the case, existed from the very beginning. This consists in
a peculiar contraction of the hands and feet; a state which may likewise
not infrequently be noticed during infancy, unattended by any
peculiarity in breathing. It differs much in degree; sometimes the thumb
is simply drawn into the palm while the fingers are unaffected; at other
times the fingers are closed more or less firmly, and the thumb is shut
into the palm; or, coupled with this, the hand itself is forcibly flexed
on the wrist. In the slightest degree of affection of the foot, the
great toe is drawn a little away from the other toes; in severer degrees
the toe is drawn away still further, and the whole foot is forcibly bent
upon the ankle, and its sole directed a little inwards. Affection of the
hands generally precedes the affection of the feet, and may even exist
without it, but the spasmodic contraction of the feet never exists
without the hands being involved likewise. At first this state is
temporary, but it does not come on and cease simultaneously with the
attacks of crowing breathing, though generally much aggravated during
its paroxysms. Sometimes a child in whom the crowing breathing has been
heard, will awake in the morning with the hands and feet firmly bent,
though he may not have had any attack of difficult breathing during the
night. When the contraction is but slight, children still use their
hands; but when considerable they cannot employ them, and they sometimes
cry, as if the contraction of the muscles were attended with pain.
Sometimes, too, there is a degree of puffiness both of hands and feet, a
sort of dropsical condition, which, whenever it is present, adds much to
the anxiety with reference to the child.

As the condition becomes more serious, a slight crowing sound is heard
each time the child draws its breath, the fits of difficult breathing
are much more severe; they last longer, and sometimes end in general
convulsions. The breathing now does not return at once to its natural
frequency, but continues hurried for a few minutes after the occurrence
of each fit of difficult breathing, and is sometimes attended with a
little wheezing. The slightest cause is now sufficient to bring on an
attack; it may be produced by a current of air, by a sudden change of
temperature, by slight pressure on the windpipe, by the act of
swallowing, or by momentary excitement. The state of sleep seems
particularly favourable to its occurrence, and t