Action of Senna

CASE REPORT A boy aged 1 year 9 months was admitted to hospital on November 13, 1955, with a history that three weeks previously he had had a coryza with " wheezing," which had cleared in a week. Five days before his admission he developed another cold in the head, and later began coughing and wheezing. On admission the child was miserable and frightened. He cried lustily while being examined, and then quite suddenly swellings began to appear on each side of his neck, and these gradually increased in size. The crackling sensation elicited on palpation showed these to be due to subcutaneous emphysema. Clinical examination of the chest was impossible, as the child was very apprehensive, but a chest x-ray examination showed that he had a right pneumothorax and also demonstrated the subcutaneous emphysema of the neck. During the next two or three days this subcutaneous emphysema spread up into his face and down over the anterior and posterior chest walls, and then gradually disappeared. Treatment consisted in sedation and a course of oxytetracycline. A month later the child was readmitted for four days with a mild attack of asthma, which gradually subsided without treatment. On May 12, 1956, the boy was again admitted, this time with a 24-hour history of breathlessness and wheezing, for which he had been given ephedrine, without improvement. His temperature was 99.60 F. (37.60 C.), his right tonsil was injected, and there were generalized rhonchi in the chest. On sedation he settled down well. The following morning the child, although generally much better, seemed to have a rather puffy face. This was found to be due to subcutaneous emphysema which had developed overnight and involved the neck and chest wall as well as the face. Over the next 48 hours this increased in extent and then disappeared during the following week. An x-ray examination of the chest on this occasion showed consolidation of the anterior segment of the right lower lobe. There was no pneumothorax. Treatment was again sedation, and he was also given a course of sulphadimidine. At no time was the child particularly distressed by the presence of the subcutaneous emphysema. Family History.-The patient was an only child. His mother suffered from hay fever. His father gave a rather interesting story: he had been in the R.A.F., and described how, when undergoing an examination in which he had to perform the Valsalva manceuvre, he had suddenly developed a swelling in the neck. In his case, however, further investigations proved that he had a laryngocele.