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renewed more or less frequently for some length of time, under the influence of causes we have previously enumerated, and also end by disappearing. In this case the attacks are less frequent and their successive accessions less violent. Severe intercurrent diseases caused them to disappear rapidly, just as is observed in hooping cough. A certain number of children die of these phreno-glottic convulsions, and I believe, with M. Herard, that the death is to be ascribed to one ol the three following causes: 1st, to the asphyxia resulting from a too

fi/jui-j prolonged closure of the glottis; 2nd, to cerebral lesions, such as con

gestion of the brain and meningeal hiemorrhage, or to the destruction \ ilTu. . of the nervous tissue itself; 3rd, and lastly, to exhaustion of the strength. In this latter case, death i9 slow and results from important changes taking place in the blood, and consecutively in the other functions.


The diagnosis of phreno-glottic convulsions is sometimes embarrassing, and it is sometimes rather difficult to distinguish them from the isolated convulsions of the larynx and bronchi, which constitute stridulous lanvngitis and the asthma of Millar. The following is a brief outline of the characteristics of these different convulsive diseases. • ., /'v. _ In stridulous lanyngitis, or false croup, there is a hoarse, sonorous hissing and dry cough, which comes on by fits, and threatens the child

»'' with suffocation.

In the asthma of Millar considerable oppression, little cough, sonorous, hollow respiration, and a threatening of asphyxia.

In phreno-glottism, a momentary absence of respiration, followed by a roaring inspiration, like a hiccough, a threatening of asphyxia, but no cough. Besides, there is also observed, at the end of the attack, contractions of the fingers, which are not observed in false croup and in the acute asthma of Millar.

Several other diseases may also be confounded with phreno-glottism, as, for instance, hooping cough and oedema of the glottis; but hooping cough is characterized by a convulsive cough, and by fits of cotigh separated by long sonorous and hissing respirations, known under the name of the hoop (repriie). This cough and hoop have no resemblance to the suffocation or the hiccough of phreno-glottism. As for oedema 'of the glottis, there is little chanco of mistake, for it does not exist 'amongst young children, or at least has never yet been met with.


* "■''/tU- Phreno-glottism is a very serious convulsive affection. It is a nervous

disease which occasions the death of a great number of young children.

. ,,, i _ One third die asphyxiated at the commencement of an attack; some

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are carried off by intercurrent or consecutive diseases; one half, at///, /*/*,; most, are cured.

The prognosis of this affection is so much the more serious in pro-//t^Hit" portion as the children are young and delicate, the attacks more frequent or more prolonged, and the disease more complicated. General convulsions often announce an approaching death.

Pathological Anatomy. _ . '«-'

Children who die in consequence of phreno-glottic convulsions do not present sufficient anatomical lesions to explain the disease. The t-4-<-l+*-/**-4U.. buccal and lanyngeal mucous membrane presents nothing peculiar, the Jr. j ,«,,/ lungs are emphysematous, as they always are in infancy after death from suffocative diseases, and no considerable alteration is found in the s,' brain, spinal cord, phrenic, pneumo-gastric, or recurrent nerves. ctlOg

If there are anatomical alterations in the children who die, they are fcjjjj (. purely accidental, and there is not one of them which can be considered as the true cause of death. This anatomical cause remains yet to be ^ frr-t.;. discovered. *,

Kopp and his followers, who consider phreno-glottism as the result (A' of hypertrophy of the thymus gland, and who have consequently ^ jJt, . imagined thymic asthma, are of opinion that this hypertrophy always exists. But this is a mistake; for Hirsch has seen an infant die of {...'* this disease without finding the hypertrophy of the thymus, and this' was also the case five times out of six in the children which came under /i Imaajijl the observation of M. Herard. Besides, in the norma] state, Meckel, j Burdach, Haller, and M. Herard have remarked a considerable number J^j 1 y *. of cases of hypertrophy of the thymus without convulsive attacks of the glottis ensuing. It follows, therefore, that as the thymus is not y hypertrophied in many cases of phreno-glottism, and also is hyper- ^ *"^" ^' trophicd in many children that are very healthy, hypertrophy of the ) ^ ,i j thymus has no connection with the disease now under consideration. /

Other physicians, who have found amongst many children hypertrophy ft. ^,L i , and tuberculization of the glands of the neck, have considered it a ."—'' cause of phreno-glottismus. But for once that by chance these two ^-t^)TM-} l things are found united they are met with a hundred times separate, // ^ / which sufficiently establishes their reciprocal independence.

The incomplete closure of the foramen ovale has been very frequently//^ £ met with in conjunction with phreno-glottic convulsion, and Kopp has considered this anatomical state as the cause of the attacks. But he ^"u^im << u'' is in error, for M. Herard has examined the hearts of forty children of from two to three years old, who died of any disease except phreuo- -tttt &-(< glottism, and in twenty cases he found a communication between the two auricles. , t .-W v "• •' •

Several alterations in the brain have been observed and regarded ,

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as the cause of the disease, such as congestion and the effusion of genua in the meninges, or in the ventricles. These changes are evidently only an effect of the disease, resulting from the obstruction to the I respiration and circulation 'which has preceded death. Others have thought that the spinal cord might be the seat of some change—I perhaps inflamed; but as they have abstained from furnishing the I proofs of this, their opinion is of no weight. / To resume, then, hypertrophy of the thymus, hypertrophy of thij

..' y'ii-iU^ glands of the neck, their tubercular degenerescence, the patency of tbt J foramen ovale, cerebral congestion, serous effusion into the meningeal •"" which have been each cited as a cause of phreno-glottic convulsions, d[

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not at all explain the disease. In consequence of an abuse of path< I logical anatomy, and for want of having made, like M. HerarJ comparative researches, physicians of considerable eminence have tak simple coincidences for causes, or even have deceived themselves transforming effects into causes.


Phreno-glottism ought to be treated at the moment of the attac in the interval of the accessions, and in that of the attacks, in or] to prevent their return.

When asphyxia comes on there is indeed little to be done; one n I be satisfied with throwing water in the face, exposing the bodjj the air, causing the respiration of ether or chloroform in order to r I the tetanic muscles. But here the tonic spasm of the glottis, coif tuting the principal element of the disease, is that which it is neces to treat and remove. The means for doing so will be presently gi \ In this case, however, etherization requires the greatest precautions j • as not to add a new danger and a second chance of death to I which already exists.

Perhaps this would also be a fitting opportunity to employ d I narcotism by the endennic method, by means of two small bli | produced by ammonia, applied on the sides of the neck, and I sprinkled with a powder containing .30 and sometimes .15 of a j I of sulphate of morphine.

But if the arrival is too late, and the child during a violent at f has succumbed for some seconds to the effects of asphyxia, the (| must not yet be given up. The death may only be apparent; feJ contractions and some distant bruits may yet exist in the cari region; artificial respiration must be immediately made use of, | sometimes the efforts are crowned with success, as in cases cited , Marsch and Gunther.

In the interval of the attacks, the treatment is a little differe ] the children ought to be kept as quiet as possible, free from

excitement or cause of fretting. They should be left to eat according i

to their appetite, if there are no febrile complications. The bowels j -4 i

should be kept free and occasionally relieved by slight purgatives.

If dentition is difficult and painful, the state of the gums should be .^ L&/4+44

carefully examined, and if any tooth appears ready to protude, its

exit should be facilitated by incision or excision of the gum. /, X^ A )S^

In order to prevent the return of the convulsive attacks, the air which the children breathe should be changed, and they should be (lust 6t< * sept to the country. It is the same case here as with hooping „_ cough. Children labouring under pbreno-glottisni are taken into the 't"""' country and immediately their convulsive attacks disappear. On iC . / returning to town the attacks return, but disappear if the child is again sent back into the country.

Every antispasmodic has been applied against this disease: opium, morphine by the endennic method; belladonna powder, from \ to J of . j— a grain; tincture of belladonna, by the drop; the powder and extract fiM-^ <**/.■ of valerian, foxglove—but this is a dangerous remedy; sulphate of * quinine—very difficult to administer except by enemata; cherry laurel water, in gradually increasing doses; assafetida, in enemata; oxide of zinc, f of a grain every two hours; hydrocyanate of zinc, from J to j of a grain every six hours; tincture of Indian hemp, so useful in tetanus, five to six drops every hour, gradually increasing the dose until the spasm gives way.

Some medical men have seriously proposed tracheotomy at the time of the accession, when suffocation is imminent, but they have never practised it successfully as regards their reputation. Others guided by false ideas on the nature of the disease, and believing it to be caused by hypertrophy of the thymus, have recommended the extirpation of this gland; others, equally convinced of the influence of the thymus over phreno-glottism, are more wisely satisfied by bringing about atrophy of this gland; some by weaning, regulated diet, and leeches every four days; others, amongst whom may be reckoned Kopp and his followers, by means of iodine, iodide of potassium, burnt sponge, cod's liver oil, calomel, &c.


114. Phreno-glottic convulsions are characterized by short attacks of suffocation and asphyxia, unattended with fever, and terminated by a small, very sharp hiccough.

115. Phreno-glottism very often ceases under the influence of an acute intercurrent disease.

116. Phreno-glottism is cured by change of air, and by the removal of the children to the country.

117. Phreno-glottism followed by general convulsions is a mortal disease.

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T The tetanus of infants has been sometimes described under the names

of trismus infantum and eclampsia tetaniformis. The disease is characterized by clonic spasms of the muscles of the thorax and limbs, • . accompanied by rigidity of the jaws and trunk.

The tetanus of infants is very rare at Paris; but it is rather common

in America and in several localities in Europe, as at St. Petcrsburgh,

t- i /t . Stockholm, Copenhagen, Vienna, and in the south of Germany. It is

said to be frequently observed at Algiers under the form of trismus,

'LiU& m changeable weather, among European children who are teething.

/ It is also developed under the influence of too tightly laced swaddling

clothes, and is a consequence of retention of the meconium and of

constipation. James Clarke assures us, that in America the action of

the smoke of green wood which fills their chimneyless cabins is a very

/J frequent cause of tetanus amongst negro children. Some say it results

from ligature of the cord and from inflammation of the umbilical vein;

according to others, it is a consequence of meningeal and spinal

'« '' j! A haemorrhage external to the dura mater. But it may be here suggested

that the effusion of the blood is rather an effect of the disease instead

{' J of being the cause, and that the sanguineous congestion of the tissues

is the result of the tetanic convulsion of the muscles of the spine.

/• 'AS 44 In other children no appreciable cause can be assigned as likely to

cause this disease. It sometimes appears all at once, like an epidemic,

amongst a great number of children at a time, as Underwood and

-,' t, Cejerchsjoeld have several times observed, the former at London, tho

latter at Stockholm. It is some general unknown peculiarity of the

•,, . atmosphere which then favours its development.

• Under the influence of these different causes, the disease appears on

the sixteenth or nineteenth day after birth, according to Evans and

Underwood, but sometimes from the first day of life to the end of the

first year at the latest. It is either idiopathic or symptomatic, but

in both cases the symptoms are very nearly the same.

. . .'^J.t*''f7? >The children are restless, sleep badly, and wake with a start. They

are affrighted at night and cry, a little after the manner'of hydrocephalic

;'l>'\ y patients, in uttering a sharp and peculiar shriek. They are disposed

to suck, but drop their head on the bosom after having seized the

'*. nipple. They havo nausea, frequent vomitings, and often slight

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