Taken internally, even in the minute doses already detailed, croton oil very soon causes much colic and the occurrence of a fluid diarrhoea which usually recurs several times. It is characteristic of this purgative that it is a hydragogue even in minimal dose, the fluid secretions of the bowel being most markedly increased. The drug appears to act only upon the small intestine. In somewhat larger doses it produces severe gastro-enteritis. The flow of bile is somewhat increased. Such effects may all be produced, even up to the discharge of blood, by the absorption of croton oil from the skin.
The minuteness of the dose, the certainty of the action, and the large amount of fluid drained away constitute this the best drug for administration to an unconscious patient (especially in cases of apoplexy, when it is desirable to remove fluid from the body), or to insane patients who refuse to take any drug. One drop of the oil, placed on the back of the tongue, must inevitably be swallowed by reflex action. A dose should never be repeated. The characters of this drug obviously contra-indicate its use in all cases of organic disease or obstruction of the bowel, in pregnancy, or in cases of constipation in children or the aged.
CROUP, a name formerly given to diseases characterized by distress in breathing accompanied by a metallic cough and some hoarseness of speech. It is now known that these symptoms are often associated with diphtheria (q.v.), spasmodic laryngitis (q.v.), and a third disease, spasmodic croup, to which the term is now alone applied. This occurs most frequently in children above two years of age; the child goes to bed quite well, and a few hours later suddenly awakes with great difficulty in inspiration, the chest wall becomes markedly retracted, and there is a metallic cough. The child becomes cyanosed, and, to the inexperienced nurse, seems in an almost moribund condition. In the course of four or five minutes, normal respiration starts again, and the attack is over for the time being; but it may recur several times a day. The seizure may be accompanied by convulsions, and death has occurred from dyspnoea. The best treatment is to plunge the child into a warm bath, and sponge the back and chest with cold water. Subsequently this can be done two or three times a day. Should the cyanosis become very severe, respiration can be restarted by making the child sick, either with a dose of ipecacuanha wine, or by forcing one's finger down the throat. Generally the bowels should be attended to; and the throat carefully examined for enlarged tonsils or adenoids, which if present should be treated.