124 
although, as might be expected, the causes that 
produce these terrific affections have not been 
explained, yet it may be desirable to examine 
into the symptoms and some of the circum- 
roe that occasionally precede or accompany 
them. 
Spasm of the glottis is either idiopathic or 
symptomatic. 
The idiopathic occurs, as far as 1 know, only 
in children, as in the “spasmodic croup,” or 
laryngismus stridulus, unless we also choose to 
include within this class the hysteric dyspnea 
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 particle of salt. 
3. The presence of a foreign body within the 
trachea or bronchial tubes. 
4. The presence of a foreign body in the 
cesophagus. 
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- 
nsion of respiration for several seconds. 
is 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 stridulous noise; when 
in death, by such convulsive struggles as might 
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 greater or less 
ABNORMAL ANATOMY OF TILE LARYNX. 
extent, and in a omer to such Closm 
terfering with and obstructing respiration 
But what is the cause of this spasm 
have supposed it to have an intin 
nexion with an hydrocephalic ; 
cause it has been sometimes seen in chil 
with large heads and sluggish dispositions 
because signs of cerebral congestion hay 
discovered after death ; but I have se 
sease prove fatal to the liveliest and 
Prd 
a 
most healthy children, and the congestiol 
just as well be the consequence as the 
of the closure of the glottis. Others aga 
referred it to the general constitution 
tation that proceeds from painful dentition 
doubtless cases have occurred in whit 
crowing respiration was relieved by suet 
scarifications of the gums, according as” 
tooth became prominent underneath; but 
although teaching an important practical Ie 
leaves the pathological connexion betw 
facts in as much obscurity as ever. Ac 
ing to others there is a constitutional tent 
to thi§ disease in some children, a fact wh 
must be conceded has been painfully exen 
fied in more families than one; but this 
ditary disposition to disease, al 1 
dantly obvious, is too imperfectly under 
to be discussed with any thing approach 
pathological accuracy. Lastly, improper oF 
wholesome food, indifferent clothing, a ¢ 
and tainted atmosphere, and exposure to ¥ 
situdes of climate, have been regarded as 
fluential exciting causes, and change of ei 
stances in these respects has often produce 
almost magical amendment in the conditi 
our little patients ; but still we are at a lo 
discover the immediate modus operandi ¢ ft 
pernicious iofluences, or why they show 
determined to the larynx in the form of an 
voluntary spastic contraction of its museles. 
Other causes have been assigned for the j 
duction of this disease, some of whic 
eminently deserving of attention; at the sai 
time it may be observed that its being ¢ 
buted to such a number of influences § 
that its real exciting cause is probably 
unknown. For instance, either this dise: 
an affection bearing a strong resemblance 
has been described by Dr. Kopp, and _ 
wards by Dr. Hirsch of Konigsberg, unde 
name of thymic asthma, and by them | 
buted to an hypertrophied condition o 
thymus gland, which by its weight and voh 
presses on the heart, the lungs, the large 
rial and venous vessels, and prevents the | 
exercise of their functions. Dr. Me ntgo' 
has published an interesting paper on this 
ject, in which he attributes the sudden ¢ 
to an enlargement of this gland, whether 
arises from hypertrophy of its substance 
alteration of its structure from scrofula or 
disease ; and explains how agitation or @ 
ment may suddenly distend and increase 
size of the organ in such a manner as to 4 
materially the condition of the surrour 
parts. Again, in the work by Dr. Ley alve 
referred to, a different explanation has | 
offered. Apparently relying on the ex{ 
