SPASMS OF THE MUSCLES OF THE GLOTTIS, ETC. 53 



The paroxysms thus described take place at varying intervals; a 

 week or more may pass without their repetition. In bad cases the fits 

 multiply, and follow one another more closely, and it is these cases that 

 are most apt to be accompanied by general convulsions. There always 

 remains a great tendency to relapse, which is still to be feared, even 

 though a child have remained for months without a paroxysm. Finally, 

 instances have no doubt been observed in which laryngeal asthma has 

 shown itself but once, never again to recur. In rare instances a par- 

 oxysm terminates in suffocation, the closure of the glottis, and conse- 

 quent privation of oxygen, outlasting the endurance of the organism. 

 The pallid face assumes a deathly hue, the muscles are relaxed, the child 

 sinks back and expires. 



TREATMENT. The indication as to cause cannot be met, as the 

 causes of spasm of the glottis are obscure. However, we should en- 

 deavor most carefully to allay all disorders of digestion and nutrition in 

 children who show a tendency to this malady, before we proceed to the 

 employment of specifics of doubtful efficacy. This is what is meant 

 when we prescribe calomel, rhubarb, and other remedies in spasm of the 

 glottis. Children fed by hand should be placed to the breast when they 

 show signs of the disease. In older children, examine the milk, and 

 cause the nourishment in use at the time of the attack to be changed, 

 and so forth. 



In hysterical glottic spasm, the causal indication first of all demands 

 treatment of the main disease. Meantime the hysterical symptoms, like 

 all other hysterical manifestations, are to be combated by psychical 

 measures. I have cured both glottic cramp and glottic palsy by means 

 of local faradization of the laryngeal muscles, the treatment undoubtedly 

 acting solely by the psychological effect which it produced. 



The indicatio morbi in this obscure and incomprehensible affection 

 is equally difficult of fulfilment. JRombergr recommends and lauds the 

 effects of the aqua fcetida anti-hysterica which he orders for children in 

 their first year, mixed with equal parts of simple syrup, a small spoonful 

 four to six times a day. If, in spite of the asafcetida, the seizures recur, 

 we may give musk instead, a medicine almost universally prized as a 

 specific. (Moschi gr. iij. iv., gum. mimos. 3 as., syr. simpl., aqua 

 fceniculi, aa j, liq. ammon. succin. 3j. m. s. a teaspoonful everv 

 two hours.) 



During the fit it is impossible to give the patient medicine, as he is 

 anable to swallow. We should instruct the parents to take the child up 

 as soon as the paroxysm begins, to fan it in fresh air, to rub its back, 

 and to administer a clyster of camomile or valerian tea. It is well to 

 have a mustard plaster in readiness, and to lay it upon the precordium 

 when the fit occurs. If the injections of camomile or valerian fail, it if 



