TREATMENT. - Besides treatment of the central cause, strychnine hypodermic ally and general tonics are almost always indicated. Arsenic is especially valuable when the affection is a sequel to diph theria. Electricity serves the double pur pose of assisting in the diagnosis and re storing motion. When the paralysis is of central origin, an interrupted current will cause contraction of the muscles, but this contraction will not occur if atrophy of the muscles is the principal patholog ical element of the case; the cure will then be rendered much more difficult, if at all possible. Therapeutically, elec tricity should be applied with both elec trodes over the muscles for about ten minutes every other day.
Laryngismus Stridulus, or Spasmodic Laryngitis. — This is an affection of poorly-nourished or weak children in which dyspncea, caused by spasmodic closure of the laryngeal aperture, sud denly occurs.
a ttacks usually come on at night while the child is asleep. Awaking suddenly, the patient gasps for breath and shows every evidence of prompt suffocation without cough or hoarseness. The pulse becomes weak, cold sweats and cyanosis soon come on, and in a few moments the child may be at death's door. Often, however, after a few gasps, a quantity of air is suddenly drawn into the lungs with a "crowing" sound, the respiration becomes more nor mal, and in a few minutes the child seems out of danger. This improvement is sometimes ephemeral, however, and the attack may return after a few minutes or hours, and continue several succeeding days and nights. The number of deaths, in a series of one hundred and sixty-four cases collected by Loos (Archiv f. Kin derh., 13. 21, H. 5 and 6) amounted to fourteen.
Four cases of an hitherto-undescribed form of laryngitis stridula characterized by inspiratory dyspncea protracted for several weeks, but there were no parox ysmal attacks such as are the principal feature of the ordinary form. J. Comby (Archives de Mad. des Enfants, Jan., '98).
—There being no inflamma tion of the larynx, the term "laryngitis" is not applicable, a spasmodic or nervous clement alone prevailing, which, accord ing to Escherich, is closely allied to any. It occurs about equally in children of both sexes, and may be caused by a nervous shock or excitement such as oc curs when children arc severely punished or even scolded. It occurs mainly in children who have soft bones and carti lages, flabby muscles, and general ness; hence rachitis is considered as the main pathogenic factor in the vast major ity of cases. The pressure of enlarged bronchial glands upon the vagus, adenoid vegetations, and hypertrophied tonsils seem to bear a close association with the disease. Gastro-intestinal disorders and exposure to cold and damp also repre sent common causes of this disorder.
In 144 cases of laryngismus stridulus 79 were boys and 65 were girls. In 55 the disease appeared at the age of from 1 to 6 months, in 55 from 6 to 12 months. and in 34 after the first year. Stage (Bibl. for Laeger, p. 251, '94).
In 100 cases of laryngismus stridulus —52 girls and 48 boys-94 showed posi tive signs of rachitis, 3 were free from this disease, and in 3 the diagnosis was uncertain. Sixty-two were between the ages of 6 and 18 months when the dis ease developed. Bull (Archiv f. Kin derh., B. 18, H. 1 and 2, '94).
Case in which laryngismus stridulns followed a bullet wound in the arm. J. W. Irwin (Med. and Surg. Reporter, Jan. 27, '94).
Two cases of laryngismus stridulus in which the spasm was due to the reflex irritation or impacted faces in the colon.
Zancudo (Med. Press and Circ., May 30, '94).
TREATMENT.—Measures calculated to meet the danger of suffocation, leaving the determination of its true nature until all immediate danger has been elim inated, are first indicated. A warm mus tard foot-bath or a general bath usually serves its purpose very rapidly; some times cloths wrung out of cold water placed over the thyroid are sufficient. Of value is the production of emesis, either by titillating the back of the mouth with a feather or administering ipecac. The triturate tablets of the latter drug are recommended by Northrup, four or five of the tablets being given every ten to thirty minutes until four or five have been taken, are specially valu able for this purpose. A few whiffs of chloroform or ether sometimes act favor ably at once. The possibility of impac tion of the epiglottis is to be remembered as a causative element, and, should it be found free, no harm will follow the in troduction of the finger, which, in case of impaction, world have raised it with out difficulty. The application of a sina pism to the liver tends to prevent re currence of the attacks. The bromides, chloral, opium, belladonna, etc., also act advantageously. Morphine injections sometimes cut the attack short in a few moments.
When all means fail to re-establish nor mal respiration and the dyspncea con tinues marked, intubation should be practiced. If instruments be not at hand to perform the operation, the tra chea must be opened or a catheter intro duced into the larynx to temporize until intubation instruments can be obtained.
Motor Laryngeal Neuroses.
Adductor and Tensor Paralysis.— -The main varieties of adductor paralysis—i.e., paralysis of the muscles which close the glottis—are: paralysis of the adductors or lateral cricoarytenoids; paralysis of the internal tensors of the vocal cords or internal thyroarytenoid muscles, and paralysis of the interarytenoid muscle.