ething. At length, after
these symptoms have lasted for a few days or weeks, a slight crowing
sound is occasionally heard with the child's respiration, shorter, more
high-pitched, but less loud than the hoop of hooping cough. Usually it
is first noticed on the child awaking out of sleep, but sometimes it is
perceived during a fit of crying, or comes on while the infant is
sucking. The spasm may have been excited by some temporary cause, and
the sound which is its token may not be heard again; but generally it
returns after the lapse of a few hours, or of a day or two, and its
loudness usually increases in proportion as its return becomes more
frequent. It will soon be found that certain conditions favour its
occurrence; that the child wakes suddenly with an attack of it, that
excitement induces it, or the act of swallowing, or the effort at
sucking, so that the child will drop the nipple, make a peculiar croupy
sound with its breathing, and then return to the breast again.
Throughout the whole course of the affection, its attacks will be found
to be more frequent by night than by day; and to occur mostly soon after
the child has lain down to sleep, or towards midnight, when the first
sound sleep is drawing to a close.

At first, the child seems, during the intervals of the attack, much as
before; except, perhaps, that it is rather more pettish and wilful; but
it is not long before graver symptoms than the occasional occurrence of
an unusual sound when the child draws a deep breath excite attention,
and give rise to alarm. Fits of difficult breathing occasionally come
on, in which the child throws its head back, while its face and lips
become livid, or an ashy paleness surrounds the mouth, slight convulsive
movements pass over the muscles of the face; the chest is motionless,
and suffocation seems impending. But in a few seconds the spasm yields,
expiration is effected, and a long loud crowing inspiration succeeds, or
the child begins to cry. Breathing now goes on naturally: the crowing is
not repeated, or the crying ceases; a look of apprehension dwells for a
moment on the infant's features, but then passes away; it turns once
more to its playthings, or begins sucking again as if nothing were the
matter. A few hours, or even a few days, may pass before this alarming
occurrence is again observed, but it does recur, and another symptom of
the disturbance of the nervous system is soon superadded, if it has not,
as is often