   It produces irritability of the skin, and  every
slight change of temperature generates  catarrhous  affec-
tions.  Cold  bathing every day, and  a  glass of fresh
water before going out  in the air,  is an excellent pre-
ventive of this disease.
   The nourishment of  nursing  children should be very
simple, and food  be given to them in  very small  quan-
tities.   Overloading the  stomach  with food  produces
dyspepsy, as they are unable to digest  substantial  food ;
and overfeeding would produce abdominal difficulties,
 pain, crying,  and, by the latter, an early disposition for
inflammation of the respiratory organs.   Children should
also never be weaned at once, in order to prevent much
crying.  Coffee, tea, wine, high-seasoned and too warm
 food, as they come in immediate contact with the larynx,
 produce an irritability of the same ;  and the least changlj
of atmosphere  brings  on  inflammation of the mucous
 membrane.   More cool  than warm  food is highly re-
 commendable, in order to prevent this  disease. 
11
             f
               COURSE  AND SYMPTOMS.

.   Croup appears either  suddenly, with a strange-sound-
ing, spasmodic  cough, or with catarrhous affections, as,
hoarseness and harshness  of  voice, a dry  and rough
cough, with febrile motions of  the  blood,  the  cough
passing over into that peculiar croup-cough, resembling
the barking of  a dog, or the crowing of a young cock.
The hoarseness increases, and the breathing becomes
more whistling.  Afterwards a  remission  follows :  the
patient plays and eats, and the peculiar sound of respi-
ration  is only noticed  when he is laughing,  coughing or
crying.  All danger seems to be over.
   Second period.  Towards evening, or midnight, the
child becomes low-spirited, and awakes with the peculiar
barking cough, accompanied by slight pains  or contrac-
tions in the  trachea,  and an increased whistling sound
during  inspiration.   The face becomes red  during the
paroxysms, the bloodvessels of the neck and head in-
crease  in  size, and the pulse beats hard  and rapid.
From  one to three quarters of an hour afterwards, they
again become quiet, and sleep; and we could think the
danger had gone by, did not the pulse remain frequent,
the  trachea painful, and  the  cough rough  and rather
difficult.  Inflammation has now  taken place, and an
aggravation of the symptoms will be noticed, as soon as
the effusion of plastic lymph takes place, and as long as
the  same  continues.    The greater the collection  of
lymph is on the inner walls of the trachea, and after the
organization of the same into a pseudo-membrane, the
more is  the canal contracted, and respiration rendered
difficult.  After effusion, the paroxysms become more
violent and frequent, the  cough more barking, accom-
panied  sometimes with expectoration  of  membranous
masses.  The  patients  grasp with  the  hand  at  the
larynx, and complain  of pain there ; and the formation
of the  pseudo-membrane has now taken place.  By con-
tinued effusion, and formation  of the plastic lymph into 
12
an organic mass, the respiratory canal becomes shut up
almost entirely, and suffocating paroxysms appear.   In-
flammation of the pharynx  is very rare, and  has  only
been  noticed in those cases where the tonsils were in-
flamed.
   Third period.  Inspiration becomes more loud, whist-
ling, short, difficult; the head is bent backwards ; the
throat stretched and extended upwards, and painful to
the touch or in coughing.   In the beginning of the dis-
ease the constitutional affections are very slight; in the
third  period, however,  when the paroxysms  become
very  frequent,  the  whole  organism  is  affected, and
convulsions of the muscles of the face and other parts
take place.  Drinking irritates the cough, and  produces
new paroxysms ;  therefore the  patients  are  averse  to
taking liquids.  The pulsation of the heart and arteries
varies, according  to the  slow or quick, deep  or short
respiration.   The anxiety  becomes indescribable ; no
position is comfortable ; the patients jump out of the
bed, tear out the tongue, pull the hair, run to the nurse
or mother, clasping  their clothes firmly and begging for
air; or brace their hands and feet against the wall, in
order to obtain inspiration.  Shortly after such a parox-
ysm, we see them sink on the bed, pale, exhausted, and
of  a  bloated  appearance.  They seem  sleeping, with
the eyes half open, and the albuginea of  an inflamed
appearance.  But not long does the patient  remain in
that quiet state.  Again he is roused up.   We feel the
trembling of the  heart, the vibrating of the  carotids ;
we see spasmodic  contractions of the diaphragm, the
cartilages of the ribs, and even the sternum is violently
drawn back ; the shoulders rise high up, the abdominal
muscles are drawn towards the back, the larynx up to
the chin ;  the  nostrils wide open ;  the eyes sunk and
extinguished, surrounded  by blue borders.  We  hear
only a hoarse, cawing, whimpering for air  and liquids.
In the adjoining room, we can hear the sawing noise of
breathing, which at length becomes rattling, the cough*
having disappeared entirely.  Medicine  is  taken  by 
13
these  unfortunate  children  with  their  full  senses.
Larger children force down  sugar and crusts of bread,
in order to remove the obstacle ; and, if unable to whis-
per, they give  signs imploring for help.   They  some-
times lacerate themselves with the  finger-nails and teeth,
or push the hands deep  into the mouth, and rush with
their heads against the walls, crying for air, till they at
length fall dead upon  the floor.   Some die during a
spasm ; others become quiet, and, with  cold sweat all
over, expire, like the going out of a candle.
   Its course is very  rapid.   The  disease terminates
within two, three, to six days.  Death ensues by suffo-
cation or by apoplexy.
   The  appearances after death are like those of suffo-
cated persons.  The mouth is covered with mucus ;  the
walls of the same are perfectly sound ; tonsils and pha-
rynx sometimes inflamed ; larynx,  trachea, and  often
the bronchial  tubes, are covered  with the false mem-
brane, producing entire obstruction, or considerable con-
traction of the glottis, and  in many cases closed by it as
by a valve.  The thickness of the membrane is  not in
all cases alike ; it is commonly like thin paper, and in-
soluble in water.

                      DIAGNOSIS.

   The characteristic signs of croup, already described,
leave almost no doubt of its  existence ; nevertheless it
has been confounded with simple laryngitis, in which
hoarseness and the so-called sheep-cough were present;
also with asthma acutum  infantile.   The latter is  dis-
tinguished from croup by  this: that  it appears without
being preceded by  any  catarrhal symptoms, accom-
panied with no febrile affections,  and the  attacks cease
entirely for hours.   Angina tonsillaris, which disease
consists in swelling of  the  tonsils,  has  some similarity
with croup ; but is attended with no cough.  Combina-
tions of croup with pneumonia and gastritis are not un-
 frequent.   They are   ascertained  by percussion  and
 auscultation. 
14
                     PROGNOSIS.

  In the majority of cases, croup  is to be considered as
a  dangerous,  fatally  terminating  disease,  especially
under allopathic treatment.  Nursing children recover
easily, and in a short time, and are not liable  to such
violent  paroxysms as  older children.   Scrofulous  pa-
tients recover very slowly.   Combined with measles, it
is less dangerous than sporadic.  In the first and second
stage, before the formation of the false  membrane  has
taken place, there is a greater chance of saving the child
than in the third period.  Death sometimes ensues by
great weakness and  dyspnoea, even if expectoration of
the pseudo-membrane has taken place.  The symptoms
of  the  third period — increasing dyspnoea, whistling
respiration, accompanied with a loud rattling, rapid con-
traction and extension  of  the  abdominal muscles, are
commonly signs of approaching death.  Bloatedness is
one of the gravest symptoms.   Recovery might be  ex-
pected,  if the  paroxysms become less, and the cough
loose, accompanied  with a slight rattling.   If strong
emetics have been administered,  we generally find that
the patients are troubled with hoarseness and dyspnoea
for  a  long time,  which may arise  from  coagulated
lymph, settled  down  in different places of the lungs and
air-tubes.

            TREATMENT BY COLD WATER.

  The treatment of  croup  by cold water is  not a new
discovery.  Drs. Harder, Hagen, and others, have  re-
ported cases already in which  they applied cold water
with great success,  after leeches, emetics, blisters  and
calomel had been administered in  vain.  Few physicians,
however,  took  notice  of these facts.  The first case
which I treated myself with cold water, after the usual
medicines had been given without any particular effect,
was executed with  a febrile  anxiety.   However, the 
15
operation proved  successful ;  and  since  that, I have
cured  all croup cases which came under my treatment
with the mere application of cold  water.  How such an
effect  can be produced by a simple remedy, like cold
water, is astonishing, but nevertheless very natural and
obvious.  By the sudden application of cold water,  the
great heat in the affected parts is vanquished  at once,
and the swelling of  the  inflamed larynx is  immediately
diminished ; hereby the air-passage becomes enlarged,
and the  patient  is  enabled to  breathe  more  freely.
Moreover, the lungs, by the shock produced by  the
sudden affusion of the cold water, become irritated, and
make  a strong  effort to draw  in  the  atmospheric air
with all their power.  The consequence of this  is, that
an extension of the air-passages, and a  separation of the
plastic  lymph  or false  membrane, takes  place.  This
effort is so certain, and so natural, that  every body, who
is  able to  reason, will  find it  true.   As  suddenly as
children are attacked by this fatal disease, as easily  can
they be cured of it, by an early and proper water-treat-
ment.

    UTENSILS, ETC., NECESSARY FOR  THE OPERATION.

   These are : several dry and soft towels ; a large,  not
too coarse sheet; a straw pillow ; a large  sponge, or a
clean piece of linen, for washing  the child ; a bath or
common wash-tub, filled with three or four pails full of
fresh well-water; another  empty tub, which  must  be
large enough to put the  child in it in a sitting position ;
a large pitcher; several pounds of ice, and two or three
hogs' bladders.  In winter, the room should have a tem-
perature of 15°  or 16° R. (66° or  68° Fahrenheit.)

             HOW TO APPLY THE WATER.

   After all these things have been put  in readiness,  the
patient is undressed, and the  sweat wiped off  from  the
whole body with a dry towel.   We  then  take a large 
16
sponge, dipped  into  fresh water, and  wash  first  the
head, neck, thorax, back and abdomen, and finally, the
upper and  lower extremities.   The patient is  then  put
into the bathing-tub, and  held  in  a  sitting position by
two assistants.  Again  the whole body, from  head to
foot, must be washed  with cold water.   As soon as the
patient  is thus cooled off, we  proceed  by pouring the
cold water  (a gallon or  more, at once,) at short  inter-
vals, alternately over his head and neck, and  continue
these affusions for  five or ten  minutes, according to the
degree of the disease.  The  water must not be poured
slowly over the patient,  but suddenly, from a height of
about two feet, and directed particularly upon  the back
part of  the head and  back of  the  neck.  During these
affusions, one of the assistants keeps rubbing gently the
back, and  the  other  the  breast and abdomen of  the
child.   The physician,  or operator, puts his left hand
upon the head of the  patient, in order to prevent bend-
ing back of trie head,  and  running  of the water into the
mouth.   After this, the  child is taken out of the water,
wrapped in a large linen sheet, wiped  carefully, and a
shirt put on.   In dangerous cases, it is  necessary to re-
peat the operation  several times, and as repeated dress-
ing and undressing of the child would  become trouble-
some, we only wrap it  in a large sheet.   Having brought
the patient to bed, he should be  covered lightly,  (one
or two blankets,) and a  cold compress, or, in dangerous
cases, a bladder filled with small  pieces of ice, placed
around his  neck.  The  compress  must  be renewed as
soon as it becomes warm, or as the ice is melted.   In
higher stages  of croup, when the child's breathing is
very difficult, or  if  it be  accompanied with inflammation
of the brain, a bladder filled  with ice  is also applied
upon the head and breast.  If the  child  cannot bear the
bladder upon the skin, as it produces sometimes a burn-
ing  sensation, we   may apply a  double-folded  linen
beneath. Water, as a drink,  should be  offered to them
once in five  minutes, and so  much  given to  them as
they desire.  Nursing children seldom like  to drink 
17
water, and to these the breast should be offered, if they
do not  sleep, as soon  as  they  have recovered a little
from the operation.  This, however, must be done with-
out taking them out of the bed, or removing the bladders
or compresses from  their place, which  can  be accom-
plished if the mother or nurse bends  herself over  the
child.  A teaspoonful of water should be given to them
once  in  five minutes, for every drop is balsam  to  the
inflamed larynx.
  Shortly after the operation, they commonly fall asleep.
Grown-up  children, who do not  desire to  go to bed,
may dress themselves, and walk around in the room, by
which the chilliness they feel after the operation  will
soon disappear.

PHENOMENA WHICH ARE PERCEIVED DURING  AND AFTER
  THE COLD-WATER AFFUSIONS, AND WHEN, HOW OFTEN,
  AND IN WHAT MANNER, THEY MUST BE  REPEATED.

  The  phenomena which we  notice, according  to  the
degree of the disease, during and after the affusion, are
the following:
  When the water is  poured over the patient, he is
obliged to inspire quickly and deeply.   Shortly after-
wards, however, he expires with great exertion, accom-
panied with a loud cry, cough and expectoration.  By
continuing with the showers, the cough becomes  loose,
and, sometimes  in  five minutes, all the mucus is  ex-
pectorated, and respiration is normal.  These favorable
changes, however,  take  place  only in light cases of
croup, or when the operation is performed at an early
hour;  also, oftener in children with a light than a dark
complexion, as the nervous system of the former is more
excitable, and  the effect of a sudden  affusion of cold
water  upon their  delicate skin more  violent and  in-
tense.   Some  children  are much  affected by affusions
upon the head.   In such a case, the stream of the water
should be directed more upon the  neck ; yet the head
must not be neglected entirely, in order to prevent con-
             3 
18
gestion and inflammation.  After the deep inspiration
has taken place, we should wait with a new affusion till
expiration has followed.  The deeper  the child inspires,
the more the larynx becomes extended, and the sooner
must the lymph separate from the inner walls.   By the
intense contraction  of  the integuments of the  neck,
coughing and hawking is produced, and the mucus ex-
pectorated.  This plastic lymph  is generally swallowed
by the children.  If it is expectorated, it swims in the
water, and has the appearance of white blotting-paper,
or the white of an egg.  All the grave symptoms, some-
times, appear again in three or four hours after the first
affusion ;  and  a second is required.  The patient is
then  less  affected, expectorates  easier, and  the voice
becomes natural.  The difficult breathing,  and the rat-
tling noise in the throat, commonly appears again in six
or seven hours after the second affusion.   As  often  as
difficult breathing, with a peculiar metallic  tone, and a
barking cough,  reappears,  the operation must  be re-
peated ; and a careful observation of these changes in
cough and respiration is therefore absolutely necessary.
Is the proper  time for  a renewed  application  of cold
water  neglected, inflammation will increase again, the
cure is prolonged, and very often the child  dies by
suffocation.  In such a case, however, death  is not
caused by the  water, but by the  ignorance  and neglect
of the physician.   Should we be  doubtful about the
proper time of a renewed affusion, we always may repeat
the operation rather a little too soon than too late.  In
almost all cases the cough is a sure guide.   The more
dry and painful it is, the more the patient suppresses it,
the more  anxious he turns from one side to  another
before a paroxysm, the oftener he changes  the position
of the head ; the more certainly  is the repetition of the
operation indicated.  In light croup cases, the metallic
tone during breathing, and the violent  pain when cough-
ing,  is removed entirely after the first two affusions;
and a physician, who has not seen the  patient before the
commencement of the cure, could not perceive that the 
19
child had the croup.  The whole disease has then the
appearance of a common catarrh, or any other catarrhal
affection.
   Has croup reached a higher degree, then we will per-
ceive, during and after the first affusion, the following
phenomena :
   The  child  expectorates  no mucus ;  makes also  no
effort to hawk up any ;  is more restless; struggles often
and anxiously for air, especially when  the water  is
thrown  over the  head ; the breathing remains laborious
for the  first five  minutes during the operation, and be-
comes, in some cases, even more difficult than before ;
however, the sharp metallic sound,  noticed  during in-
spiration and  expiration, disappears entirely, or dimin-
ishes at least  considerably  after  the  third or  fourth
pitcher of water has been thrown  over the child.  By
continuing the affusion, the  lips of the child  become
bluish ;  the bloatedness of the face decreases ; the eyes
lose their weakness, and his looks become  fresh ; the
voice, however, remains hoarse.  In  the second five
minutes of the operation, we notice an easier  breathing;
disappearance of the bluish  color around the  mouth ;
more quietness ; and he is less affected by directing the
stream of water over the head.  During, or shortly after
the affusion, discharges of urine and faeces take place.
In  such  cases, the children are not taken out of the
bath, till back, breast and  abdomen have become red
by gentle rubbing.   Fifteen minutes after the affusion.
the patient having recovered from  chilliness and  terror,
we notice,  although every respiration is heard distinctly
at a distance, a  more easy and free  breathing.  The
tone, which before the operation was hard and sharp,  is
now like that of boiling water.
   Besides, we notice that the child hawks up from time
to time small portions  of  mucus, which is  swallowed
down ; and after this, the breathing becomes  more easy.
It also happens that the patient after the first shower-
bath already coughs loosely, without turning from one
side to the other, and without becoming restless.   This 
20
is  a very favorable  symptom, and  the  physician may
prophesy a speedy recovery.  If much mucus has col-
lected in the  larynx  and trachea, vomiting takes place,
after which a quiet sleep commonly  follows.
   The  more intense the inflammation has  been, the
sooner reappears the sharp  metallic tone when breath-
ing.   The patient becomes again hot  all over, and the
breathing more  difficult.  The more  the  child sleeps,
the greater is the danger.  As  long  as the cough  is
barking, hollow  and dry, the inflammation exists to a
considerable degree; and the physician should not leave
his patient for a long time, as a  second  shower-bath  is
required before  restlessness  again takes place.  Some-
times it is necessary to repeat the operation two hours,
or even one  hour and a half, after the  first.
   Cold hands and feet are not always the  consequence
of the bath, and give no counter-indication for a repeti-
tion  of the  same.   Is,  however, a second shower-bath
necessary before the extremities have  become warm,
the assistants must rub them gently  during the bath, by
which  a more equal distribution of heat in the body is
effected.  Should a decrease of the dangerous symptoms
be noticed, the  duration of the bath must  be shortened
about one or two minutes.
   Has croup reached a  still  higher  degree, so that the
child can only  breathe  in a certain position, we must
pay great attention to a careful washing with the sponge
or linen rag before the  shower-bath.  By washing and
rubbing gently the breast and neck of the  patient, he is
obliged to inspire in  quick succession, and the inflamed
larynx becomes thus prepared for a more  deep inspira-
tion during the  shower-bath.  Cold washing of the head
before the bath prevents  an accumulation of blood  in
the brain.  Taking these precautions, I never have seen
any bad consequences from these shower-baths, even  in
the most dangerous cases.  Parents, or physicians, who
have not courage enough to apply a shower-bath in very
dangerous cases, may use the cold  ablutions as a sub-
stitute. 
21
  The  phenomena, which, in  far advanced  cases  of
croup, make their  appearance  during and  after the
operation, seem  very  alarming, indeed;  and  a physi-
cian who for the first time performs such an operation,
will perhaps hesitate to go on, for fear the patient might
suffocate under his hands.  During the shower-bath, the
children become blue over  the  whole face,  and this
color is noticed some time after the  same; they bend
their heads far backwards ; they breathe very difficultly ;
they raise the shoulders  high up when inspiring;  they
draw in the  abdomen; the front part of the thorax is in
violent  motion ; the  tone, when  breathing, is sharper,
and  more whistling, than before the operation, and we
hear distinctly how the air must  be forced through the
narrow  space of the larynx.   All these symptoms, how-
ever, have existed before  the operation already, and are,
by the chilliness the patients  feel by the  sudden appli-
cation of cold water, only brought more to light.
  In these cases the physician  must be fully convinced
that he has the right remedy in his hands — the  only
remedy by which the life of the child can be saved.
Without its  application, the child is in a few  hours no
more.
  No drug  in  the world can do any good in a  high
stage of croup.   What benefit can ten or twelve leeches
do, who suck the blood  out  of the skin, and  leave the
highly inflamed larynx as it was ?   What good  can
calomel or  cuprum sulphuricum do,  being swallowed
into the  stomach, and  there  waiting for digestion ?
What effect can a vesicatory have in  cases where im-
mediate relief is wanted  ?  Such an unrational, absurd
treatment is only an  addition to the   sufferings of the
poor child, whose end is so near at hand.
  If the physician does not lose  his presence  of mind,
and  performs the operation with boldness, and accord-
ing to the given  prescriptions, and if no paralysis of the
lungs has commenced already, I assure you  the child
will not suffocate by application of  the shower-bath.
We  have no remedy  which increases the activity of the 
22
lungs more  energetically than cold water.   Place only
a hand or foot  in cold water, and you are obliged to
make immediately a  deeper inspiration.  What an ex-
cellent effect have not cold applications upon the organs
of generation in  hemorrhage of the lungs ?   Indeed, the
effects of  cold water upon the organs of respiration are
so powerful, that with no other remedy can a suffocated
person be brought back to life (if any life yet exists) so
quickly and- certainly, as by a cold shower-bath.
  Children who have  died of croup  never should  be
buried before applications  of cold  water have  been
tried, or certain  signs of death exist;. for  several cases
are  on record, where children, one  day after  they had
been declared dead, gave signs of life again, before they
suffocated entirely.
  The greatest  mistake a  physician  can make, during
the operation, is, to  take the  child out of  the bath, as
soon  as  he notices  an aggravation of the symptoms.
By  such  a  cowardice the  patient  may lose  his life.
Patients with  a  higher  degree of croup should, during
the first and second shower-bath, remain ten minutes.in
the water.  Any  aggravation  of symptoms disappears
as soon as the sensation of coldness ceases.

              DIET AND  CONVALESCENCE.

  Grown children need, as long as  croup exists in a
high degree, no nourishment but water.    As soon as
they have an appetite again, I allow them  soups, sweet
roasted apples, cooked  prunes, &c.   Nursing children
should have the breast as often and whenever they
desire it.  The milk  of the  mother is an excellent medi-
cine for these  little ones, and only a  few drops are suffi-
cient to  give  great  relief  to  the  hot and dry throat.
Nothing relieves the cough of babies more  than the
milk of a mother or  nurse.
  Drugs,  during  the  treatment  of  croup with cold
water, are not  only unnecessary, but  also highly  in-
jurious.   Even  in complicated croup cases, cold water
always has conquered the disease. 
23
  Sometimes there appears an eruption, during or after
the treatment of croup with cold water, particularly on
the neck, breast and back of the patient.  This eruption
consists of little red, hard, itching knots, as large as the
head of a pin, which, however, disappear in a few days
by  continuing  cold  ablutions.  All  other  complaints
after croup, as, catarrh, cough and hoarseness, disappear
also by a continued water-treatment.
   If we compare children who have recovered from
croup  under homoeopathic  treatment, with  those  who
have been  treated  by calomel, leeches, vesicatories, &c,
we perceive  a  most remarkable difference.   Children
who were  near t6  suffocation, are, after a cold-water
treatment which only lasts a few days, quite as healthy,
as  cheerful and lively, as they  ever  had been  before.
They have lost very little or no flesh ; complain of no
pain ;  sleep, eat  and drink  perfectly well:  whereas
children who have taken a great deal of calomel, &c,
become  really sick after   croup  has been  removed.
Many  of them do not  recover till after several years,
others remain feeble, enervated and sickly all  their life-
time, and by every cool  breeze  become  sick ;  they are
a burden to themselves, and give to their families great
trouble and sorrow.
   It is impossible  that physicians can think it an unim-
portant matter, when the whole constitution of a child
is poisoned by  calomel, in  order to  remove an inflam-
mation in  the  larynx ;  it is impossible that physicians
should not know  that poisoning by mercury, and solu-
tion of all the  glands, has the most injurious conse-
quences for  the future life of  the  children. •! do not
blame physicians  that they have administered calomel
in large doses, in  order to  save a beloved child, even if
its health became  ruined forever; for they had no other
remedy.   Calomel was their only and last resource.
   But  now  the  case is altered.   We  have another
remedy, a  specific for croup, — and a more sure, a more
gentle remedy than calomel; which leaves no afterpains,
and by which the  life of children, already standing on 
24
the border of the grave, can be saved.  Every physician,
therefore, owes it  to  his conscience, and humanity, to
consider well  whether he will  continue in future to
poison his croup patients by calomel, or will cure them
by the application  of cold water.
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