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Stridulous Laryngitis

complaint, catarrh, usually, attack, sometimes and affection

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Stridulous laryngitis (false croup, catarrhal croup, spasmodic laryngitis) is a common affection in early life. For a long time it was confounded with diphtheritic laryngitis, and no doubt a sharp attack of laryngeal ca tarrh with spasm produces sufficiently serious symptoms. The disease, however, is rarely fatal.

Causation.—Stridulous laryngitis is especially a disease of childhood after the period of infancy has passed, for it is comparatively rare under the age of two years. Between the second and seventh year the disorder is common ; but after the latter date it again becomes exceptional. I have met with it, however, as late as the fourteenth year. When it occurs in the course of the second year the patient will be usually found on exam ination to be the subject of rickets. The complaint appears to be predis posed to by an hereditary spasmodic tendency ; but the patients are not necessarily in any way feeble or under-nourished. As a rule, perhaps they are sturdy looking and strong. Boys are attacked twice as often as girls ; and the affection is frequently seen more than once in the same individual ; indeed, it may be said to have a tendency to recur.

The exciting causes of the complaint are those common to laryngeal catarrh. The affection is sometimes an early symptom of measles and whooping-cough. It may occur as a complication in the course of the latter, and occasionally returns under the influence of a slight chill after the attack of pertussis is at an end.

Morbid Anatomy.—In the rare cases where death has resulted from this complaint the glottis and vocal cords have been found little altered, or more or less uniformly reddened. Sometimes they have been slightly swollen. An excess of mucus has been usually present. It is stated that small linear ulcers have been sometimes noticed on close inspection of the vocal cords.

laryngitis consists of a catarrh of the larynx with superaclded spasm—the spasmodic element being probably the con sequence of special nervous excitability in the individual patient. In some

children (and these are usually rickety infants) a very trifling degree of catarrh may induce spasm. These cases are very mild as a rule, and quickly subside. In older children the catarrh is more serious. The complaint then lasts longer and is accompanied by more violent symptoms.

In the mildest form of the complaint the pulmonary catarrh is often very trifling. The child may be put to bed apparently well, or with merely a slight cold. About eleven or twelve o'clock he starts up suddenly from his sleep with a hoarse, barking, sonorous cough, and a loud, whistling, stri dor in his breathing. It will be noticed, however, that the stridulous character is confined to the inspiration, and that the expiration is short and comparatively noiseless. The movements of the chest are laboured and violent, the soft parts sink in at each inspiration, the flares act, and the eyes are staring and frightened-looking. If the impediment to breathing is great, the face becomes livid, the eyes are injected, and the child is ex cessively restless and agitated. His voice, however, remains hoarse and loud. It is rarely weak, and only becomes. suppressed and whispering in cases of exceptional severity.

The seizure lasts from a few minutes to half an hour, or even longer, for sometimes, after appearing to relax, the spasm becomes again distress ing. In the end it subsides completely and the child falls asleep, but he may again be roused up by a milder seizure a few hours afterwards. On the following morning he may wake up apparently well, or with some slight thickness of the voice and a loud clang in his cough, but these symp toms pass off after a day or two. In many cases the attack returns on the following night, and may be repeated yet a third time, but the symptoms are seldom so severe as on the first occasion. During the attack the tem perature may rise to 102° or 103°, or higher, but in the morning is usually normal.

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