In the violent struggles for the recovery of the breath to which I have alluded, all the muscles supplied by the respiratory system of nerves are thrown into violent action; the eyes are often involuntarily rolled upwards by the agency of the trochlearis; the muscles of the face are expressive of agony; or occasionally convulsed; the head is thrown back by the muscles supplied by the spinal accessory nerve; the serratus magnus is in violent action; the diaphragm and abdominal muscles contract vehemently, and even the extremities are rigid. With all this, however, the face is commonly pallid, and has that lurid denominated cadaverous; and the external veins, tinged with highly carbonized blood, form long streaks upon the forehead and temples, which continue long after the cessation of the paroxysms.
The cause of this terrible malady was long but imperfectly understood. Dr. Ley, whose description of “child-crowing, we have already quoted, published his very learned and able monograph in 1836, in this he attributes the malady to pressure exerted by enlarged bronchial glands upon the pneumogastric and recurrent nerves. This opinion he founded upon actual post-mortem examinations, and he illustrated it by five lithographic engravings from morbid specimens, which show the nerves thus flattened and compressed by such enlarged glands. Dr. F. Barrier, of France, writing in 1844, attributes the disorder to pressure exerted directly upon the air-passages. “Bien que nous partagion l’opinion de M. Blache, qui attribute au spasme de la glotte la dyspnee decrite par des auteurs Anglois et Allemands sous le nom d’asthme thymique, nous dirons plustard qu’il nous repugnerait point de placer la cause de cet asthme dans la compression exercee par le thymus hypertrophie sur les voies aeriennes. Traite Pratique des Maladies de L’Enfance, par F. Barrier, D.M., Paris, 1845. Laennec, writing in 1808, says inflammation of the bronchial glands is very little known, and appears to be very rare. He speaks of tuberculous affection of these glands, particularly in scrofulous children. Louis, in 1843, says of the bronchial glands, “these bodies very frequently undergo tuberculous transformation, not only in children in whom all accurate observers coincide in regarding the transformation of these organs as even more frequent than that of the lungs. And he states that the compression of the trachea and bronchi, causing difficulty of breathing and of swallowing, impeded circulation, and even fatal hemorrhage, is far from being a rare effect of their enlargement. Researches in Phthisis, Syd. ed., pp. 91 and 92.
From a careful study of the different descriptions of the disorder under consideration, which has indeed a great variety of designations, but which is commonly called laryngismus stridulus, it will appear that on the one hand the symptoms are so various that they are almost capable of being distinguished into two or three different diseases. And on the other it will appear also that the causes are no less various in their seat and mode of action. Thus, again, we have on the one hand the paralysis of the trunk of the vagus and its branches, resulting from the swelling and induration if the parts exerting pressure upon them, “Its conducting power is frequently impaired by scrofulous affections of the cervical and thoracic glands, and especially of the bronchial glands. And on the other hand spasm of the glottis, which has very similar results although under somewhat different conditions. That is it is more apt to occur in early infancy; the attacks of spasm of the glottis more frequently appear at night, on awaking from sleep; or from any sudden movement or exertion; they may often be traced to hereditary predisposition. This form disease is more frequent in the city than in the country; in those who are brought up by hand, or prematurely weaned, instead of being nursed; and in many cases it may be seen to result, in some way, from the influence of the first dentition. In a note to one of his Lectures, Dr. West thus speaks of this disorder: “There is a form of spasmodic affection of the larynx which, under the name of thymic asthma, has attracted considerable attention among continental writers. The spasm of the glottis, which is the most prominent symptom in this affection, is supposed to be due to the pressure of the hypertrophied thymus upon the larynx, and the consequent irritation of its nerves.
There can be no doubt that the several forms of dyspnoea, more or less variously described under the different names above given, are due to pressure exerted by the cervical glands, by the thymus gland, or by the bronchial glands, in a morbidly enlarged and indurated condition, either upon the nerves, upon the bronchia, or directly upon the larynx. But whether in any particular case they act by producing direct spasm of the glottis, through pressure upon the bronchus or larynx, irritating the peripheral extremities of their nerves; or whether they cause paralysis, by pressing directly upon the vagus or one of its branches, the physician must determine for himself, from the study of the symptoms present. Sufficient has been here stated to lead him to a careful study of his case; to realize that he may have to contend, not so much with a temporary or accidental affection, as with a disorder of a most important function; a disorder resulting from some deep-seated, even hereditary dyscrasia, which may have been developing itself in these obscure glandular structures, and which only reveals itself to his observation in its secondary consequences.
Hypertrophy of the thymus gland is no doubt the most frequent in earliest infancy, and this morbid condition may have originated even before birth. The corresponding enlargement of the thyroid gland occurs later in life, and constitutes the disorder known as goitre, or bronchocele.
Arsenicum. If there is much thirst and restlessness.
Belladonna. The face and eyes are very red; the head is very hot.
Ipecacuanha. If much nausea prevails; or there is much strangling as if from mucus.
Laurocerasus. If the spells seem to be excited by some abnormal condition of the heart.
Moschus. In cases similar to the above but not so violent.
Phosphorus. This remedy may be called for in some cases of very tall, slim children.
Sambucus n. The child suddenly awakens, nearly suffocated, sits up in bed and turns blue, gasps for breath, which it finally gets; the spell passes off; it lies down again in bed, but to be aroused sooner or later in the same manner.
Stramonium. If the child seems quite delirious, does not know where it is; as soon as it can speak it constantly calls for papa and mamma, although they may be at the same time present and trying to console the child.
In chronic cases, such as may be supposed to arise from enlargement of the cervical or bronchial glands, study Calcarea c.; Jodium; Iodide of Mercury, and Spongia.
DISEASES OF CHILDREN continued
SCARLET FEVER–SCARLATINA.
SCARLET FEVER forms the most terrible and fatal scourge of infancy and childhood. Its highest mortality is said to occur during the third year of life; and under the old-school treatment entire families of children have been swept away. The Homoeopathic treatment of this much-dreaded disease renders it far less fatal. In fact from all but the more malignant forms of scarlet fever, the danger of a fatal termination seems almost wholly removed. Still the cases of this latter variety, and even others of less original severity, require for their successful treatment the utmost patience and skill on the part of both physician and nurse. This is due in part to the unsteady and even treacherous nature of the disease itself in the severer cases, and to the serious complication which may arise during its progress; and in part to the Sequelae which may change an apparently favorable convalescence, even in milder cases, to a new and still more dangerous form of disease.
Scarlet fever has usually been divided into three varieties; scarlatina simplex; scarlatina anginosa; and scarlatina maligna. But this difference in degree of the severity of the disease, whether confined to particular cases, or extended to epidemics, is of little practical value. A more simple classification, and one which refers to the kind of disorder, consists in a two-fold division; scarlatina Sydenhami; and scarlatina miliaris, or rubeola.
The scarlet fever of Sydenham, the true Belladonna scarlet fever of Hahnemann, is now comparatively rare. But it is important to distinguish it when it does appear, from the more common scarlet rash, if for no other reason than because the prophylactic use of Belladonna, so strongly recommended by Hahnemann and proved so wonderfully efficacious in the former variety, is of no avail in the latter form. The true scarlet fever of Sydenham, the scarlatina laevigata or smooth scarlet fever of some authors, runs a comparatively regular course; and is much less disposed to strike in, and occasion dangerous metastases, than is the scarlet rash. This latter and more common form of scarlet fever is at once more insidious, more treacherous and vastly more dangerous than the former. In its severer forms it is always impossible to tell how much more or the malignant element may yet remain behind and waiting for the favorable moment, of convalescence even, for development; and;in the milder cases, we know not what an hour may bring forth; the the eruption apparently well out, may suddenly recede, without apparent cause; and the most critical and alarming symptoms replace a condition which had been encouraging and satisfactory.
