BY P. P. WELLS, M.D., BROOKLYN, N. Y.

Practically, Croup is attended with so much of suffering and danger to the patient and anxious solicitude on the part of friends and physicians, that no apology can be necessary for calling attention to a method of treatment which promises to diminish these in any degree. To the patient it is always painful, dangerous, and too often fatal, to be other than a cause of alarm to friends and dread to the intelligent and faithful practitioner. Every week it claims its victims among the young and helpless, and the skill of the best talent and learning of the profession has been wholly unavailing to avert the fatal result. Whatever then adds to our power over this destroyer, is worthy of the profoundest attention; and any method of treatment which, after fair trial, claims to have diminished its duration or mortality, cannot be passed by, as of little moment, by intelligent and conscientious practitioners. It is notorious that the current methods, both of the old school and new, are too often followed by misfortune, to be regarded with much complacency, if indeed it be not too great grace to the different, desultory, and often scarcely better than empirical practices in this disease, to call them methods.

The old school has relied, and still does, on blood letting, emetics, mercury, fomentations, nauseating doses of different emetic substances, vesications, &c.; the new, with better result, on Aconite, Hepar, Spongia, Bromine, Bi-chromate of Potash, Prot-iodide of Mercury, &c; and yet the weekly reports of mortality are constantly adding testimony to the want of success which the ordinary use of these means is wholly unequal to prevent.

Is the ordinary success of the ordinary use of these means the best which the nature of the case admits? If so we must be satisfied. But who dares be satisfied if a better can be obtained by other courses of practice? The profession in this country are indebted to our esteemed colleague, Dr. Carroll Dunham, of Newburgh, N. Y., for an introduction to a method, which after protracted trial, claims a far greater success than has heretofore followed any other, both in the matters of mortality and duration. In the Feb. No. of the 2d vol. of the American Homoeopathic Review, p. 212, in a foot-note appended to a translation of Boenninghausen's paper on the “Advantages of the High Potencies,” by Dr. Dunham, he gives the method of treatment of Croup by this great master. In the body of the article, pp. 211, 212, the writer says: “Often cases of Membranous Croup in children, in at least nine, the first, or the first two powders of my high potencies, when promptly administered, suffice for the most complete cure. The necessity for three powders is very rare indeed, and among 300 cases, not 10 have occurred in which all the five powders, as I am accustomed to prescribe them, have had to be given“His five powders are, 1st Acon., 2d and 4th Hepar sulph., 3d and 5th Spongia, all of the 200th potence. These are given in the order of their numbers, every thirty minutes, and their administration suspended as soon as relief is manifest. So that, according to the statement above, more than 290 out of 300 cases of Croup which were of such a character that the writer is willing to designate them as ”Membranous,” were cured inside of two hours, and the whole 300 were cured. There was not a failure. This is certainly a remarkable success, very remarkable, in comparison with the results of any other known treatment.

It was the privilege of the writer of this paper to call the attention of the members of the American Institute of Homoeopathy to this success, at their meeting in Philadelphia, in June last, and to urge on them a trial of Dr. Boenninghausen's method by these, among other considerations.

1st — Its simplicity. Anybody can apply it. The most inexperienced can make no important mistake by its trial, provided he is sufficiently intelligent to suspend the administration of the powders as soon as improvement is realized. This rule cannot be neglected, if the best success is to be secured. The anxiety to do a little more, with the expectation of something a little better, should never be allowed to tempt to its violation. Confusion, vexation, and disappointment can only result from this folly.

2d — Its Safety. To carry out the entire plan requires, even in cases where it may result in failure, only about two hours of time, the loss of which cannot seriously prejudice a case in its prospects of benefit from other treatment, if such should be necessary after the trial of this. If it does this in some degree, the fact can hardly be urged against the greater success of this method. This remark is made with a full consciousness of the importance of early appropriate treatment in every case.

3rd. — The method of Dr. Boenninghausen, cannot be supposed to complicate a case by medicinal symptoms of the agents employed, if they are not effectual to a cure, which can hardly be said of most of the other methods employed.

4th — It is prompt in its efficacy, beyond any other method.

5th — If the rules given by the master are observed, the cure is more complete, as well as prompt.

In the twenty years experience of the writer in the treatment of croup by the ordinary homoeopathic method, it has been the common course of the disease to return on the second and third nights, with more or less severity, and till the lapse of the third night, and the then change of the cough to the catarrhal character, there was no relief to his anxiety. Exceptions to this return have been occasional, but rare. Since adopting the method of Dr. B., there has yet been no return on the second or third nights in a single case.

The, force of these reasons was then felt by the writer to be great. Here was, undeniably, simplicity, safety, promptness and completeness of cure, with freedom from medicinal complications, to urge the claims of the method to attention, and better than all, these claims were backed by an alleged success altogether without a parallel. But the question has risen and been asked, “Will this method cure every case of croup?” I can only reply, very likely not. I don't know, but I do know it has cured every case of croup proper, in which I have employed it, in a time and manner that has given me one of ray sweetest delights. I have had no second or third night anxieties. But in this connection I may as well warn the practitioner who may be inclined to try the five powders as directed, that all loud, course cough, with or without wheezing and fever, are not croup, and that he may find many such which these powders will not cure, simply because they are not remedies appropriate to their treatment. These are cases much less important than true croup, and far easier of cure by Bell, Hepar sulph., Phos. &c, as ordinarily administered. “But will these powders really cure true membranous croup, after the membrane is formed?” was asked by one of my friends in Philadelphia. Then I could not answer from personal observation. Now I can. And I answer, Yes. The following cases will illustrate this.

Case I. — Sept. 1, 1860, 9¼ p.m. saw a child 4½ years old, of fair complexion, moderately fleshy, suffering with symptoms of Croup. Breathing difficult, with loud sawing wheeze, cough frequent and violent, with the characteristic sound of croup, great restlessness. Expression of face anxious. The whole surface covered with profuse hot perspiration, pulse 130 per minute, full and hard. Breath offensive. I prepared the five Boenninghausen powders, gave No. 1, and in half an hour No. 2, and then No. 3, when the child became more tranquil, the skin cooler, less perspiration, cough less frequent, the peculiar sound of the respiration gone, and the child was drowsy and wanted to go to bed. He had been in his mother's lap. I supposed the battle was won and left with directions if the breathing became embarrassed again to give the other powders at half hour intervals.

At 2 o'clock, a.m. I was called again, the child being reported much worse, and the parents thought him dying. I found him breathing with great difficulty — respiration loud, with the peculiar wheeze of croup — cough frequent, violent, and dry, with strong croup tone, perspiration profuse, and hot, great anxiety and restlessness. Inspection of the throat showed a patch of membranous deposit on the left tonsil, as large as my finger nail. The mother had given powders 4 and 5 with no relief. I gave Spongia 200, Lehrman's, with partial relief for a time, when the symptoms returned, and Spongia gave no relief. I then gave Bromine, from 4 a.m. to 7 a.m. at half hour intervals, the only result of which was an increase in the frequency of the pulse and heat of skin. No relief of respiration or cough. I determined to repeat the “five powders” looking on the case as a second attack or relapse, the result of cold feet and legs, when he awoke at 2 o'clock, from exposure during sleep, a fact which I now learned for the first time. The three first were given and all symptoms of croup disappeared in less than two hours, and did not return. There was a slight catarrhal cough which yielded to Phos. 200. At 10, a.m. the membranous patch was evidently thinner than when examined in the night, and at 5 p.m. had disappeared entirely, leaving the surface of the tonsils and fauces generally deep red, and a good deal swollen. This inflammation soon disappeared under the influence of the remedies above named.

Was not here two attacks of croup? My first impression was that the powders had failed. When I learned of the cold feet and legs I took another view of the case and treated it as a new attack, with the above result. But suppose there was only one, and the symptoms at 2 o'clock a.m. were only a recurrence of those seemingly subdued at 11 p.m. what is the objection to a repetition of the series of powders if a case should occur where the first five should prove inadequate to the cure? I have not the slightest doubt I should have lost my case if I had adhered to my first impression of the failure of the treatment. The case grew worse rather than better under Bromine, and the cases this has not cured, after the failure of the ordinary remedies, nothing has in my practice. But on giving the five magical powders the second time, or rather three of them, the result was even more prompt and satisfactory than when given the first time. Would this have been the case if the second attack had been only a recurrence of partially subdued symptoms. Do not such recurrences come with increased inveteracy? as is so often seen in cases of Hydrocephalus.

In this case the membrane was perfectly apparent on the tonsils. Indeed the whole train of symptoms, without this, was indicative of this form of the disease, but the sight of the deposit places the matter beyond doubt.

It is worthy of remark that powders 4 and 5, Hepar and Spongia, given by the mother, after the relapse, previous to my seeing the little patient the second time, were followed by no mitigation of the symptoms; but that Aconite, Hepar and Spongia were afterwards promptly efficacious, even more so than at the first. From this it would appear that the order of sequence of the administration of the powders is not a matter of indifference. It may prove to be essential to success.

Case II. — The following case has been kindly furnished me by my esteemed friend, Dr. Carroll Dunham, of Newburgh, N. Y. It further and beautifully illustrates the affirmative answer given above in relation to the cure of membranous croup, and also answers the question as to a repetition of the series of powders in any case.

On the evening of January 24th, I received a message to the effect that a little boy, aged 18 months, fat and healthy, was slightly feverish, and somewhat hoarse. I was requested to send some medicine. I sent a powder of Acon.¹² mentioning to the messenger that croup might perhaps be threatening and requesting to be sent for on the first indications of that disease. The next morning I was told that the child was not much better, and was requested to visit it in the course of the day. I went immediately. As soon as the hall door was opened, I heard the hoarse ringing respiration of the child which was in the second story, and which I found sitting up in its crib, with an expression of great anguish, breathing at the rate of 35 in the minute and with great labor. There was but little cough; occasionally, an effort which resulted in a hoarse dry bark, but which was immediately suppressed, apparently because it interfered with respiration. The face was turgid and of a purple hue. The hands were frequently applied convulsively to the larynx, but as a general thing the child was quiet, looking with pitiful appealing eyes to the bystander as if for aid. The skin was hot and dry except on the forehead; which was moist and cool, pulse hard, not full, 130. On saying to the mother, “the child is exceeding ill,” I was told, “he has been as bad if not worse all night.” He had vomited once, about an hour before my arrival, bringing up a small piece of tough membrane.

Here was a case of membranous croup, of great severity which had been in full blast at least 12 hours before I was called to it; in which the purple turgid face and the exhausted aspect of the child, showed that the powers of life had already begun to fail under the imperfect decarbonization of the blood. Considering the gravity of the case, and its long duration before treatment was begun, I hesitated to give the powders recommended by Boenninghausen, but gave at once Bromine,¹ centesimal, in water, a tea spoonful of the solution every fifteen minutes.

At the end of two hours, the child was in no respect better — the pulse was weaker and more frequent, there had been no relief for an instant to the labored character of the respiration which numbered now 40 in the minute. I gave Hepar Sulph.² trit., alternately with the Bromine. At the end of two hours there was still no change for the better; the disease was steadily advancing, as it seemed, to a fatal termination. Already it had reached a point at which I have seen both Guersant and Trousseau at the Enfans Malades refuse to perform tracheotomy on the ground that the disease had by its long duration, so prevented oxygenation of the blood and consequent renovation of tissues that a favorable issue could not be hoped for. I determined now to give the Boenninghausen powders; waiting therefore a half. hour from the time at which the last dose of the Hepar was given, I gave a powder of Acon.²⁰⁰, to be followed at intervals of a half hour by Hepar,²⁰⁰, Spongia,²⁰⁰, and this series repeated, (the method indicated in a foot-note to my translation of Boenninghausen's article, American Homoeopathic Review, Vol. 2, p. 212.) It was now 5 p.m., a time of day after which Croup generally begins to be aggravated. At 7 o'clock the child was greatly relieved, respiration 30 in the minute, much less labored, the sound softer, cough rather more frequent and somewhat loose in sound. I left a second series of the powders to be taken at intervals of one hour. The child slept at 11 p.m., and at intervals during the night, and the next morning was so much better that it seemed unnecessary to give more medicine, although I left a series of the powders to be given in case of a relapse. They were not given however. The child recovered rapidly without relapse or sequelae of any kind, and on the fifth day was as well as usual.

This was unqestionably the most severe case of croup that I have ever seen recover in this or any country. Judging from my experience with Bromine and Hepar in other cases I have no hesitation in saying that, not acting more evidently and more promptly than they appeared to do in this case, nothing whatever was to be hoped for from them. In croup, if they act beneficially at all, they do so promptly. It seems impossible therefore to ascribe the recovery of this child in any degree to these remedies or to deny the curative action of the Boenninghausen powders.

Case III. — May 7, 1860. At 10 o'clock, a.m., saw M. F., 21/2 years old, who had been suffering from severe catarrhal symptoms with sore throat the last four days. At 4 o'clock this morning she awoke her parents by her choking, strangling, and loud croup cough, for which she had had from them, Aconite and Spongia in alternation every half hour without relief. The skin was hot and rather moist, the face red, the eyes staring, expression anxious, breathing loud, wheezing and labored, cough frequent, and loud with the characteristic croup tone. Swallowing difficult and evidently painful, with great restlessness. I gave the five powders as directed by Boenninghausen, with instruction to suspend their administration on the appearance of relief of the symptoms. She took the first three, and the relief was so apparent that, in accordance with instructions, she was left to their action. I saw her again at 5 p.m. She was playing on the floor and apparently well of all her troubles except the difficulty of swallowing which was removed promptly by Bell. 200. The next morning she was dismissed cured.

It is hardly necessary to remark that the worst form of croup is very often preceded by a catarrhal stage like that by which this case was ushered in, is of the most obstinate nature, and not unfrequently fatal.

Case IV. — The following case, furnished by my friend and neighbor, Dr. R. C. Moffat, is given to illustrate the fact that this method is curative, and triumphantly so even in cases where massive doses of the same medicines have failed.

Called in the morning to attend a child attacked during the night with croupy cough and restlessness, which were represented as severe. The child was 9 months old, large, healthful and vigorous. The usual remission had occurred, and then presented nothing but the usual loose cough. I prescribed Aconite and Spongia, one drop each, in two-thirds of a tumbler of water, a teaspoonful alternately every hour and a half, the intervals to be shortened to half an hour if necessary during the night.

The next day, the report was a very bad night; the cough, fever and restlessness worse than the night before; and still the remission of the morning was very marked, only a loose cough with hardly any croupy tone to it. Thinking the family (a nervous one) had exaggerated their report, I gave directions — Hepar,² ever hour and a half till the cough should lighten in the evening — and then, if the fever, & c., returned — as on the previous night, Acon and Spongia, stronger than before, every half hour.

Making an early morning call, I found the night had been worse than either of the preceding; and the cough was distinctly croupy, though the respiration, &c, were easy.

I gave Sacch. Lact. for five hours, (from 10 a.m., till 3 p.m.,) and then set out Boenninghausen's prescription, Acon. Hep, Spong, Hep, Spong, each 200th, at half hourly intervals, with directions to call me in the night, if disturbed.

At my morning call, I found the child had slept well all night, and it required no treatment subsequently.

Case V. — The following case in the practice of my friend and neighbor, Dr. J. Barker, illustrates the efficacy of the method in a class of cases almost always fatal when treated by any of the ordinary courses of practice.

In the fall of 1859, W. L., a child six months of age, while suffering from a severe attack of Scarlet Fever, was seized with marked symptoms of croup. Regarding the complication as serious and not being satisfied with the usual remedies in similar cases I resorted, for the first time, to Boenninghausen's treatment for croup, viz: Aconite, Hepar and Spongia, each of the 200th potency. The powders were numbered in the following order: Aconite 1, Hepar 2 and 4, Spongia, 3 and 5 and directed to be given with an interval of thirty minutes in the order marked. After the expiration of three hours I again saw my patient, and found him almost wholly relieved from all croupy symptoms. The attendants expressed great surprise at the prompt action of the remedies, assuring me that after giving three powders the disease at once gave way. I have since used the same prescription with most marked success in other cases of croup, and am convinced that no other treatment in my hands has proved equally efficient.

This case occurred during a severe anginose affection of the throat, and interested me much when first related to me by my friend, as it was then the first case of recovery from a similar condition I had known. In my previous experience, all such cases had terminated fatally.

Case VI. — The following case in the practice of my friend Dr. Morrill, of this city, exhibits the efficacy of the Boenninghausen method after a continuance of the croup two days, without relief from massive doses of Ipecac and Squill, a common allopathic treatment of the disease, and also after a failure of lower attenuations of Aconite and Spongia.

Mary Kelly, aged 2½ years, took a severe cold a day or two before leaving Montreal, on her way to this city, the first night from home, had a slight attack of croup, which her mother treated with Syrup of Ipecac and Squills. She appeared better in the morning, but the cough continuing, the same medicine was repeated.

The next night she had a second attack, more severe than the first. The mother administered Ipecac and Squills, and these not helping the child I was sent for. The symptoms of croup were very decided. Gave Aconite 1, in alternation with Spongia 3, which soon gave relief, and the child slept quietly till morning.

The next night I was again sent for about 11 o'clock, and found the child in apparently the advanced stages of croup. There was the ringing, metallic cough — the stridulous breathing, and great difficulty of inspiration at all. The pulse was very quick, and the skin hot and very moist. Appearances were very unpromising; gave the 5 powders of 200th, Acon. then Hepar, then Spong, in alternation. In about an hour the child became easier, and soon after it took the 5th powder, dropped asleep. I called the next day and found the patient quite well. It has had no return of the disease since.

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