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My daughter has listened to me talk about medicine all her life. And she comes up with brilliant questions.

"Mom, if the three year old in Anne of Green Gables had croup, why did she get better when Anne treated her with ipecac?"

"Hmmmm." My daughter has learned enough from me talking about croup to know that I don't use ipecac. I use a dose of steroids, an oxygen tent with cold mist if needed and possibly epinephrine.

"The doctor in the book says that the baby would have died if Anne hadn't known what to do."

I reread the passage in Anne of Green Gables. The book was written in 1908 by Lucy Maud Montgomery. Anne is such an imaginative extrovert that my daughter objected the first time we read it. "Mom, no one is like that." I named two very extroverted girls in her class. "Oh. Ok, yes." Anne has been a foster child who helped raise three pairs of twins. She is eleven. This is from Chapter 18:

    "Oh, Anne, do come quick," implored Diana nervously. "Minnie May is awful sick—she's got croup. Young Mary Joe says—and Father and Mother are away to town and there's nobody to go for the doctor. Minnie May is awful bad and Young Mary Joe doesn't know what to do—and oh, Anne, I'm so scared!"
    Matthew, without a word, reached out for cap and coat, slipped past Diana and away into the darkness of the yard.
    "He's gone to harness the sorrel mare to go to Carmody for the doctor," said Anne, who was hurrying on hood and jacket. "I know it as well as if he'd said so. Matthew and I are such kindred spirits I can read his thoughts without words at all."
    "I don't believe he'll find the doctor at Carmody," sobbed Diana. "I know that Dr. Blair went to town and I guess Dr. Spencer would go too. Young Mary Joe never saw anybody with croup and Mrs. Lynde is away. Oh, Anne!"
    "Don't cry, Di," said Anne cheerily. "I know exactly what to do for croup. You forget that Mrs. Hammond had twins three times. When you look after three pairs of twins you naturally get a lot of experience. They all had croup regularly. Just wait till I get the ipecac bottle—you mayn't have any at your house. Come on now."
    The two little girls hastened out hand in hand and hurried through Lover's Lane and across the crusted field beyond, for the snow was too deep to go by the shorter wood way. Anne, although sincerely sorry for Minnie May, was far from being insensible to the romance of the situation and to the sweetness of once more sharing that romance with a kindred spirit.
    The night was clear and frosty, all ebony of shadow and silver of snowy slope; big stars were shining over the silent fields; here and there the dark pointed firs stood up with snow powdering their branches and the wind whistling through them. Anne thought it was truly delightful to go skimming through all this mystery and loveliness with your bosom friend who had been so long estranged.
    Minnie May, aged three, was really very sick. She lay on the kitchen sofa feverish and restless, while her hoarse breathing could be heard all over the house. Young Mary Joe, a buxom, broad-faced French girl from the creek, whom Mrs. Barry had engaged to stay with the children during her absence, was helpless and bewildered, quite incapable of thinking what to do, or doing it if she thought of it.
    Anne went to work with skill and promptness.
    "Minnie May has croup all right; she's pretty bad, but I've seen them worse. First we must have lots of hot water. I declare, Diana, there isn't more than a cupful in the kettle! There, I've filled it up, and, Mary Joe, you may put some wood in the stove. I don't want to hurt your feelings but it seems to me you might have thought of this before if you'd any imagination. Now, I'll undress Minnie May and put her to bed and you try to find some soft flannel cloths, Diana. I'm going to give her a dose of ipecac first of all."
    Minnie May did not take kindly to the ipecac but Anne had not brought up three pairs of twins for nothing. Down that ipecac went, not only once, but many times during the long, anxious night when the two little girls worked patiently over the suffering Minnie May, and Young Mary Joe, honestly anxious to do all she could, kept up a roaring fire and heated more water than would have been needed for a hospital of croupy babies.
    It was three o'clock when Matthew came with a doctor, for he had been obliged to go all the way to Spencervale for one. But the pressing need for assistance was past. Minnie May was much better and was sleeping soundly.
    "I was awfully near giving up in despair," explained Anne. "She got worse and worse until she was sicker than ever the Hammond twins were, even the last pair. I actually thought she was going to choke to death. I gave her every drop of ipecac in that bottle and when the last dose went down I said to myself—not to Diana or Young Mary Joe, because I didn't want to worry them any more than they were worried, but I had to say it to myself just to relieve my feelings—'This is the last lingering hope and I fear, tis a vain one.' But in about three minutes she coughed up the phlegm and began to get better right away. You must just imagine my relief, doctor, because I can't express it in words. You know there are some things that cannot be expressed in words."
    "Yes, I know," nodded the doctor. He looked at Anne as if he were thinking some things about her that couldn't be expressed in words. Later on, however, he expressed them to Mr. and Mrs. Barry.
    "That little redheaded girl they have over at Cuthbert's is as smart as they make 'em. I tell you she saved that baby's life, for it would have been too late by the time I got there. She seems to have a skill and presence of mind perfectly wonderful in a child of her age. I never saw anything like the eyes of her when she was explaining the case to me."
    Anne had gone home in the wonderful, white-frosted winter morning, heavy eyed from loss of sleep, but still talking unweariedly to Matthew as they crossed the long white field and walked under the glittering fairy arch of the Lover's Lane maples.
    "Oh, Matthew, isn't it a wonderful morning? The world looks like something God had just imagined for His own pleasure, doesn't it? Those trees look as if I could blow them away with a breath—pouf! I'm so glad I live in a world where there are white frosts, aren't you? And I'm so glad Mrs. Hammond had three pairs of twins after all. If she hadn't I mightn't have known what to do for Minnie May. I'm real sorry I was ever cross with Mrs. Hammond for having twins. But, oh, Matthew, I'm so sleepy. I can't go to school. I just know I couldn't keep my eyes open and I'd be so stupid. But I hate to stay home, for Gil—some of the others will get head of the class, and it's so hard to get up again—although of course the harder it is the more satisfaction you have when you do get up, haven't you?"
    "Well now, I guess you'll manage all right," said Matthew, looking at Anne's white little face and the dark shadows under her eyes. "You just go right to bed and have a good sleep. I'll do all the chores."

I finished reading. "I think that the reason ipecac worked is because it wasn't what we call croup now. I think it was diptheria. With diptheria kids can't breathe because there is a grey membrane of dead cells that covers the airway and can totally block it. The native americans used spiky seedpods to try to remove it. Vomiting would work too. By making the baby throw up, she was clearing her airway. I have never seen a child with diptheria because of vaccinations. I hope I never do see diptheria because it is much much worse than croup. Croup now is usually a virus like parainfluenza but diptheria is a bacteria and can kill."

We looked it up on the CDC website. One in two people with diptheria die without treatment. One in ten die with treatment. That little "d" in your tetnus shot, the Td? That is the diptheria part of the vaccination, that you should update every ten years.

"They may have called both "croup" at the time the book was written. That was a really good question."

My daughter was satisfied that this is a reasonable explanation for the puzzle.


http://www.cdc.gov/diphtheria/about/symptoms.html
http://www.cdc.gov/diphtheria/about/complications.html
http://www.cdc.gov/diphtheria/about/bam-villain-for-kids-fs.html
http://blogs.discovermagazine.com/inkfish/2014/03/25/classic-childrens-books-ruined-modern-medicine/
http://www.politedissent.com/archives/7950

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