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.