A medical handbook : for the use of practitioners and students / by R.S. Aitchison.

  • Aitchison, R. S. (Robert Swan)
Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: A medical handbook : for the use of practitioners and students / by R.S. Aitchison. Source: Wellcome Collection.

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    gitis in children, associated with sudden spasm and “crowing” inspiration, and -without the development of a false membrane. &It has a tendency to recur again and again in the same child, when ex¬ posed to cold or wet. The symptoms and treatment of the spasm have been considered with laryngismus stridulus. The causes of true croup are exposure to cold and wet, or the inhalation of irritating vapours, swallowing hot water, &c. It some¬ times occurs as a complication in measles, scarlatina, erysipelas typhus and typhoid fevers. ’ The symptoms commence with slight fever and hoarseness, the cough being shrill, dry, and “brassy.” There is at first no dyspnoea, but during the course of the disease this may arise sud¬ denly. There is then much distress, the patient’s muscles of forced inspiration come into play, the nostrils dilate, and all the symptoms of asphyxia are present. The inspiration is whistling and crowing, the voice is lost completely, and the cough is husky, while expec¬ toration of fragments of membrane is attended with marked relief. The disease runs a remittent course, extending usually from two to six days, the child’s breathing being noisy and difficult throughout, but with frequent exacerbations of suffocative distress. If the cough be loose, and the expectoration free, recovery may take place; but death may occur from suffocation, or from asthenia if the disease be severe and continued. The prognosis is, therefore, always grave. Diagnosis. In individual cases it is sometimes impossible to diagnose membranous croup and exclude the possibility of laryngeal diphtheria; but should the disease commence in the throat and a deposit be seen there, and if there be a history of contagion with enlargement of the glands, albuminuria, and much constitutional disturbance before the laryngeal symptoms—diphtheria will probably be the correct diagnosis. The absence of a history of contagion, the disease beginning in the larynx, and a history of exposure to damp or cold, point, in single cases, to croup. The age of the patient may also be suggestive. The presence of the membrane differentiates the true croup from the false, but in the earliest stages it may not be possible to dis¬ tinguish them ; while spasmodic croup, beginning suddenly, without -any previous history of illness, may either be laryngismus stridulus, or icatarrhal laryngitis, with spasm superadded to the general symp¬ toms spurious croup. A few hours will generally settle the ques- ttion. A post-pharyngeal abscess has been known to give rise to a brassy cough ” with dyspnoea; while pertussis, in the early stage, *when the cough is dry and harsh, may resemble croup. 1 lie treatment of true membranous croup is the same as in cicute catarrhal laryngitis. The patient should be kept in a warm W>m, and hot sponges or poultices should be applied to the throat. Une bronchitis steam kettle should be rigged up, and ipecacuanha hould be given in small doses as an expectorant, or in teaspoonful doses as an emetic, when there is much obstruction to the breathing. *'or the solution of the membrane, a spray of lime water, or painting • be throat with lactic acid, is recommended. Fragments of mem-