Synonyms:—Spasmodic croup; false croup; catarrhal croup; laryngismus stridulus.
Definition:—An acute spasmodic form of laryngeal inflammation limited to children usually under seven years of age. Characterized by a spasm of the larynx, difficult breathing and usually a very hoarse, barking cough.
Etiology:—The most common cause, in the author's experience, is the excessively dry air of furnace heated houses, which is especially provocative of the disease in the months of October and November, when the furnace fire is first lighted for the winter. The hot, dry air charged with a very fine dust, in close rooms will induce repeated attacks in the same child.
Other causes are those which induce acute laryngitis, especially sudden exposure to cold air. Where these causes are not conspicuous, patients suffering from impaired constitutions; especially those that have rachitis or adenitis or other evidence of a tubercular diathesis are especially liable to it. Children suffering from disease of the post-nasal structure whereby mouth breathing is induced are frequently attacked, atmospheric conditions being favorable. Nervous irritation is a common cause of this disorder in neurotic children.
Symptomatology:—A distinction must be made between spasmodic croup from laryngeal inflammation and the purely neurotic form of laryngeal spasm. In spasmodic croup proper the child awakes suddenly from a sound sleep, usually between ten and two o'clock in the night, and crying out from some apparent obstruction to the breathing, coughs two or three times with a loud, dry, ringing, croupy cough; an examination shows the child to have considerable fever, the difficult breathing increases there is a harsh, stridulous inspiration, the child showing anxiety and increasing restlessness. In mild cases the symptoms of distressed breathing may not last but a few moments, the child falling asleep, to be awakened in perhaps half an hour with the symptoms greatly exaggerated, the breathing is now very difficult and distressing, the countenance becomes somewhat cyanotic and if not relieved, markedly so. Sometimes there is an abrupt termination of the laryngeal symptoms for a short time, the patient breathing quite naturally. The fever, however, continues. In the purely neurotic spasm there maybe no fever or constitutional symptoms. There is a sudden oppression of breathing with the chracteristic dry, resonant cough accompanied with a crowing inspiration, accomplished with great effort. There may be a complete intermission or general convulsions may occur. Considering the-severity of the difficult breathing, there is but very little cough as compared with true spasmodic croup. In some cases the cough is entirely absent; this form may occur at any time during the twenty four hours.
In the inflammatory form the fever will continue during the night, even when the distressing symptoms abate, but will not be apparent in the morning, the child seeming quite well. If no attention is paid to the condition during the day the fever will recur in the evening and the distressing breathing will be more severe than on the previous night. Even with good treatment there is a tendency for the condition to recur on three or four consecutive nights.
Diagnosis:—The condition in either form is readily distinguished from membranous croup by the slowly increasing difficulty in breathing which characterizes that disease, and in which the development of this symptom is gradual throughout its entire course and without interruption.
Prognosis:—The prognosis is good, death seldom occurring from spasmodic croup.
Treatment:—The treatment of the inflammatory form is simple and effectual, the entire train of symptoms may be abated in some cases by the use of aconite alone. If the fever is conspicuous, and the difficult breathing not yet severe, drop five drops of the tincture in four ounces of water and give half a teaspoonful every ten minutes until the skin becomes moist and the breathing easier, when a teaspoonful may be given every hour or two. If the difficult breathing is the conspicuous symptom give half of a teaspoonful of the syrup of ipecac. If vomiting is not induced this may be repeated in an hour if necessary. The application of libradol to the throat produces, perhaps, the most immediately satisfactory results of any treatment we have yet used. If applied during the spasm, it should be of full strength and removed with the first appearance of nausea at which time the difficult breathing will have abated. The throat should be thoroughly washed and an application made of the liniment of stillingia and covered with a dry, warm, flannel compress. In a number of the author's cases there has been no recurrence of the symptoms after this treatment. On the following day, however, the child should be kept in a moderately warm room, the air of which is kept moist, and should have a very light nutritious diet.
The purely nervous form of laryngeal spasm should be treated with hot applications to the throat, a general hot bath and the specific anti-spasmodics, such as gelsemium, lobelia, ipecac and sanguinaria or the bromids and chloral. In extreme neurotic spasm the inhalation of a whiflf or two of chloroform will sometimes give immediate relief until other measures can be used.
It is quite common for the irritating causes of this disease to induce a general laryngitis or a clear case of bronchitis without intermission between the two conditions. In this case, the inflammatory symptoms increase, the croupal cough changes in character, becoming moist and losing its resonant note. The difficulty in breathing disappears, the temperature rises to perhaps 103° F. or perhaps 103.5° F. with a slight morning remission, and may continue for from one to two weeks. The treatment under these circumstances should be distinctly that of the consecutive disease. The course suggested in acute laryngitis, to preserve a condition of continued moisture in the atmosphere during the entire course of either of these diseases, should be adopted and persisted in.
The patient should receive careful attention during convalescence. There should be ho exposure to the cold or to draughts and the patient should be kept in a room in which the temperature is uniform. The administration of a tonic which contains small doses of quinin and iron will confer an immunity against a sudden recurrence of the disease.