(False Croup)
=Definition.=—A catarrhal inflammation of the mucous membrane of the
larynx with spasm of the glottis.
=Osteopathic Etiology= and =Pathology=.—This affection is practically
the same as laryngismus stridulus associated with catarrhal
inflammation of the mucous membrane. It is a disease of young children.
Derangements of the innervation and blood supply to the laryngeal
mucous membrane and muscles of the larynx are found in the same
locality as noted under acute catarrhal laryngitis and laryngismus
stridulus. There is acute catarrh causing a croupy cough, and
difficult breathing due to spasm of the glottis.
=Symptoms.=—These attacks generally occur during the night, the child
being suddenly awakened by severe paroxysms of suffocating and a dry,
hard cough, associated with evidences of dyspnea. In half an hour or
an hour or two the coughing ceases, perspiration follows and the child
falls asleep. If proper treatment is not given, these attacks may occur
for several successive nights, the child appearing almost or quite well
during the day.
=Diagnosis.=—The symptoms are so characteristic that the diagnosis is
easy. In all instances the prognosis is favorable.
=Treatment.=—The catarrhal inflammation of the mucous membrane of the
larynx should be treated in the same manner as simple inflammation of
the laryngeal mucosa, i. e., thorough treatment of the cervical spine
and direct treatment over the larynx.
During the paroxysm, if the patient cannot be relieved very shortly
by the cervical treatment, he should be placed in a hot bath of a
temperature from 98 to 110 degrees F. This will, in the majority of
cases, relieve the attack. In addition a hot compress may be placed
about the throat. Producing emesis by irritating the fauces with the
finger is necessary in a number of cases in order that the secretions
in the laryngeal region may be ejected, thus relieving suffocation and
labored breathing. Also, an overloaded stomach which is causing an
irritation, should be emptied at once by vomiting. The bowels should be
kept well open in all cases. Occasionally the epiglottis becomes wedged
in the chink of the glottis. Such a condition requires an introduction
of a finger into the fauces to release the disorder.
Care should be taken, especially following an attack, that the child
is not exposed to cold or rapid changes of temperature, so as to avoid
repetition of the spasms.
=Coughing.=—Coughing, not only in spasmodic laryngitis, but also in
various diseases where coughing is a prominent symptom, is a most
irritating and annoying feature. The osteopath is many times called
upon to relieve the cough, whether it is due to slight irritation of
a nerve fiber alone or is a symptom of a serious chronic disease. The
coughing center is located in the medulla oblongata; the afferent
nerves are sensory branches of the vagus; the efferent nerve fibers
are found in the nerves of expiration and in those that close the
glottis. Consequently, coughing may be caused by stimuli to various
sensory nerves, various cutaneous areas (chiefly the upper part of the
body), mucous membrane of the respiratory and digestive tracts, the
mammae, liver, spleen, ovaries, uterus, kidneys, etc. Perhaps the most
common cause of cough is contraction of some of the muscles of the
neck, irritating sensory fibers. Contraction of the omo-hyoid muscle
may produce an irritating cough by causing traction on the hyoid bone.
In a few cases the larynx may prolapse to some extent and thus be a
source of irritation. Lesions of the spinal cord between the seventh
and eighth dorsal, also at various points above in the dorsal vertebræ
and in the ribs (especially at the second and third ribs), are very
apt to produce a cough. Impaction of the sigmoid flexure is oftentimes
accompanied by coughing. Enlargement of the heart may cause pressure
upon the respiratory tract directly and cause a deep, dull cough.
Foreign bodies in the external meatus of the ear are occasionally a
source of irritation which is accompanied by coughing. Thus there are
innumerable sources of stimuli that may produce coughing. In all cases
it is necessary to make a careful diagnosis as to whether it is an
irritation to some fiber that can be corrected at once or whether it
is a symptom of a disease that can only be relieved by the cure of the
disease. In local congestions the cold pack will often be of service.