A practical treatise on the diseases of children / By J. Forsyth Meigs ... and William Pepper.

  • Meigs, J. Forsyth (John Forsyth), 1818-1882.
Date:
1877
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Licence: Public Domain Mark

Credit: A practical treatise on the diseases of children / By J. Forsyth Meigs ... and William Pepper. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    one element of the malady. The nervous element predominates in the early part of the attack, but towards the conclusion, the spasmodic symptoms disappear entirely, and we have left only those which depend on the local tissue-changes. In severe cases of the disease we have the same element of laryngeal spasm, or laryngismus, coincident with, and produced by, a much more in- tense and dangerous inflammation of the mucous membrane of the part than exists in the mild form. Diagnosis.—Unquestionably the disease with which spasmodic laryn- gitis is most likely to be confounded is pseudo-membranous laryngitis, or true croup. There is very little difficulty, however, in distinguishing the mild form of spasmodic croup from true croup, whilst in regard to the severe form, it may be safely stated, that the distinction cannot, in some cases, be made with positive certainty, except by watching the course of the sickness. Mild cases of spasmodic croup may be distinguished from membranous croup by a comparison of the different symptoms as they arise. The most important of these are : the invasion, in one sudden and almost invariably in the evening or night, in the other slow and creeping, the paroxysm first occurring indifferently day or night; the cough, in one hoarse and boister- ous, in the other hoarse and frequent at first, but rare and smothered to- wards the end; the voice, in one hoarse, but never scarcely whispering, and if so, only during the height of the paroxysm, in the other hoarse at first, and soon permanently whispering or entirely lost; the cry, in one hoarse and stridulous only at the moment of the paroxysm, in the other per- manently so ; the respiration, in one stridulous and difficult only during the paroxysm, and in the interval perfectly natural, in the other, at first natu- ral, becoming by degrees permanently stridulous, and attended by the most violent dyspnoea, with remarkable prolongation of the expiration, and even with recession of the base of the thorax in inspiration ; the fever, in one very slight and generally observed only during the nocturnal paroxysm, in the other much more considerable and permanent; and lastly, the duration, in one seldom more than two or three days, in the other rarely less than six, and very often eight or ten days. M. Trousseau states that the hoarse- sounding croupal cough is not a sign of the presence of exudation in the larynx, but rather of its absence; but, when the cough, croupal at first, becomes less and less frequent, and ends with being nearly insonorous with suffocation, there is true croup, that is to say, with plastic exudation in the larynx. This is precisely our own experience. The rare, insonorous cough of M. Trousseau is the condition which we have expressed by the term smothered. In order to render the diagnosis still clearer, we add the following table, which is altered from one given by MM. Rilliet and Barthez: MILD SPASMODIC LARYNGITIS. PSEUDO-MEMBRANOUS LARYNGITIS. Begins with coryza and hoarse cough, In epidemic form, begins as pseudo- or more frequently with a sudden attack membranous angina. In sporadic form, of suffocation in the night. Fauces natu- invasion of slight hoarseness for a day