Croup; its history, nature, and treatment. Fiske fund prize dissertation of the Rhode Island Medical Society.

  • Newman, Albert.
Date:
1855
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Licence: Public Domain Mark

Credit: Croup; its history, nature, and treatment. Fiske fund prize dissertation of the Rhode Island Medical Society. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    wise be indicated, this may be so administered as to form a safe and valuable substitute. It should be given in small doses, frequently repeated, so as to maintain a constant and steady sedative effect upon the circulation. It is generally proper to begin with doses of one-thirtieth to one-twentieth of a grain dissolved in water every hour or two, for a child one year old. For a child three or four years old the dose may be increased to one-fifteenth or one-tenth of a grain ; the quantity given may be increased or diminished according to the effect produced. When administered in this way, its action upon the circulation is generally prompt and decided. The skin becomes cooler and the pulse slower and softer. The amount and frequency of the dose may be increased or diminished, as is found necessary to secure and main- tain this effect. In administering this remedy, it should be borne in mind that severe pros- tration is sometimes produced by it in very young children, and in those of a debilitated constitution. In all cases the patient should be carefully watched, and, upon the first appearance of prostration or diarrhoea, the medicine should be diminished or altogether withheld till the symptoms again indicate its repe- tition. It is not uncommon for diarrhoea to occur suddenly during its admin- istration, and this diarrhoea it is sometimes exceedingly difficult to check. The stools are peculiarly watery and without odour. An infant six months old has been destroyed by one-thirtieth of a grain of this remedy, and another barely escaped with life after taking, in three doses, sixty drops of the hive syrup. (Peaslee.) In the majority of cases of sthenic croup, this remedy cautiously administered, as already advised, constitutes our main dependence, so far as internal medication is concerned, for arresting the inflammation. But it is not well borne in asthenic cases, and in those of a more sthenic type, after exudation has occurred and the febrile excitement somewhat subsided; it should generally be given in diminished doses. If vomiting is produced by the remedy, its sedative effect is diminished. We consider it, therefore, more efficient in controlling the inflammation when its administration is so regulated as not to produce this effect. The addition of opium in very small doses in- creases the tolerance of the medicine. When a sufficient amount of the medicine to produce the desired effect upon the circulation is not borne by the stomach, and opium is not contraindicated, we are in the habit of adding one-half a drop, or more, in proportion to the age of the patient, of tincture of opium to each dose. The same addition may also be made when called for to diminish the action of the antimony on the bowels. This remedy has been used and recommended by some in very large doses in this disease. The largest quantity we have ever seen asserted to have been given, is in a case reported by Prof. Mettaucr, of Baltimore, in the Boston Medical and Swyical Journal, vol. xiv. To a child about nineteen months old he gave, in a little more than two hours, the enormous amount of half an ounce, with as much ipecacuanha and antimonial wine.1 Recovery 1 The following extract from Prof. Mettauer's Case of Protracted Croup, shows the manner in which the remedy was administered. After describing the condition of the patient and the preliminary step of moistening the mouth, he says : I next care- fully introduced into the stomach, with a teaspoon, a mixture composed of five grains of tartar emetic and ten of ipecacuanha, rendered semifluid with antimonial wine. This effort was finally successful, but the accomplishment of it was exceedingly difficult. A second dose of the medicines, mixed in the same manner, only augmenting the propor- tion of tartar to twenty grains, was quickly prepared and administered. After this attempt, a third and succeeding doses were prepared and administered in rapid suc- cession ; and I was now emboldened to give a heaping teaspoonful of tartar at each dose, only employing the ipecacuanha and antimonial wine in quantities sufficient to