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

  • J. Forsyth Meigs
Date:
1886
Catalogue details

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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    usually affects the whole of the larynx, and sometimes extends to the tra- chea. In cases attended with ulcerations, these alterations exist in con- nection with those already described. The ulcerations are generally small, few in number, very superficial, linear in sliape, and are almost always found upon the vocal cords. Tliey are so slight often as to escape observation, unless a very careful examination be made ; and this, per- haps, explains the circumstance of so few jjcrsons having met with them in the simple acute disease. Not unfrequently a certain amount of [jha- ryngeal irritation is present at the same time, with or without some degree of tonsillitis. Symptoms ; Course ; Duration—The attack generally begins with an alteration of the voice or cry. In infants the change in the cry alone exists, so that to detect the disease, it is necessary to hear the child cry. In older children the same alteration of the cry is present, but there is in addition a change of the voice, consisting of various degrees of hoarseness. These symptoms may be so slight as to be observed in the cry only when it is strong and forcible, and in the voice so as to strike only the ear of one accustomed to be with the child ; or they may be so marked as to be heard in the faintest cry that is uttered, and to be evident in the voice in a moment to the most careless observer ; or there may be complete aphonia. They are often intermittent in this form, and are generally most marked in the after-part of the day and during the night. Simultaneously with this symptom, or very soon after, cough occurs. This is generally hoarse and rough, and early iii the attack, dry; at a later period it usually be- comes loose, and as this change occurs, loses its character of hoarseness. The frequency of the cough is variable, but usually moderate ; as a gene- ral rule it is most frequent in the evening, and early in the morning, par- ticularly in infants and young children. The disease is almost always preceded and attended with some coryza, which, in the early stage, is marked by sneezing and slight incrustations about the nostrils, and at a later period, by mucous and sero-mucous discharges. The respiration remains natural, except that it is sometimes nasal, and sometimes a little acceleratetl. There is rarely any fever, or it is slight, and occurs only at night. There is no pain in the larynx. In some cases, the hoarseness of the ciy, voice, or cough scarcely exists, or is but slightly marked, and the only symptom is a dry, hard, teasing, and paroxysmal cough, which, from its sound, evidently proceeds from the larynx, and resembles very much that produced by the tickling of a foreign body in the throat. The symptoms of this disease, instead of being of the mild character just described, may be much more severe. The cough is more frequent, lioarse, troublesome, and ]iainful, from the scraping and tearing sensations it occasions in the larynx. The voice is more affected, becoming from husky more and more hoarse, though it is very unusual for it to become weak and whispering, as in membranous and severe spasmodic croup. The respiration is decidedly accelerated, giving rise to sliglit dyspncea, and there is more or less fever, which is most marked usually in the after- part of the day and in the night. The pulse is more frequent than in health risin to 120 or 130 in the minute; the skin is hot and dry; the