52 AFFECTIONS OF THE LARYNX. 



Spasm of the glottis occurs almost exclusively during childhood, and 

 especially in the first year of life. It is most frequent during the period 

 of the first dentition. Romberg considers congenital predisposition to 

 exist beyond doubt, as in many families almost all the children in suc- 

 cession are affected by the disease. In great cities, and among children 

 brought up by the bottle, it seems to be more common than in the 

 country and among children who receive the breast. Among adults, 

 none but hysterical persons suffer from spasm of the glottis, and these 

 only exceptionally. There have been solitary cases noted in which hys- 

 teria has produced death by protracted spasmodic closure of the glottis, 

 but I have seldom seen instances in which such spasm had attained even 

 a dangerous degree of intensity in hysterical persons. 



ANATOMICAL APPEARANCES. Enlargement of the thymus gland, 

 which Kopp regarded as the organic cause of spasm of the glottis, in 

 many instances does not exist. This is also the case with the soft occiput 

 of Elsdsser (a rachitic phenomenon). Enlargement and degeneration of 

 the glands of the throat and bronchi, the occurrence of hypertrophy, of 

 hyperaemia, or of exudative processes in the brain, are in part accidental, 

 and in part (as we have said regarding the pathogeny) are matters not al- 

 ways found post mortem after asthma laryngeum. At all events, we must, 

 find the larynx apparently sound if the autopsy is to bear out the diagnosis^ 



SYMPTOMS AND COURSE. The course of the disease, like that of most 

 neuroses, is an interrupted one, marked by paroxysms and intervals of ex- 

 emption. A sudden violent interruption of the respiration, which may 

 last for several minutes, is pathognomonic of the seizure. By-and-by the 

 air again begins to penetrate into or out from the glottis, which at first is 

 completely closed, and still remains contracted. In addition to this, the 

 attack is accompanied by the often-mentioned prolonged whistling, in- 

 spiratory noise, the fear, the restlessness, the livid countenance, the 

 strenuous contraction of the inspiratory muscles, and the position up- 

 right, or bent forward After a few minutes, as soon as the child has 

 forgotten his fright, he is completely restored. There is no cough in 

 laryngeal asthma, as the laryngeal mucous membrane and the vocal 

 chords are healthy; nor, as the vocal chords are neither relaxed nor 

 thickened, is there any hoarseness. If, therefore, we only hold fast to 

 the idea that laryngeal asthma is a nervous affection of the par vagum, it 

 becomes easy to avoid all confusion of it with croup, or with those noo- 

 turnal attacks of dyspnoea which accompany catarrh of the larynx. 



In many instances the spasm does not confine itself to the motor 

 fibres of the vagus alone. Sometimes spasmodic contractions of the 

 Angers and toes, or of the hands and feet, accompany the attack, or 

 jramps of these parts alternate with spasm of the glottis. Occasionally 

 oven genera] convulsions occur, in wnich the sufferer may perish. 



