ACUTE CATARRHAL LARYNGITIS Acute catarrh of the larynx is more common in children than in adults, because the laryngeal mucous membrane is more sensitive in children, and catarrhal laryngitis is also a symptom of certain infec tious diseases. It occurs more frequently in boys than in girls, and particularly in amenne, rachitic, and scrofulous children. These con ditions seem to bring about almost a predisposition to catarrhal laryn gitis. Primary catarrh of the larynx, may be caused by exposure to cold, the secondary catarrhal conditions, complicating the infectious diseases, particularly measles, influenza, and whooping-cough. Sudden changes in the temperature with strong east and north winds, in spring and fall, are also etiological factors.
Bacteriological examinations in cases of laryngitis are usually negative, but varieties of pneumococeic and streptococeic laryngitis have been described. B. Frankel has described a peculiar form of laryngitis, occurring with influenza, -which is characterized by the presence of small white points.
Ordinarily, only the mucous membrane is involved in the inflam matory process, and this varies from a mild to the most severe inflam niation. In some cases the membrane is only slightly reddened and not swollen, while in others the mucosa is dark red and much swollen. There is an increased mucus secretion which in the mild cases is white; in the more severe cases it dries and clings to the mucous membrane in the form of crusts (larynOtis sicca).
Symptoms.—In the severe forms of catarrhal laryngitis, the secre tion becomes mueopurulent, and there may be superficial erosions of the epithelium. There is a form of laryngitis involving only the portion of the larynx below the vocal cords (subcordal or hypoglottic laryngitis), in which the symptoms may be very severe. In this form, recurrences are common, and predisposition plays an important role. It is often the result of a tracheitis, and then the vocal cords may be normal. There is great redness under the cords however, the swelling being often slight, but at times being so considerable that respiration may be em barrassed. The typical symptom-complex which has given this affec
tion the name "false croup" is present when this condition develops. A primary laryngeal catarrh may begin with some temperature eleva tion, and it is very often preceded by a coryza lasting for several days. Then with the inflammation of the phary-nx and larynx, cough, some pain in the throat, disturbances in deglutition and changes in the voice develop.
The fever runs its course in from one to three days, the cough which is at first dry becomes looser with expectoration, and in about a week the attack subsides. Cases of pseudocroup run an altogether different course. The child, who may have had a slight coryza, wakes up during the night with alarming symptoms.
Respiration is audible and difficult, there is the characteristic barlcing cough with some cyanosis of the face. Hoarseness to the point of aphonia is present. The attack lasts from a few minutes to several hours, and rarely recurs during the night.
In the mild cases, the child soon goes back to sleep and dyspncea subsides. The voice becomes clearer and there is a mucus expectoration.
In the severe attacks, alarming suffocative symptoms come on, and death has occurred.
On laryngeal examination, the mucosa may not appear sufficiently swollen to account for the symptoms, and many authors attribute these attacks to a spasm of the glottis brought on by the laryngeal catarrh. The child breathes with difficulty and there is cyanosis of the face. Such attacks may last for hours. As soon as the attack begins to sub side, the child perspires and nothing remains but the cough and hoarse ness. As a rule, no attacks develop during the succeeding night, except in some rachitic children. Fever may be present with the onset of the attack, and may last for a few days. At times the dyspncea is slight while the cough is very severe. In uncomplicated cases, the attack runs its course in from five to ten days. Bronchial catarrhs and even pneu monia are not uncommon complications of such attacks.