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laryngitis, attack, acute, inspiration, conditions and child

CROUP, a term popularly used for a num ber of conditions which have been more specifi cally defined. It is in reality a symptom present in a large number of diseases or disorders of the larynx, which are spasmodic or inflamma tory. Croup occurs mostly in children and is characterized by the peculiar strident sound, sometimes a distinct cough, which accompanies inspiration or expiration due to interference with the passage of air through the vocal cords because of spasm, inflammation or growth af fecting the larynx, vocal cords or adjacent tis sues. The term has been popularly used to denote a diphtheritic laryngitis (acute mem branous laryngitis), which however, distinctly to that disease. (See DIPHTHERTA). It is also used generally for acute catarrhal spasm of the larynx (catarrhal croup, false croup, spasmodic croup, laryngitis stridulosa). This is common to childhood and may follow a slight coryza, dietetic disturbances or sometimes comes on without any apparent premonitory symptoms. The attack comes on suddenly and usually at night. The respiration is obstructed and consequently labored with a peculiar stri dent inspiration and there may be extreme cyanosis. There is a loud metallic cough. The pulse is small and rapid and there is usually a marked rise in temperature. The attack lasts several hours when the child gradually becomes easier and falls asleep. The attack may be re peated several successive nights after which a slight catarrh remains for a week or two and then disappears. The most effective means of treatment is by the use of steam inhalations with warmth and rest in bed. Occasionally in more severe cases other means of treatment may also be used. Although the attacks are fre quently very alarming fatality is extremely rare. Attention should be given to certain prophy lactic measures in the child disposed to this form of attack. Exposure should be avoided but the child should not be kept in too warm an atmosphere or one deprived of some amount of moisture. The condition of the tonsils and

adenoids should be ascertained as these will often be found enlarged. There is also an acute simple laryngitis which is more serious but less frequent than laryngitis stridulosa. It is often associated with infectious diseases of childhood or with coryza or inflammation of some adjacent portion of the respiratory tract. Recovery is usual in a few days or two weeks. Sometimes the inflammatory process extends to the bron chial tubes or even develops into bronchopneu monia. A laryngospasm, known as laryngis mus stridulus (cerebral croup), occurs chiefly in infants under 18 months of age who are rachitic or have a tendency to convulsions. It manifests itself in a sudden attack of apnma followed by a protracted crowing inspiration and ending in crying and fretfulness with per haps a general convulsion.

This form especially marks the psychogenic origin of croup, which is not absent likewise from the more general conditions already de scribed. They call attention to the presence of a neurotic diathesis which determines such a mode of response by which the infant seeks to express the lack of conformity between its individual power seeking and the demands of environment. Diphtheritic laryngitis represents such a reaction upon the level of physicochemi cal activity and has therefore found its place among the distinctly infectious conditions. Laryngitis stridulus also manifests disturbance of the vegetative nervous functions. In all of these forms the psychogenic factor finds its separate mode of control. This is further em phasized by the fact that as the tendency toward these forms of reaction diminish, thumb-suck ing, enuresis or other psychoneurotic manifesta tions become substituted for these more acute symptoms.