In the year 1850, after submitting to the manipulations of a dentist, I was advised to wash the mouth with a solution of Chlorine. A weak solution of Chlorine gas in cold water was accordingly prepared, and I proceeded to rinse the mouth with it. Scarcely had the liquid been received into my mouth, when I became sensible of a spasmodic action of some part of the respiratory organs of the following character: Inspiration was unimpeded, and could be effected in the natural manner, but expiration was absolutely impossible, and this impossibility arose, if I might trust my sensations, not from any inability of the muscles of expiration, but from a closure of the rima glottidis.
Expiration being felt to be impossible, inspiration was again attempted, and was accomplished, fully and easily, although the act was attended by a slight crowing noise. Expiration, which was again attempted, was impossible as before. By these successive operations, the lungs became inflated to a most painful degree, but, so firmly did the glottis appear to be closed, that it seemed as though air might pass through any part of the thoracic walls more readily than by the way of the larynx. This arrest of respiration having endured for about a minute, the face becoming turgid and livid, partial coma supervened, the spasm relaxed, and respiration became free again.
In 1852, I had an opportunity of witnessing the effect of a strong accidental inhalation of chlorine gas by an adult. The same phenomena of comparatively free, but crowing inspiration, and of absolutely obstructed expiration presented themselves; the face became extremely livid, convulsive movements of the extremities began, and the patient became partially comatose. I administered ammonia by olfaction; the spasm relaxed, and consciousness returned along with normal respiration.
These experiments show a power in chlorine to produce the following condition: Spasm of the glottis, which interferes but little with inspiration, giving to it a crowing sound, but which prevents expiration. During the continuance of the spasm, the respiratory acts consist of a succession of crowing inspirations, each followed by an ineffectual effort at expiration, the whole serving to inflate the chest to a most painful extent, and attended at last by turgescence of the face, and more or less complete coma, with or without convulsive movements of the extremities, and during which the spasm relaxes.
In the Proving of Chlorine, (1 1In vol. ii. of the Neues Archiv.) a similar effect is indistinctly indicated. Pereira says: “If an attempt be made to inhale undiluted chlorine gas, it produces spasm of the glottis. Twice I have suffered severely from the accidental inhalation of it; and each time it gave the sensation of constriction of the air-tubes, such as might be produced by a spasmodic condition of the muscular fibers of the bronchial tubes.” The peculiar nature of the chlorine spasm, viz., that it affects expiration almost exclusively, is not mentioned by Pereira.
Bearing in mind the odium which has been attempted to be cast upon some of our colleagues for flooding our literature with “fragmentary provings.” which serve no purpose but to “cumber th e Materia Medica,” and to annoy our practitioners with an “embarras de richesses” (as if it were not worth while to publish and to study anything, however “fragmentary,” if it furnish us the means of curing, were it but a single case!), I might have abstained from publishing the above symptoms of Chlorine, had not the following case demonstrated their practical value.
June 24th. A female infant, seven months old, well developed and large, the fourth child of healthy parents, was brought to me with the following history: Having been previously in perfect health, she was seized three weeks ago, with a spasmodic affection of the respiratory organs. Suddenly and without any warning, she would make a long inspiration, with a slight crowing noise; an attempt to exhale would be made, but without success; another crowing inspiration followed by a forcible, but ineffectual effort to exhale; and this would be repeated until the child became blue around the mouth, and sank into partial unconsciousness, when free respiration would take place, and the child would generally sink into a deep sleep. Frequently toward the close of an attack, convulsive movements of the extremities would be noticed, and once, general spasm occurred. At first, these attacks came on only after some excitement, or on the child being startled. They frequently occurred during sleep, arousing the child suddenly, and they were most frequent from midnight to 7 A.M. Within the week before I saw her, they had become very frequent as many as thirty to forty, occurring during the twenty-four hours. The child had begun to emaciate rapidly, had lost appetite, strength and playfulness, the face was pale and bloated, and the eyes had a dull and glassy expression. The child had been under most skilful homoeopathic treatment since the commencement of the attacks, and as she failed to improve, change of air was recommended, and she was brought to Newburgh. The climate failing to benefit her, the child was placed under my care. The case seemed all the more serious from the fact that, last year, the parents had lost an older child, a boy, with the same affection. In the fourth week of the disease, of which the course had been in every respect similar to that of the infant above narrated, convulsions supervened, and the child died at the end of the sixth week. This child was under enlightened allopathic care. It may be interesting to note, that the autopsy revealed no malformation, and no organic lesion; simply emaciation and atrophy.
On careful examination of my little patient, I could discover nothing abnormal in the condition of the heart or lungs, and no sign of disease that was not fairly attributed to the frequent recurrence of these spasms with the venous congestion consequent upon them. It was evidently a case of spasmus glottidis (asthma thymicum, asthma millari, asthma laryngeum infantum, laryngismus stridulus), and had advanced almost to the second or convulsive stage in which the prognosis is decidedly unfavorable.
The remedy which is recommended before all others for this disease, in our hand-books and repertories, is Sambucus. The symptom on which this recommendation is based is the following: “Slumber with half-open eyes and mouth; on awaking from it, he could not draw a breath, and was compelled to sit up, whereupon respiration was very hurried, with wheezing in the chest, as if he should suffocate; he lashed about with his hands; the head and face were bloated and bluish; he was not, without thirst; weeping at the approach of a paroxysm, all this without cough, and especially at night, from twelve to four o’clock.” On comparing this picture with the case under consideration, we find correspondence in the general characters of the affection. The spasmodic embarrassment of respiration, the absence of fever and of cough, the occurrence of the paroxysms suddenly, chiefly at night, and on awaking, show a general appropriateness of Sambucus to spasms of the larynx and bronchial tubes. But we seek in vain for the unequal disturbance of the inspiratory and the expiratory acts, which are the individual, and therefore the characteristic, peculiarity of the case under consideration. And failing to find this, we should, as a matter of course, expect that Sambucus would fail to cure, or in any way to affect the case. And this had been the fact. So, too, of Lachesis and several other remedies which, as well as Sambucus, had already been tried before the case came under my care. In this very peculiarity, which was characteristic of the case, the similarity of Chlorine was most striking. And it was with the utmost confidence of a happy result, that I determined, after a careful examination of the case, to administer Chlorine. I accordingly prepared a saturated solution of Chlorine gas in water at 60 degree Fahrenheit, and made from this the first centesimal dilution, in which the odor of the Chlorine could be faintly perceived.
Of this I ordered twenty drops to be dissolved in four table-spoonfuls of water, and a tea-spoonful to be given to the child every three hours. (A porcelain spoon was used.) I also directed a few drops to be placed in the child’s mouth at the beginning of each paroxysm, if this should be possible.
The first dose was given at four P.M., June 24th. During the preceding twenty- four hours the child had had forty paroxysms. During the succeeding twenty-four hours there occurred but four paroxysms, only one of which began with any severity, and this one was instantly arrested midway by a few drops of the solution placed upon the child’s tongue. During the night of the 26th not a single paroxysm. Improvement in the general condition of the patient now became apparent; appetite and playfulness returned; the bloated aspect of the face and the dullness of the eye disappeared. On the 27th the paroxysms increased in number and severity. On examining the solution, I found that it had changed in character, and no longer contained Chlorine. A fresh solution was prepared, and thenceforward it was prepared afresh every second day. From this time, July 1st, the remedy was continued; a dose every four hours, when, the spasms having wholly ceased, and the child appearing well, it was finally discontinued. On the 2d July a slight spasm occurred, and the child appeared feverish and excited, with greenish diarrhoea. I found a lower incisor pressing strongly upon the gum, which was hot and swollen, and which I forthwith lanced. In two hours the child had lost every trace of illness. Since this date she has continued in good health, with the exception of some trifling disorder attendant upon dentition. (1 1Marshall Hall advises, that in this disease special attention should be paid to the state of the gums, if, as is generally the case, it occur during dentition, and he advises frequent, even daily scarifications of the gums. Until the 2d of July there was no sign of irritation of the gums, which had been carefully examined by me every day.) There has been no sign of a recurrence of the spasm of the glottis.
I am aware that children who are subjects of this disease have occasionally periods of exemption from its attacks, though this is not the case when the attacks are so frequent and also violent as in the above case, and it is possible that this child may be again attacked under provocation of difficult dentition or of some equally powerful exciting cause. As there can be no doubt, however, of the controlling power of chlorine over the first attack, I should have no misgivings about its success in subsequent attacks should the condition be the same as before.
In connection with the above remarks upon Chlorine, it may not be amiss to call attention to a kind of spasm of the glottis occasionally produced by chloroform, and which strikingly resembles the spasms produced by Chlorine. Now, by the presence of an alkaline solution, chloroform is readily decomposed, and Chlorine set free. The question at once suggests itself whether in these cases of spasms such a decomposition has been induced by the reaction of the alkaline saliva upon the vapor of chloroform, and whether the spasm is caused by the Chlorine thus set free.
In this case, the spasm of the glottis constituted the whole of the morbid condition. But sometimes spasm of the glottis occurs as a complication of some affection of the throat or of the respiratory apparatus, and in such cases Chlorine may be of great service. In the winter of 1853, I visited in consultation a case of scarlatina, in which sloughing of the pharynx to a great extent had taken place and in which spasm of the glottis had set in, threatening to cause a speedily fatal termination. The attacks of spasm were almost constant, the child, a boy of eight years, scarcely rallying from one paroxysm before another came on. The character of the spasm was precisely such as I had seen produced by Chlorine. Chlorine water was administered, and the spasms ceased instantly, with but one or two very slight recurrences.