Acute Catarrhal Laryngitis.
Definition.—An acute catarrhal inflammation of the larynx, characterized by a hoarse croupal cough.
Etiology.—The most common cause is cold, induced by sudden atmospheric changes so common in the early spring and late fall months. The inhalation of irritating vapors may give rise to it and certain articles of food may produce it; thus, in one of my own children, hot oyster-soup would invariably bring on an attack, usually while the child was still at the table.
The disease occurs most frequently in children between the ages of two and six years, and when appearing in the adult is of a different type than croup in children, and will necessitate a separate description.
Pathology.—Although a true inflammation of the mucous membrane, there is not such marked changes as one would expect from the severity of the clinical symptoms. There is hyperemia of the mucous membrane, which is red, tumid, and slightly swollen.
At first the membrane is dry, but soon a glairy, tenacious mucus is secreted. Edema of the larynx is seen in several types. There may be slight hemorrhage in the mucous membrane, and erosions may be seen on the vocal cords and portions of the larynx. The changes, however, are not sufficient to account for the severe dyspnea so often met with in croup, and must be accounted for by spasmodic contraction of the intrinsic muscles of the larynx. In rare cases ulceration of the larynx is noted.
Symptoms.—The symptoms vary with the age of the patient. In the child the croupal symptoms are characteristic, while in the adult they are entirely different, each needing a separate consideration.
In the Child.—Catarrhal or Mucous Croup.—Dr. Scudder's description of the disease being so realistic, I reproduce it here.
"Frequently, for a day or two before the attack, the child will have had symptoms of cold, with a slight cough. Both the cough and voice are frequently a little hoarse and rough, and would be recognized by a person acquainted with the disease as croupy.
"The attack of croup occurs most frequently in the night, though it may be in the daytime. The child seems to be suffering from a cold during the evening, but is put to bed without probably a thought of danger. But along about the middle of the night the parents are aroused by the child starting out of sleep with difficult respiration, a hoarse voice, and croupal cough.
"The respiration is rough and whistling, the cry hoarse and feeble, except when a great effort is made, when it becomes shrill and piping. At first the difficulty of respiration is intermittent, but after an hour or two it becomes permanent, and there is a peculiar whistling or gurgling sound as the air passes into and out of the larynx.
"As the disease progresses the difficulty of respiration becomes more marked, and the cough is hoarser, has a peculiar metallic tone, and the voice sinks to a whisper. If the child sleeps, mucus accumulates in the throat, the breathing becomes more and more difficult, until at last the child wakes with symptoms of asphyxia.
"At first the skin is dry, the temperature is increased, and the pulse is full and hard; but as the respiration becomes more difficult, a cold, clammy perspiration breaks out, the extremities become cold, and the pulse frequent and feeble. The disease runs its course in from twelve to twenty-four hours, terminating in a subsidence of the disease or death."
Laryngitis in the Adult.—It usually commences with a slight chill, soreness, and stiffness of the throat, difficulty of swallowing, a sense of constriction and a desire to clear the throat. Following the chill, febrile action comes up, and is quite intense, considering the extent of the inflammation. Then a dull pain is felt in the throat, the sense of constriction is markedly increased, and there is tenderness on pressure; the voice is harsh, hoarse, or stridulous, and there is a frequent dry, short cough.
If the throat is now examined, the fauces will be found red and tumid, and when the tongue is pressed down, the epiglottis may be seen erect, swollen, and red. In the course of from twelve to twenty-four hours the inflammation has markedly diminished the aperture of the glottis, the voice becomes small, piping, whispering, and soon suppressed. The breathing is difficult, inspiration being sibilus, shrill, prolonged, and laborious, the larynx being forcibly drawn down on each attempt to inflate the lungs.
The cough is stridulous and convulsive, and is attended by attacks of spasm of the glottis, which threaten suffocation; the expectoration is scanty and viscid, and removed with difficulty. In the last stage of the disease, the patient exerts all his power in respiration, sitting upright and grasping objects in reach to bring into play the external inspiratory muscles. The countenance is pale and anxious, the lips livid, and the eyes almost start from their sockets, the extremities are cold, and covered with a clammy perspiration. Soon a low delirium, or coma, comes on, the pulse becomes more feeble and intermittent, imminent symptoms of asphyxia appear, and the patient rapidly sinks.
Fortunately, the termination is not so serious in most cases, and, after twenty-four or forty-eight hours, the cough is attended by expectoration of mucus, with relief to the dry, sibilant respiration and a subsidence of all the grave symptoms, though the voice remains hoarse for several days.
Diagnosis.—In the child, the hoarse, metallic (croupal) cough, with hoarseness and change of voice, is sufficient evidence of croup, but it does not inform us which of the three varieties it is.
In mucous croup, there is the slight febrile action to distinguish it from the spasmodic variety, and the evident presence of mucus in the larynx manifested by the rattling sound heard on auscultation and in coughing, which distinguishes it from the pseudo-membranous form.
In the adult, the hoarse voice, sibilant respiration, cough, and sense of soreness and constriction in the larynx enables one to recognize the disease.
Prognosis.—The prognosis is nearly always favorable.
Treatment.—Aconite seems to possess a peculiar affinity for the larynx, and in acute cases it is one of our surest remedies. Add two to five drops of the specific tincture to a half a glass of water, and give a teaspoonful every ten, twenty, thirty, or sixty minutes. It quiets the irritable larynx and favorably influences the fever and inflammation. In connection with this, drop doses of stillingia liniment may be used, and also rubbed over the larynx. It is a good plan to alternate one drop of the stillingia with one teaspoonful of the aconite mixture every ten minutes.
When the respiration is dry, sibilant, and labored, wring a sponge out of hot water, and drop a few drops of stillingia liniment on it, and hold to the mouth, the patient inhaling the medicated steam. In very severe cases, however, inhalations of steam from hot water and vinegar and hops will give better results.
Lobelia.—When there is dyspnea, add fifteen or twenty drops of specific tincture of lobelia to the aconite solution. Cloths wrung out of hot water and pinned snugly around the throat, with a dry binder over the wet one, assists in producing relaxation.
Potassium, bichromate is often used with benefit after the inflammation has spent its force, the voice remaining hoarse and husky. Of the second trituration, add five grains to a half a glass of water, a teaspoonful every hour.
The acetous tincture of lobelia and sanguinaria, used by the early Eclectics, is a very successful remedy, though not pleasant. It should be given often enough to produce nausea, but not carried to emesis.
|Acetous Emetic Tincture||½ ounce.|
|Simple Syrup and Water||2 ounces each. M.|
|Sig. A teaspoonful every twenty, thirty, or sixty minutes, till relaxation is produced.|