GEN. VII. The writers on croup have given but one form of it, Empresma except what has been erroneously called spasmodic Bronchlem- croup, a disease of a different kind, which has already mitis. been described under the name of LARYNGISMUS STRICroup. Hitherto er- DULUS. Properly speaking, however, there are two forms, roneously an acute and chronic, under which the present species arranged. shows itself, and which may thus be distinguished as va Import of bronchus formerly, and on the present oc casion. a E. Bronchlemmitis acuta. rieties : Acute croup. Chronica. Chronic croup. Bronchial polypus. Sense of suffocation keen, and constrictive; chiefly seated in the larynx; respiration sonorous; voice harsh; cough ringing; great restlessness; terminating in a few days. Sense of suffocation obtuse and heavy; chiefly seated in the chest; cough severe, but intermitting; extending to some weeks or months. The disease, in both varieties, usually commences with the common symptoms of a cough or catarrh; but essentially consists in a peculiar inflammation that spreads through different parts or even the whole range of the windpipe, from the larynx to the minutest ramifications of the bronchiæ. In this extensive sense, the tube was called bronchus by the ancients; and I have hence preferred the term bronchlemmitis to that of trachlemmitis, or membranous inflammation of the trachea, as such a term would imply a limitation of the inflammatory action to the upper part of the bronchus alone, to which it is not confined in either of the forms before us. The FIRST VARIETY, importing the COMMON or ACUTE CROUP, the suffocatio stridula of Dr. Home, who has Common or the merit of having earliest called the attention of meacute croup. dical practitioners to it as a distinct disease, though it extends thus widely, usually commences in the larger parts of the tube; during which a peculiar effusion is secreted, that readily assumes a membranous form, and lines, not only the trachea above its divarication, but SPEC. VI. acuta. also its minutest branches, though the larger parts of the GEN. VII. tube are first affected. When chemically examined the secretion appears to consist chiefly, if not entirely, of the gluten, or coagulable lymph of the blood, diluted with its serosity, and copiously combined with that peculiar substance of the blood, detected by the labours of modern chemistry, which, from its essential tendency to concrete into a fibrous, and even a membranous texture, 'has received the name of fibrin. lemmitis Common or acute croup. Peculiar like secre membrane tion. Chemical character. secreted in By what means the mucous secernents throw forth this peculiar effusion on this peculiar occasion we know not. It is said by some writers to be secreted on no other occasion, and by no other organ; but this is unquestionably a mistake. There are few practitioners, Sometimes perhaps, of accurate observation, who have not found it other parts discharged at times from the intestinal canal; of which I of the syshave already given examples under DIARRHŒA tubularis; in which, as in croup, there is an inflammatory affection of the morbid organ, and a spasmodic constriction of the passage. tem: and in the formation of polypi. Whence croup has been named angina poly Jj In reality the effusion, distinct from the inflammation that gives rise to it, is not essentially different in its principles from what occurs in genuine polypus, or that of the nostrils, and those polypous concretions which are often to be found in other cavities: and hence Dr. Michaelis and some other writers have given to the disease the name of angina polyposa*: a term, however, inconve- posa, nient, and indeed, inaccurate, since angina, as commonly but incorunderstood, imports inflammatiom of the fauces accomrectly. panied with difficulty of swallowing, neither of which are necessary or even accidental symptoms of bronchlemmitis. This disease appears in the present day to exist in most parts of the world, and in the American States is called hives, supposed by my distinguished friend Dr. Hosack to be a corruption of the term heaves, and pro Disease known in most parts of the world at present; though not distinctly noticed till within the • De Anginâ Polyposâ. Auctore Christ. Fred. Michaëlis. 12mo. Argentor. last century. SPEC. VI. lemmitis acuta. GEN. VII, bably so named from the heaving or violent efforts of the E.Bronch muscles of the chest and abdomen which take place in breathing during its course. It is hence extremely singuCominon or lar that till within the last century it should either not have acute croup. had any existence or not have been definitely noticed or described by medical writers: for Dr. Cullen appears to be perfectly correct in referring to Dr. Home as the first person who has given any distinct account of it". Its attack on children not counted for. easily ac Rarely attacks them after twelve years of age, It is also not a little singular that children should be chiefly subject to its attack, at whose age fibrin is not peculiarly abundant, and whose blood contains comparatively but a small proportion of azote, which in fibrin is so large a constituent. These are among the many curiosities which the prying eye of physiology has yet to follow up and much has it to accomplish before it will be able to explain them. Dr. Cullen asserts that acute croup seldom attacks infants till after they have been weaned; and that there is no instance of its occurring in children above twelve years of age. As a general rule this remark holds, but the disorder is by no means unfrequent to infants at the breast, of which I had one example not long ago: and it has been found occasionally in persons considerably above twelve years of age. Those who have once had it are more susceptible of it than before; though the susceptibility gradually wears off as they grow older. It is found equally in midland regions and on the coast; but perhaps more frequently in low, marshy grounds, than in drier uplands. There is no unequivocal instance of its being contagious, though it seems to have been oc casionally epidemic. Description. It commences usually with a slight cough, hoarseness, and sneezing, as though the patient had caught cold and was about to suffer from a catarrh. And to these in a day or two, succeed a peculiar shrillness and singing of the voice, as if the sound were sent through a brazen tube. "At the same time", says Dr. Cullen, who has De Suffocatione Stridula. pas SPEC. VI. lemmitis acuta. well described the progress of the disease, "there is a sense of pain about the larynx, some difficulty of respi- E. Bronchration, with a whizzing sound in inspiration, as if the sage of the air were straitened. The cough which at- Common or tends it is sometimes dry; and if any thing be spit up, acute croup. it is a matter of a purulent appearance, and sometimes films resembling portions of a membrane. Together with these symptoms, there is a frequency of pulse, a restlessness, and an uneasy sense of heat. When the internal fauces are viewed they are sometimes without any appearance of inflammation; but frequently a redness, and even swelling appear: and sometimes in the fauces there is an appearance of matter like that rejected by coughing. With the symptoms now described, and particularly with great difficulty of breathing, and a sense of strangling in the fauces, the patient is sometimes suddenly cut off."* To which I may add that the countenance exhibits great distress; the head and face are covered with perspiration from the violence of the struggle; the lips and cheeks are alternately pale and livid. Whence the danger of whether The essence of croup consists in the secretion of this viscid and concrete lining, which is perpetually endan- the disease: gering suffocation. Dr. Cullen does not dwell sufficiently upon this symptom; but ascribes the danger principally to spasmodic action, and represents the accompanying fever, which, on his hypothesis, is also a spasmodic action, to be very considerable; but spasm from spasm, was with him, as we have already seen, a favourite doctrine, and his judgement was often warped by it. Dr. Marcus of Bamberg in Bavaria, who regards all fevers as inflammation of some organ or other, and as entirely seated in the arterial system, regards croup also as a local inflammation alone, utterly independent of spasm, which neither exists here, nor in fevers of any kind: and attributes the danger to this symptom solely: which is the more extraordinary as he regarded croup to be a disease identic with hooping-cough, in which the spasm Pract. of Phys. cccxxiv. or inflam mation : SPEC. VI. lemmitis acuta. Common or acute croup. both of which are present. GEN. VII. or convulsion is the most prominent symptom. That a E.Bronch- there is some degree of spasmodic action, however, as well as of fever, is unquestionable, though neither are very considerable; and the locality of the disease as well as the peculiar character of the inflammation, sufficiently distinguish it from catarrh, in which there is also some inflammation of the mucous membrane of the trachea, though of a common kind, and rarely limited to this organ. In children, however, it frequently treads close upon catarrh, measles, hooping-cough, and any other disease that has debilitated the powers of the lungs: for as Dr. Michaelis observes, whatever tends to weaken or produce any degree of irritation in the lungs so as to occasion a preternatural secretion into that organ, may be considered as a predisposing cause of croup. Professor Dupuy of the Veterinary School at Alfort, gives an instance of its having been communicated in a village, in which it was epidemic, to a dog, brought under his care from a mistaken idea that the dog was suffering from hydrophobia. During the progress of the disease he had the shrill, ringing voice of children labouring under it; and speedily died of suffocation. On opening the body, a false membrane was found in the larynx, of a reddish colour, which extended to the bronchiæ; and the lungs were filled with an abundant serous effusion*. Communi cable to dogs. The cure must depend ing the membranous secretion, The cure demands a prompt and active attention; and upon remov- must depend not so much upon searching into and correcting the remote cause, or even counteracting the spasm, as in counteracting and removing the membrawhich chiefly nous secretion, which is every moment in danger of prosuffocation. ducing suffocation; and especially in children, in whom the natural aperture of the glottis is much smaller in proportion than in adolescents; and occasionally not more than a line and a half in breadth. endangers Copious bleeding. There is in the patient a perpetual effort to remove this solid secretion by coughing; but the cough is for the most part dry and ineffectual, and nothing more than Bibliotheque Medicale, Août, 1822. |