124 



ABNORMAL ANATOMY OF THE LARYNX. 



although, as might be expected, the causes that 

 produce these terrific affections have not been 

 explained, yet it may be desirable to examine 

 inlo the symptoms and some of the circum- 

 stances that occasionally precede or accompany 

 them. 



Spasm of the glottis is either idiopathic or 

 symptomatic. 



The idiopathic occurs, as far as I know, only 

 in children, as in the " spasmodic croup," or 

 laryngismus stridulus, unless we also choose to 

 include within this class the hysteric dyspnoea 

 that occurs in young females. 



The symptomatic occurs as indicative of, or 

 in connexion with, 



1. The application of some deleterious sub- 

 stance to the larynx, as carbonic acid, boiling- 

 water, or steam. 



2. The application of some irritating mate- 

 rial, as a paiticle of salt. 



3. The presence of a foreign body within the 

 trachea or bronchial tubes. 



4. The presence of a foreign body in the 

 oesophagus. 



5. The existence (occasionally) of an aneur- 

 ism of the aorta. 



6. The existence of any other disease within 

 the larynx or trachea. Any of these latter may 

 be present in the adult or the child indif- 

 ferently. 



Few diseases have attracted more attention 

 than the spasmodic croup of children ; few 

 have been more accurately described as to 

 symptoms, and in none is our pathological in- 

 formation more deficient; a fact that may al- 

 most be proved by the number of different 

 names by which it has been designated. It is 

 the asthma of infants of Millar; the cerebral 

 croup of Pretty ; the spasm of the glottis of 

 Marsh ; the spasmodic croup of other writers ; 

 and the laryngismus stridulus of Mason Good 

 and Ley. It occurs in very young children, 

 with a peculiar difficulty of breathing, attack- 

 ing for the most part suddenly, accompanied 

 by a crowing sound, and oftentimes with a sus- 

 pension of respiration for several seconds. 

 This difficulty of respiration varies in intensity 

 from a single crow to a more prolonged paro- 

 xysm threatening suffocation, and terminates 

 when in recovery by a long deep-drawn respi- 

 ration, with a peculiar sthdulous noise; when 

 in death, by such convulsive struggles as misjht 

 lead, and indeed have led, to a belief that the 

 cerebrum was engaged. Pallid and exhausted, 

 the child falls lifeless upon the nurse's arm, 

 and is then generally said to have died in a 

 fit. In these cases there is no cough ; no 

 raucal sound of voice; no continued stridulous 

 breathing, except an occasional mucous rattle 

 heard only while the infant sleeps be con- 

 sidered as such ; there is no fever ; and on ex- 

 amination after death no trace of inflammation, 

 nor indeed any deviation from the ordinary 

 healthy appearance of the organ, can be disco- 

 vered. Under these circumstances, patholo- 

 gists had no method of explaining the pheno- 

 mena but by spasm, an irregular and invo- 

 luntary contraction of the muscles of the larynx 

 closing up the rima glottidis to a LM eater or k'ss 



extent, and in proportion to such closure in- 

 terfering with and obstructing respiration. 



But what is the cause of this spasm ? Some 

 have supposed it to have an intimate con- 

 nexion with an hydrocephalic tendency, be- 

 cause it has been sometimes seen in children 

 with large heads and sluggish dispositions, and 

 because signs of cerebral congestion have been 

 discovered after death ; but I have seen the di- 

 sease prove fatal to the liveliest and apparently 

 most healthy children, and the congestion may 

 just as well be the consequence as the cause 

 of the closure of the glottis. Others again have 

 referred it to the general constitutional irri- 

 tation that proceeds from painful dentition, and 

 doubtless cases have occurred in which the 

 crowing respiration was relieved by successive 

 scar.fications of the gums, according as each 

 tooth became prominent underneath ; but this, 

 although teaching an important practical lesson, 

 leaves the pathological connexion between the 

 facts in as much obscurity as ever. Accord- 

 ing to others there is a constitutional tendency 

 to this disease in some children, a fact which it 

 must be conceded has been painfully exempli- 

 fied in more families than one ; but this here- 

 ditary disposition to disease, although abun- 

 dantly obvious, is too imperfectly understood 

 to be discussed with any thing approaching to 

 pathological accuracy. Lastly, improper or un- 

 wholesome food, indifferent clothing, a close 

 and tainted atmosphere, and exposure to vicis- 

 situdes of climate, have been regarded as in- 

 fluential exciting causes, and change of circum- 

 stances in these respects has often produced an 

 almost magical amendment in the condition of 

 our little patients ; but still we are at a loss to 

 discover the immediate modus operand! of these 

 pernicious influences, or why they should be 

 determined to the larynx in the form of an in- 

 voluntary spastic contraction of its muscles. 



Other causes have been assigned for the pro- 

 duction of this disease, some of which are 

 eminently deserving of attention ; at the same 

 time it may be observed that its being attri- 

 buted to such a number of influences shews 

 that its real exciting cause is probably still 

 unknown. For instance, either this disease or 

 an affection bearing a strong resemblance to it, 

 has been described by Dr. Kopp, and after- 

 wards by Dr. Hirsch of Kbnigsberg, under the 

 name of thymic asthma, and by them attri- 

 buted to an hypertrophied condition of the 

 thymus gland, which by its weight and volume 

 presses on the heart, the lungs, the large arte- 

 rial and venous vessels, and prevents the free 

 exercise of their functions. Dr. Montgomery 

 has published an interesting paper on this sub- 

 ject, in which he attributes the sudden death 

 to an enlargement of this gland, whether that 

 arises from hypertrophy of its substance or an 

 alteration of its structure from scrofula or other 

 disease ; and explains how agitation or excite- 

 ment may suddenly distend and increase the 

 size of the organ in such a manner as to affect 

 materially the condition of the surrounding 

 parts. Again, in the work by Dr. Ley already 

 referred to, a different explanation has been 

 offered. Apparently relying on the experi- 



