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.
Belladonna.- The smallest quantity of fluid drunk, excites a spasm; larynx painfully dry yet. the child refuses all drink. Larynx feels suddenly constricted. Breathing during sleep is intermittent or irregular. On falling asleep the child awakes and starts as if frightened. Sleep restless, tossing about the bed, talking or crying out. Kicks about, quarrels in sleep. Brain excited; face red; eyes injected; strabismus or dilated pupils; opisthotonic convulsions; clenched teeth, skin hot and dry or bathed in hot sweat, or fearful convulsions of flexor muscles. Over-susceptible to impressions, and hence made worse by strong light, noises, the least contradiction or cross word, by the irritation or dentition or the presence of irritating or indigestible substances in the abdomen. Urine stains a deep yellow or is scanty, even suppressed. Larynx sensitive to pressure.
NOTE:- General convulsions may possibly be palliated by firmly grasping the child ‘s thumbs. or by forcibly flexing the thumbs and toes.
Sambucus, employed by Hahnemann. Suffocative paroxysm after 12.P.M. aroused with anxiety, trembling, shortness of breath to suffocation; wheezing in the chest, difficult inspirations; face blue, eyes and mouth half-open, profuse hot sweat. Its symptoms do not seem to point distinctively to a spasm of the glottis, however.
MOSCHUS causes a spasm of throat, larynx and lungs. Sudden sensation as if, the larynx closed on the breath, as from inhaling Sulphur-vapor., It is more applicable during the course of disease which exhibit impending Paralysis of the pneumogastrics.
STRAMONIUM.- Child arouses from sleep frightened and clings to those around. Becomes blue in the face; muscles of the chest also spasmodically affected. Violent convulsions.
CHAMOMILLA.- Sensation of oppression and slight constriction in the region of the larynx. Dyspnoea as from suffocative catarrh (the larynx feels constricted), constant irritation to cough. Hot sweat on face and head, especially during sleep. Child becomes stiff and bends backwards, kicks with his feet when carried, screams and throws everything off. Staring eyes, child reaches and grasps for something, draws the mouth back and forth. Peevish, irritable; cries for things and pushes them away when given to him. Worse from anger or other violent emotions; worse from exposure to cold winds. Worse during dentition, accompanied by “Wind Asthma” “liver-grown” or green, watery, hot offensive stools.
OPIUM, especially after a fright.
CHELIDONIUM MAJUS causes a sensation as if the larynx was pressed from without on the oesophagus, but swallowing, not breathing, is made difficult. Constructive sensation in the trachea mounting towards the larynx. Constructive spasm in the gullet, forcing him to swallow. Choking sensation in the throat, worse by breathing. It has no similarity to the disease under consideration.
OLEUM ANIMALE.- Larynx feels, as if, it would be closed by outward pressure when lying on the back with the head bent forward.
GELSEMIUM.- Long croupy inspiration and sudden forcible expiration.
PHYTOLACCA.- Frequent spasmodic closure of the larynx; drawing of the thumbs into the palms; flexion of the toes; face distorted; muscles of the eyes so effected that the motions of one eye are independent of the other.
PLUMBUM causes closure of rima with sudden difficulty of breathing and asphyxia. Convulsions, during which expiration is suddenly arrested as if a valve closed the glottis. Emaciation. Stool, with much urging; hard; balls.
CUPRUM is well-adapted to cases which have advanced to the convulsive stage. On attempting to take a deep breath, dyspnoea, stridulous inspiration. Face blue and sometimes covered with cold sweat. Body stiff, spasmodic twitchings; thumbs clenched. Gurgling down the oesophagus.
MEPHITIS.- When drinking or talking, is liable to get foreign substances into the larynx. Inspiration difficult, expiration all but impossible; convulsions. Similar to Chlorine.
IODINE.- Tightness and constriction about the larynx, with soreness, hoarse voice etc. (see Record, 1873 p.89). Glands, cervical and mesenteric, enlarged and indurated. The child has a tendency to Marasmus. Excellent appetite, yet grows thin; or is indifferent to food; stools clayey; urine high-colored, scanty. Skin yellow; heart’s action feeble, and increased by every motion. Child unbearably irritable. Well-marked, painless Goitre.
BROMINE.- Gasping for breath, with wheezing and ratting in the larynx; child awakens gasping, hoarse, cries for water, which relieves. The face is hot and red and the eyes often injected and inflamed. Suitable rather to light-complexioned and blue- eyed children.
SPONGIA.- Starts from sleep with contraction of the larynx; whistling inspiration; breathes as through a sponge; breathes with head bent backwards.
VERATRUM ALBUM.- Spasmus Glottidis, with protruded eyes; weakness and cold sweat on the forehead.
ARSENICUM.- Sudden dyspnoea at night, threatening suffocation. The child breathes freely between spells, but appears weak and is restless. Caused by suppressed hives. Pale waxen face. Convulsions; body hot, sweaty, and pale.
PHOSPHORUS.- Select by constitutional symptoms. The child is unusually tall, but not fat. The skin is clear and transparent. Easily catches cold on the chest and becomes hoarse. Parents tuberculous. Stridulous inspiration in the evening of falling asleep.
LAUROCERASUS.- Cases in which the heart is affected. The child becomes blue, gasps for breath, face even livid, pulse thready.
SILICEA.- Not from local symptoms, but from constitutional. The child is rachitic; the head is disproportionately large; but the body emaciated The head and feet sweat; in the latter locality there is offensive sweat. Is nervous and excitable; hence external impressions readily awaken convulsions. Dentition retarded.
CALC.PHOS.- Delayed dentition; the child sweats easily, especially during sleep; becomes emaciated, but the abdomen remain flabby. The skin looks yellow. The child gets suffocative attack when lifted from the crib. It subject to Rachitis. There is diarrhoea with green, hot and watery stools. Craves salt meats, bacon, etc. Compare CalcareaOst.
SULPHUR.- Attacks come on when dropping off to sleep. Sudden jerks of the limbs in sleep. Slow dentition. Disposed to fever, etc.
BARYTA CARB.- The child grows slowly and becomes dwarfish and timid. Cannot learn rapidly. Glands, especially the tonsils, become swollen and indurated. Tonsillitis after every exposure to cold and damp air.