INCOÖRDINATIONS OF THE LARYNX

CROUP

Croup is an inflammation of the larynx characterized by a more or less severe spasm of the laryngeal muscles. This spasmodic contraction distinguishes it from similar affections in adults. The spasm produced is very often more marked and results in more severe symptoms than does the inflammation. This incoördination is also called spasmodic laryngitis and catarrhal croup.

Symptoms

In spasmodic laryngitis or croup there is a slight catarrhal inflammation of the mucous membrane lining the larynx and a marked spasm of the larynx. There may be a slight discharge from the nose and slight hoarseness. The attacks usually come on at night with a hollow, metallic cough. About this time there is difficult breathing and the cough becomes more severe and of a teasing nature, the child making every possible effort to keep from coughing. The voice becomes husky but is seldom lost. There is rapid pulse and a slight temperature seldom over 101° F. The attack lasts three or four hours, after which the child will fall asleep. The dyspnea is aggravated and the spasm increased by excitement. During the day the child will appear well except for the slight cough and hoarseness, but the second night the attack will return with about the same degree of severity as that of the first night. Usually the attack may not return the third night or if it does it will be less severe.

Spasmodic laryngitis should not be confused with laryngismus stridulus, membraneous croup or with acute catarrhal laryngitis. According to Holt and Howland laryngismus stridulus occurs only in infants, and there is not only stridulous breathing, but also periods of complete arrest of respiration.

Major Adjustment

Lower cervical and S.P. is the combination major to use in this incoördination. Under adjustments results are often obtained immediately with no recurrence of the attack the following night.

In chronic cases enlarged tonsils and adenoid growths may be found. This, however, will not change the adjustment or the combination, but will increase the amount of time required to completely correct the condition so far as the chronicity is concerned. It will not interfere with the relief from acute attacks.

LARYNGISMUS STRIDULUS

This incoördination, according to Holt and Howland, occurs only in infancy. It is characterized by muscular spasms in the larynx with marked dyspnea.

Symptoms

There may be complete arrest of respiration for short periods, during which there will also be a marked lack of oxygenation of the blood. There may be recurrence of these attacks several times a day, and unless adjustments are given may last for weeks. There may be general convulsions and carpopedal spasms which are spasmodic contractions of the joints of the hands and feet. During the periods of arrested breathing the face becomes cyanosed. This terminates with a slight cough or a high-pitched crowing sound produced by the sudden inspiration of air. Because of this it is sometimes called “child crowing.” It is also known as thymic asthma and spasms of the glottis.

Major Adjustment

The combination major is lower cervical and stomach place. Under adjustments results are obtained in a very short time, in many cases almost instantly.

ACUTE CATARRHAL LARYNGITIS

This incoördination is found in children from one to five years of age. It may be severe and even cause death. It may be a secondary condition following measles, scarlet fever, influenza and other like incoördinations; however, it may result directly and not be associated with any other condition. It is often aggravated by inhaling steam, gases or irritating dusts.

There is congestion and inflammation of the mucous membrane lining the larynx; there is swelling and dryness of the membrane followed by an exudate which may become profuse. If the swelling is exaggerated there will be stenosis of the larynx. The vocal cords become swollen and produce aphonia.

Symptoms

The symptoms are hoarseness, dry metallic cough, which may become very severe and teasing. The onset is sudden with a marked tendency to cough, especially during the night. The voice often is entirely lost and the larynx becomes sore and painful. There is dyspnea and the respirations are short and shallow.

In some cases which develop more slowly there will be coryza for a day or two preceding the severe attack, or the laryngeal symptoms may precede the acute symptoms. The onset, however, may be very rapid and the most severe symptoms be present within a very few hours after the manifestation of the first symptom. In the well developed, case the cough is dry, metallic, barking and stridulus. The inspiration is labored. The dyspnea is severe, occurring in paroxysms during the night. There is temperature, rapid pulse and increased respiration. If the inflammation extends down into the bronchi it will result in bronchopneumonia. Laryngeal obstruction may occur often and prove very severe.

It is sometimes very difficult and in some cases impossible to distinguish acute catarrhal laryngitis from membranous laryngitis or laryngeal diphtheria. This is not so important to the chiropractor, for if adjustments are given soon enough results will be obtained before positive diagnostic symptoms have time to develop. However, it is well to be thoroughly informed on the difference in the symptoms since the chiropractor is sometimes not called in until the condition is well under way. At the onset the two conditions are very much alike, which is very reasonable to the chiropractor, since the only difference is in degree of severity, due to a different combination, and a difference in degree of the functions involved resulting from the same combination o£ subluxations. In the catarrhal condition the temperature is usually greater than in the membranous form. The dyspnea in catarrhal laryngitis is usually paroxysmal; it is less exaggerated during the day but worse at night, while the membranous type is constant and rapidly becomes more exaggerated. The dyspnea occurs on both inspiration and expiration, while in the catarrhal form it occurs only on inspiration. If the culture shows Klebs-Loeffler bacilli it is considered laryngeal diphtheria.

Major Adjustment

As has been stated, the chiropractor gives the same adjustment whether it is membranous or catarrhal. The major combination is L.C. and S.P. with K.P. Excellent results are obtained from adjustments in these cases. When the first symptoms are manifest adjustments should be given immediately in order to get the best results. The usual difficulty in such cases is that the parents consider the condition only a cold and of little importance. Therefore, they neglect taking the child to a chiropractor until great momentum has developed. Such cases necessitate a greater amount of time before results are obtained.

CHRONIC LARYNGITIS

This form is simply a prolongation of the acute form, but may be associated with adenoid growths of the pharynx, with tuberculosis of the larynx, with syphilis or with new growths in the larynx.

Symptoms

The symptoms are similar to those in the acute stage except they are not so severe.

It is not uncommon to find adenoid growths in the pharynx of the very young infant. There is a superficial inflammation of the mucous membrane producing a local calorific plus. This is the result of interference with transmission of mental impulses to these tissues and when this interference is removed Innate Intelligence will function normally and the growths will disappear.

Major Adjustment

The adjustment is the same as in the case of acute laryngitis. The results will be slower in the chronic case than in the acute case, but in the course of time the child will be entirely relieved of the condition without the aid of surgery. If the proper adjustment is given during the acute attack the condition will never reach the chronic state.

A chronic laryngitis is often accompanied by papillomatous growths which occur very early in life, in most cases during the first year. This condition occurs more often in boys than in girls. The size and location of the growths determine the severity of the symptoms. There is paroxysmal cough, dyspnea, loss of voice, and hoarseness. The symptoms usually develop so slowly that they do not attract attention until the growth has attained quite a size. Holt states that the prognosis is usually serious from a surgical standpoint because there is danger of bronchopneumonia following the operation. It is also stated that operations have been largely given up because of the tendency of the papilloma to return in increasing numbers. These tumors are the result of the interference with transmission of mental impulses to the tissues, preventing the normal personification of Innate Intelligence in the production of function. Under adjustments which results in the restoration of the normal transmission excellent results are obtained. In the course of time under adjustments the growths will disappear and with them all the symptoms of the chronic laryngitis. Adjustments should be given just as soon as the growths are suspected and kept up until the symptoms have disappeared.

TUBERCULAR LARYNGITIS

Tubercular laryngitis is seldom found in infants and is rare even in later childhood. Usually pulmonary tuberculosis develops later; by some it is considered to be always associated with it. There is cough and hoarseness with aphonia, expectoration of mucopurulent or in some instances bloody character. Microscopic examination of the sputum reveals the tubercle bacilli. Results are obtained under adjustments, providing a sufficient amount of time is allowed to permit Innate to overcome the momentum and rebuild the structures that have been destroyed.

FOREIGN BODIES IN LARYNX AND BRONCHI

Children are likely to acquire the habit of putting small objects, such as buttons, small playthings, and even pins, into their mouths. If the child becomes frightened, tries to cough, laugh or cry that which is held in the mouth at the time is likely to be drawn into the larynx and may lodge there, especially if it is sharp or has rough edges. If, however, it is a smooth object, such as a button or bean, it is more likely to pass into the bronchi, usually the right one.

When the foreign body enters the larynx there will be violent coughing which may result in the expulsion of the object. If it is not immediately expelled but becomes impacted in the larynx there will be marked dyspnea and even death from suffocation.

When the foreign body passes the larynx it will lodge, usually, in one of the bronchi or at the bifurcation of the trachea. If this occurs there will be localized pain over the region of the foreign body. There is a cough and may be spitting of blood. The irritation will result in a local inflammation; this may result in the formation of an abscess which may prove serious. In some cases following such conditions there is prolonged illness resembling pulmonary tuberculosis during which there may be sufficient relaxation in the muscular walls of the bronchi to permit the foreign body being expelled during a paroxysm of coughing. This has occurred in many cases. Following the expulsion of the foreign body the patient recovers very rapidly. In some cases there are repeated attacks of pneumonia. The health of the child becomes greatly impaired and thus he becomes easily susceptible to the acute attacks which may prove too much for the adaptability of the body.

Symptoms

The symptoms of a foreign body in the larynx are characteristic and consists in the very sudden appearance of the attacks and also in the severity of the symptoms. There will be a history of something having been in the child’s mouth, or the possibility of the child having placed some object in his mouth. A metallic body can always be located by means of the X-ray.

Ordinarily these cases do not come within the scope of Chiropractic. There might be a subluxation which would prevent adaptation from taking place, and if so, an adjustment might result in a relaxation of the muscles to such an extent that the foreign body could be expelled by coughing. These cases are traumatic and should be taken to a competent surgeon at once.

EDEMA OF THE GLOTTIS

This is a dropsical condition of the glottis and is very rare in infancy or early childhood. Usually there will be other symptoms indicating abnormality of the kidneys.

Symptoms

If the edema is great enough there will be attacks of suffocation because of the interference with inspiration. There is very little if any interference with expiration. There may be hoarseness, painful and difficult swallowing and a cough. The symptoms may come on suddenly and develop very rapidly and soon result fatally.

Equation and Major Adjustment

The equation for the local condition is secretion plus (T+). If the condition is involved with nephritis the equation for the nephritis is calorific plus (C+) in the kidneys with N.C.R. in suppurative nephritis, which results in excretion minus (E-). The major adjustment is K.P. with S.P. and local L.C.