Synonyms.—Spasmodic Croup; Laryngismus Stridulus; Spasm of the Larynx.
Definition.—A disease of the larynx occurring in neurotic individuals, usually in children from six months to six years old, though occasionally in the adult.
Rickets predispose to this affection, and, in those susceptible, the disease may arise as a reflex disturbance from intestinal parasites, from dentition, from irritation of the prepuce, from indigestion, or it may arise from the. ordinary causes that give rise to croup, cold being the most common. In rare cases the disease, a spasmodic contraction of the adductor muscles of the larynx is due to emotional excitement.
Pathology.—Soon after a severe attack, the mucous membrane becomes congested and swollen, which continuing the spasmodic action of the intrinsic muscles, may result in inflammation. Edema of the glottis and neighboring tissues is not uncommon.
Symptoms.—The disease usually comes on suddenly, the child being aroused from sleep with a start, there being great difficulty in breathing. The child has a hoarse, croupal cough, the voice soon sinks to a whisper, and the breathing becomes shrill and stridulous. Spasm of the glottis occurs, the child becomes cyanotic, and for several seconds holds his breath; this is followed by relaxation of the spasm, when the child utters a shrill, piping cry. In a few minutes relief is experienced, and the child drops to sleep, the breathing being comparatively easy. After a short period the child is again awakened by another paroxysm, and a repetition of the first attack occurs: thus the disease is made up of paroxysms and remissions.
During the remissions the skin is moist and the pulse regular, showing an absence of inflammatory symptoms. These attacks follow two or three nights in succession.
At other times the child will be attacked suddenly with difficult breathing, there being no cough or hoarseness. These attacks terminate in a high-pitched crowing inspiration. They may occur during the day as well as at night. During an attack, the child's face becomes livid and anxious, and in rare cases convulsions occur. Occasionally it proves fatal, the child choking to death.
Diagnosis.—We diagnose spasmodic croup by an absence of inflammatory symptoms, the dry, sibilant respiration, the shrill, piping cry, the absence of the mucous rattle, and the spasmodic character of the attack.
Prognosis.—Although a severe attack presents a frightful picture, the disease very rarely terminates fatally.
Treatment.—The remedies for spasmodic croup will form the basis for laryngitis stridulus in the older patient. If the disease is not very severe, drop doses of stillingia liniment on sugar every ten or twenty minutes, and an application of the same rubbed over the larynx every hour, will often be the only remedy needed. When very severe, the compound tincture of lobelia and sanguinaria (King's acetous emetic tincture) may be given every ten, twenty, or thirty minutes, till relaxation is produced. It is not necessary to produce emesis.
A flannel cloth wrung out of hot water and applied to the throat, and a dry binder covering the wet one, will assist greatly in producing relaxation. Should the child be unable to get its breath, insert the finger into the larynx and hook up the epiglottis.
In addition to the above treatment, inhalations of steam from hops, tansy, or lime-water should be used. An ordinary teapot may be used, to the spout of which may be attached a short piece of hose and conveyed to the face of the child.
Intubation or tracheotomy should be resorted to only in extreme cases, and where the patient's life is threatened.
After the attack is over, the case should be thoroughly examined to ascertain the exciting cause. When due to reflex disturbance, we may expect a return of the disease unless the exciting cause be removed; hence any wrongs of the stomach, digestion, or of the bowels, parasites, hemorrhoids, or other rectal troubles, or wrongs of the reproductive apparatus, should be corrected.
Spasmodic croup is often distinctly periodic, when quinine should be administered. For the hoarseness, that sometimes continues for several days, stillingia liniment or potassium bichromate, the second or third trituration, will usually be all that is required.