SPASMUS GLOTTIDIS, whether considered as a symptom, or as an idiopathic disease, possesses considerable interest, since it occasions much alarm and distress.
As a symptom, it causes the croupy cough and dyspnoeic paroxysms incident to Laryngitis. It also constitutes the main symptom in the non-inflammatory or the Spasmodic Croup. It is produced, too, during hysterical attacks, and as a reflex effect of tumors which press upon the par vaga or their branches, especially upon the recurrent or superior laryngeal. In the convulsive stage of Tubercular Meningitis it forms a frightful complication.
As a distinct disease, as a neurosis, it appears independently in inflammation, tumor or any organic affection, although it may be complicated thereby. It appears almost always in infants between the fourth and eleventh month. Very few cases of indisputable diagnosis have been noticed after the fifth year, and scarcely any among adults, except in cases of hysterical origin.
Of exciting causes the principal are: Dentition: Rachitis; over- feeding or improper food; intestinal irritation; emotions, especially in children of nervous and excitable temperament. Enlargement of the glands, especially of the thymus, has been considered as an exciting cause, but of this pathologists are uncertain. It would seem that Goitre might act as a provoking cause, since its pressure on the larynx is often sufficient to produce dyspnoea, and might create an irritation of the recurrent laryngeal nerve. Tumors, enlarged bronchial glands, atelectasis, in fact any abnormality with can embarrass the pneumo-gastric nerves, may give rise to the spasm.
The disease is unattended by fever, cough or catarrh, and the intervals between the spasms, except in far-advanced cases, are free from all symptoms. The general health, however, is always below par.
Its essential phenomenon is difficult breathing, caused by a spasmodic closure of the rima glottidis. According to the intensity and persistency of the spasm are the accompanying symptoms. In mild cases, the child is observed to suddenly stop breathing as if holding its breath. In a moment the paroxysm ceases and with it the mingled expression of astonishment and fear on its face. In rather severe cases, the child is affected with the so-called crowing breathing, especially when excited or on awaking.
When the disease is well-developed, the child is suddenly seized with dyspnoea; inspiration is crowing and prolonged, expiration all but impossible. The frequent inspiratory efforts, not followed by successful expirations, distend the lungs enormously. The child kicks, throws back its head, clenches its jaw and exhibits a very characteristic flexion of both fingers and toes. The face, at first red, becomes livid, the eyes project, and general convulsions may follow. In some instances, the diaphragm becomes convulsed, thus adding to the distress. In others, the spasm continues so long that the child presents a complete picture of asphyxia. The general convulsions rather mark a second stage of the affection.
Complicating affections are Rachitis, which exhibits the symptoms so often that it might be considered as a part of the rachitic disease; Scrofulosis, with its enlarged glands and delayed dentition, Marasmus, favoring the spasm by impairing growth and weakening resistance to disease; too rapid growth, as in the children of tuberculous parents, etc.
The neurosis may end in recovery, which, however, is generally tardy, or the paroxysms may become so frequent ad so severe as to result in death, either during an attack from asphyxia, from convulsions brought on by cerebral congestion, or between attacks from secondary affections.
The disease may be easily diagnosed. From Croup : It differs in the absence of cough, and fever, etc.
From OEDEMA GLOTTIDIS; It is distinguished. by the absence of serous infiltration about the rima and by the breathing, which is worse during inspiration in the oedema, expiration readily pushing up the dropsical sacs above the rima of the glottidis.
From ASTHMA: It is distinguished by the seat of the dyspnoea, the noisy respiratory murmur head over the chest and the free glottis belonging to that complaint.
SPASMS of the respiratory muscles may indeed. complicate Spasmus Glottidis, but as an independent symptom it is plainly separable.
If TONIC, the thorax is retained in a position of inspiration. so that breathing is diaphragmatic.
If COLONIC, inspiration and expiration are rapid and noisy. Synonyms of Spasmus Glottidis, most of which are inaccurate, are: Asthma Millari, Asthma Wigandi, Asthma Spasmodicum, Asthma Thymicum, Laryngismus Stridulus, “crowing” spasm, etc.
Treatment may be divided into; Preventive, palliative and curative.
As PREVENTIVE, avoid, all excitement as violent emotions, fright, anger, etc., provoke a paroxysm. See that the child is not overfed, and that its food is properly selected. If the mothers, milk does not seem to agree, substitute cow’s milk mixed with sweetened barley water, or milk with Ridge’s Food. If the stomach is excessively irritable, a preparation of barley, milk and a small addition of Glycerin may be needed. All so-called table-food should be proscribed if the child has not yet cut the majority of its teeth. Even oatmeal, though strained carefully, is often injurious to children under six months, old.
If dentition is difficult or tardy, see if the diet is nutritious enough, and select a remedy principally from those useful in teething. If worms excite the disease, administer honey twice daily. If constipation acts as a provoking cause, make frequent use of enemata; or, in every young children, stimulate rectal contractions by inserting a plug of castile soap or a suppository of cocoa-butter. If the child is old enough, say eight to ten months or more, prepare the food with oatmeal, strained but cooked only ten to fifteen minutes, and if its stomach is not weak, sweetened with brown sugar.
AS PALLIATIVE, instruct the mother or nurse to warm the hands or feet when they become cold. During the incipiency of an attack, pat the child on the back or on the nates; plunge the child’s hands into hot water, or into hot and cold water alternately, press down the tongue, tickle the fauces with the finger or, in extreme cases, employ artificial respiration, as in drowning or in Asphyxia Neonatorum.
Remedies calculated to cure the disease must always be selected in accordance with the rules of our Organon. Nevertheless our labor may be lightened, and our memory refreshed for an emergency by a review of those drugs most likely to be called into service.
Remedies causing more or less spasm of the glottis; Aconite, Arsenic, Asafoetida, Atropine, Belladonna, Bromine; CalcareaPhosphorus, Chamomilla, Chelid., Chlorine, Coral.Rub., Cuprum Fluorine, Gelsemium, Hepar, Hyos, Ignatia, Iodine, Ipecac., (Kaolin), Laurocerasus, Lachesis, Lobelia Inflata, Lycopodium, Mephitis, Moschus, Naja, Nux Vom., Oleum Animale, Opium, Phosphorus, Phytolacca, (physostigma), Plumb., Sambucus, Silicea, Spongia, Stramonium, Strychnie, Sulphur, VeratrumAlb.
These may conveniently be divided into three classes, only two of which strictly belong to the subject under consideration.
1st.-For the acute paroxysm: Chlorine, Cuprum, Belladonna, Lachesis, Sambucus, Stramonium, Chamomilla, Arsenicum, Hyoscyamus, Oleum Animale, Phytolacca, Veratrum Album, Fluorine, Mephitis.
2nd. – Chronic cases, constitutional accompaniments: Plumbum, CalcareaPhosphorus, Phosphorus, Silicea, Lycopodium, Sul., Baryta C., Iodine, Hepar.
3rd- Remedies adapted to diseases in which the spasm is a symptom, as Croup: Spongia, bromine, Iodine, (Kaolin), Lachesis.
Hysteria and various nervous affections; Ignatia, Asafoetida, Moschus, Strychnine, Zincum met., Cicuta, Physostigma, Gelsemium
Asthma: Ipecac., Lobelia Inflata, Camphor, Sambucus.
Brain affection: Belladonna, Hyoscyamus, Stramonium, Cicuta., Agaricus, Cuprum, Opium, Atropin.
Spinal affections (causing the spasm by reflection); Nux Vom., Zinc, Physostigma, Strychnine, Belladonna
Affections of the par vaga, or of their origins: Lobelia, Gelsemium, Laurocerasus, Naja, Arsenic.
Suppressed hives: Arsenic.
It is not necessary to enumerate the especial symptoms of any of the above, excepting those which indisputably apply to the cute and chronic symptoms of the neurotic Spasmus Glottidis.
CHLORINE., as proved and confirmed by Dr. Dunham, corresponds thoroughly to the paroxysm; inspiration unimpeded and natural, expiration absolutely impossible from a closure of the rima glottidis; inspiration again made was found easy enough, but attended with a slight crowing sound, expirations again impossible Face livid, lungs fearfully distended from frequent inspiration without any corresponding exit of air: partial coma followed, the spasm relaxed and respiration became free. Although all the halogens and even Spongia cause this spasm of the larynx, none so completely typifies the Spasmus Glottidis as Chlorine. Similar to Mephitis.
LACHESIS is of service when the spasms occur during sleep; the child, as it were, sleeps into an attack, and is aroused, gasping for breath. At other times, the paroxysms recur after each nap. The external neck, about the larynx, is very sensitive to the slightest touch.