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as the cause of the disease, such as congestion and the effusion of serum in the meninges, or in the ventricles. These changes are evidently only an effect of the disease, resulting from the obstruction to the respiration and circulation which has preceded death. Others have thought that the spinal cord might be the seat of some changeperhaps inflamed; but as they have abstained from furnishing the proofs of this, their opinion is of no weight.

To resume, then, hypertrophy of the thymus, hypertrophy of th glands of the neck, their tubercular degenerescence, the patency of the foramen ovale, cerebral congestion, serous effusion into the meninges which have been each cited as a cause of phreno-glottic convulsions, d not at all explain the disease. In consequence of an abuse of path logical anatomy, and for want of having made, like M. Hérar comparative researches, physicians of considerable eminence have tak simple coincidences for causes, or even have deceived themselves transforming effects into causes.

TREATMENT.

Phreno-glottism ought to be treated at the moment of the atta 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 be satisfied with throwing water in the face, exposing the body the air, causing the respiration of ether or chloroform in order to r the tetanic muscles. But here the tonic spasm of the glottis, co 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 g In this case, however, etherization requires the greatest precaution as not to add a new danger and a second chance of death to which already exists.

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

But if the arrival is too late, and the child during a violent at has succumbed for some seconds to the effects of asphyxia, the must not yet be given up. The death may only be apparent; f contractions and some distant bruits may yet exist in the car 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 differ the children ought to be kept as quiet as possible, free from

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no febrile complications. The bowels ist leg

sionally relieved by slight purgatives."

inful, the state of the gums should be latin
y tooth appears ready to protude, its
cision or excision of the gum.

turn of the convulsive attacks, the air

should be changed, and they should be un at.
the same case here as with hooping
nder phreno-glottism are taken into the Tula
aeir convulsive attacks disappear. On
ks return, but disappear if the child is

ntry.

been applied against this disease: opium,
nethod; belladonna powder, from to of
na, by the drop; the powder and extract Autos
this is a dangerous remedy; sulphate of
dminister except by enemata; cherry laurel
ing doses; assafætida, in enemata; oxide of
o hours; hydrocyanate of zinc, from to of
ncture of Indian hemp, so useful in tetanus,

our, gradually increasing the dose until the

seriously proposed tracheotomy at the time
ffocation is imminent, but they have never
regards their reputation. Others guided
of the disease, and believing it to be caused
mus, have recommended the extirpation of
convinced of the influence of the thymus
more wisely satisfied by bringing about
me by weaning, regulated diet, and leeches
mongst whom may be reckoned Kopp and
of iodine, iodide of potassium, burnt sponge,

APHORISMS.

onvulsions are characterized by short attacks
xia, unattended with fever, and terminated by
ugh.

very often ceases under the influence of an

8 cured by change of air, and by the removal
intry.

followed by general convulsions is a mortal 4

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

To resume, then, hypertrophy of the thymus, hypertrophy of the glands of the neck, their tubercular degenerescence, the patency of the foramen ovale, cerebral congestion, serous effusion into the meninges, which have been each cited as a cause of phreno-glottic convulsions, do not at all explain the disease. In consequence of an abuse of pathological anatomy, and for want of having made, like M. Hérard, ew comparative researches, physicians of considerable eminence have taken simple coincidences for causes, or even have deceived themselves by transforming effects into causes.

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TREATMENT.

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

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

Perhaps this would also be a fitting opportunity to employ direct narcotism by the endermic method, by means of two small blisters produced by ammonia, applied on the sides of the neck, and each sprinkled with a powder containing .30 and sometimes .15 of a grain of sulphate of morphine.

But if the arrival is too late, and the child during a violent attack has succumbed for some seconds to the effects of asphyxia, the case

must not yet be given up. The death may only be apparent; feeble

contractions and some distant bruits may yet exist in the cardiac region; artificial respiration must be immediately made use of, and sometimes the efforts are crowned with success, as in cases cited by Marsch and Gunther.

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

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Book II, Chap. IX.] ON PHRENO-GLOTTISM.

167

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excitement or cause of fretting. They should be left to eat according to their appetite, if there are no febrile complications. The bowels should be kept free and occasionally relieved by slight purgatives. If dentition is difficult and painful, the state of the gums should be Latin carefully examined, and if any tooth appears ready to protude, its exit should be facilitated by incision or excision of the gum.

In order to prevent the return of the convulsive attacks, the air which the children breathe should be changed, and they should be un al sent to the country. It is the same case here as with hooping

cough. Children labouring under phreno-glottism are taken into the Ting country and immediately their convulsive attacks disappear. On 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 endermic method; belladonna powder, from to of a grain; tincture of belladonna, by the drop; the powder and extract u of valerian, foxglove-but this is a dangerous remedy; sulphate of quinine-very difficult to administer except by enemata; cherry laurel M water, in gradually increasing doses; assafætida, in enemata; oxide of zinc, of a grain every two hours; hydrocyanate of zinc, from to 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.

APHORISMS.

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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CHAPTER X.

TETANUS OF INFANTS.

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. Petersburgh, Stockholm, Copenhagen, Vienna, and in the south of Germany. It is said to be frequently observed at Algiers under the form of trismus, in 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 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 hæmorrhage 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 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.

pures In other children no appreciable cause can be assigned as likely to

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cause this disease. It sometimes appears all at once, like an epidemic, amongst a great number of children at a time, as Underwood and Cejerchsjoeld have several times observed, the former at London, the latter at Stockholm. It is some general unknown peculiarity of the atmosphere which then favours its development.

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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.

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 S4 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 have nausea, frequent vomitings, and often slight

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