In older children the case may be mistaken for .laryngitis stridulosa. Here, too, the absence of fever is a very important distinction, if the dis ease is quite uncomplicated. But children while cutting their teeth are subject to frequent elevations of temperature from the natural process of dentition ; and this in the subjects of rickets, who cut their teeth late, may be delayed far beyond the end of the second year. We should then be careful to satisfy ourselves that the gums are not swollen, and that there is 110 stomatitis or other complication capable of giving rise to fever. Moreover, the history and course of the two diseases are different. In laryngismus the spasm comes on quite suddenly, lasts a few seconds or a minute or two, and then subsides. Laryngitis is preceded by cough and hoarseness ; the attacks of dyspncea are much more prolonged, and even in the intervals the breathing is more or less oppressed, the voice hoarse, and the cough loud and clanging. Again, stridulous laryngitis is an acute disease, while laryngismus stridulus is apt to take on a very acute course. In laryngismus there are often tonic spasms or carpopedal contractions, and the disorder is often complicated by general convulsions. In laryngitis convulsions are rare and tonic contractions are very rarely seen. Lastly, laryngitis stridulosa, as a rule, attacks children after the age at which they are most susceptible to laryngismus, and is not common in infants under two years old.
Prognosis.—In new-born infants the prospect is very serious, for the attacks at this early age are very apt to end fatally. Persistent lividity of the face or other sign of collapse of the lung is a symptom of very dan gerous import.
In older children, if the spasm remains limited to the respiratory mus cles, the prognosis is less serious than in cases where the convulsions, at first local, afterwards become general. The percentage of mortality has been put very high by some writers ; but statistics gathered from pub lished cases alone are apt to be misleading, as only the worst cases are likely to be placed on record. The prognosis depends in great measure upon the strength of the child and the degree of rickets which may be present If there be much softening of the ribs and consequent interfer ence with respiration, there is great danger of pulmonary collapse taking place, and the case is a very serious one. If, under these circumstances general convulsions ensue, the child's life is in very imminent danger. Even in the slightest cases we should speak guardedly of the patient's chances of recovery.
Treatment.—If the child be seen during an attack, attempts should be made to excite vomiting by passing the finger into the fauces. Afterwards a sponge wrung out of hot water may be applied to the throat under the chin. According to M. Charon, who first proposed the remedy, the inha lation of ammonia is almost invariably successful in arresting an attack. This physician advises all mothers whose children are subject to spasm of the glottis to carry a small bottle of ammonia—ordinary " smelling salts —about with them. He relates the case of a lady whose child was always rapidly relieved by this means. Unfortunately one day the child was seized with an attack at a time when the remedy was not at hand, and while the mother was hurriedly searching for it the child fell back dead.
If the suffocative spasm be very intense, it is well to thrust the finger deeply into the child's throat, so that the epiglottis, if incarcerated, as de scribed by Dr. Cohen, may be released. The seizure, however, in most cases, is over so quickly that there is little time to adopt measures for abridging it. But we can at any rate take steps to prevent a return of the paroxysms. For this object cold water bathing is indisputably the most important and most immediately successful. The child should be placed naked in an empty bath or large basin, and be then rapidly sponged all over the body with cold water. In winter he may be made to sit in hot water during the process. The bath should be given three times a day. Very few cases of laryngismus will be found to resist this treatment. I have used it iu obstinate cases, and to children suffering from rickets, with the most satisfactory results. Next to cold bathing fresh air is of the greatest service. The child, warmly dressed, should be taken regularly out of doors, and even in cold weather should spend many hours in the open air.
While these measures are being carried out, search must be made for any source of irritation which may serve as an exciting cause of the spasms. Tense swollen gums should be lanced, the dietary must be re constructed upon sound principles, and the condition of the digestive canal must be attended to. In many of these cases the bowels are loose with relaxed slimy motions. If this be so, a dose of rhubarb should be given, and the child should take for a few days five or six grains of bicar bonate of soda dissolved in an aromatic water sweetened with glycerine. Of special drugs musk and belladonna are the most useful. The former can be given to a child .of twelve months old in doses of one-third of a. grain every six hours, and will be found to have a powerful influence in checking the tendency to spasm. Belladonna to be of service must be given in sufficient doses. A baby of twelve months old will take well fif teen drops three times in the day. Mr. Stewart of Barnsley, speaks highly of chloral in the treatment of spasm of the glottis, and recom mends two and a half grains to be given to a child of twelve months old three times a day.
In new-born babies, for whom cold sponging is inadmissible, musk is a very important remedy. One-fourth of a grain can be given three times a day, suspended in mucilage. It can be combined with ten drops of tinc ture of belladonna if thought desirable.
If the child is markedly rickety, iron and cod-liver oil should be given as soon as the state of his digestive organs is sufficiently improved to make the use of the tonic desirable. Iron. wine is, perhaps, the best form in which that drug can be administered, for the alcohol it contains is an ad dition of great value ,to weakly children. Great care must be taken in these cases that the child is not overfed with farinaceous foods which con tribute little to his general nutrition while they overload him with un healthy fat. They are also very apt to turn acid in the stomach and favour catarrhal derangements. No mention has been made of bromide of po tassium, for in this complaint I hold the drug to be of very inferior value, and place it far below musk in its powers as an antispasmodic.