The infant : a handbook of modern treatment / by Eric Pritchard.

  • Pritchard, Eric, 1864-1943.
Date:
1938
Catalogue details

Licence: In copyright

Credit: The infant : a handbook of modern treatment / by Eric Pritchard. Source: Wellcome Collection.

    278/774 (page 252)
    Angio-Neurotic (Edema of the Larynx. (Edema of the angio-neurotic type may occur in any part of the body, and is of the group of allergic diseases which includes asthma, urticaria, hay fever, etc., and is due to some inherent hypersensibility to particular antigens or other exciting causes. The attacks start suddenly from no apparent cause, generally at night-time, and the child is greatly distressed, dyspnoeic, and cyanosed. On examination, a large smooth translucent swelling may be seen at the back of the throat, involving the epiglottis, the glottis, and neighbouring parts, and occluding the entrance to the larynx. It is a dangerous condition, and may cause death from suffocation unless tracheotomy or intubation can be promptly performed. The recognition of the condition is not as a rule difficult as the oedema is usually visible on examination of the throat, and is often accompanied by oedema of the face, or other parts of the body. Treatment. Prophylactic. Since the precise etiology of this condition is not definitely known, we have no rational basis on which to found preventive treatment. Most paediatricians believe that the attacks are due to allergic reactions to environmental factors, especially those of a dietetic nature, such as eggs, and fish, in fact that it is due to some protein hypersensibility, but there are clearly other causes, so that from the point of view of prophylaxis the most one can say is that the source of any possible exciting factor must be sought, and if found, avoided. If from skin tests or other means of inquiry, any enlightenment can be thrown on the precise nature of the exciting cause, there is evidently an oppor¬ tunity for prophylactic treatment by the application of some appropriate desensitizing method (see page 720). Curative. The treatment of this condition is clearly of an emergency nature. There is no time to apply slow-acting drugs or procedures. Ice must be applied externally to the neck, or if the child is old enough, it may be allowed to suck ice. Adrenalin to the extent of 3 minims of 1 in 1000 solution, or J to J of a grain of ephedrine hydrochloride, may be injected hypoder¬ mically, or the intravenous injection of 10 grains of gluconate of calcium may be tried. If none of these means succeed in relieving the symptoms intubation, tracheotomy or laryngotomy must be performed. Scorbutic Eccymosis of the Larynx This must be a very rare condition. I have only seen one ease myself, and I can find no other in the literature, but it is