DB. JAMES REID ON INFANTILE LARYNGISMUS.* LARYNGISMUS is a spasmodic
closure of the glottis or entrance to the air-tubes, which produces a difficulty of breathing, or rather a suspension of the breath. It is accompanied by distressful feelings ; sometimes, in infants especially, by a " crowing " noise and by severe convulsions : the paroxysms vary in their degree of severity, but if the suspension of breathing is continued beyond a minute or two death inevitably ensues. Cases are recorded in which the complaint has attacked adults; instances of children suffering from it are not so rare, but they are still exceptional; it chiefly prevails among infants, especially during the period ofdentition. Some attention appears to have been given to the subject in this country earlier than Dr. Reid assumes ; but it was rather perhaps to its symptoms as part of the " convulsions " of children, than as a distinct disease. Dr. James Simpson in 1761 first called attention to it as a separate complaint ; and his work De Asamate Infantunt Spasmodico was followed by a variety of others; in which, however, something of the old indistinctness obtained, so as to prevent that attention to the true object which is above all things necessary to success in discovery. In 1815 Dr. John Clarke, and soon after him Dr. Gooch, treated of the disorder in a more spe- cific manner. Since that time several eminent men have written upon the subject or touched it in lectures : but the violent convulsive symptoms seem to have rather diverted attention from the ultimate cause, or at least to have given it a wrong direction; accompanying or even consequential symptoms having perhaps been regarded as the origin of the evil. It is the direct and steady manner in which this origin is pursued that gives cha- racter and value to Dr. Reid's book ; though it has considerable practical and literary merits in other points of view. The treatise on Infantile Laryngismus, in fact, contains a very com- plete view of the subject. The book opens with a good medico-biblio- graphical sketch of the history of the disease ; which is followed by an account of the symptoms. The various causes of the complaint are next considered ; and to this succeeds the usual medical division of diagnosis, prognosis, treatment, and post-mortem appearances, wound up by a va- riety of cases. In each part of the treatise Dr. Reid displays great clear- ness of perception and neatness of style, a good deal of professional read- ing and statistical knowledge, with good sense and general soundness of view.
The causes of laryngismus have been ascribed to cerebral congestion, hydrocephalus, (water on the brain,) enlargement of the glands of the neck, and a peculiarly excitable state of the cerebro-spinal system. This last Dr. Reid admits to be a strong predisposing cause, and that the pe- riod of teething is very likely to produce this irritable state of the ner- vous centres ; but he holds the ultimate cause to be improper food and an impure atmosphere, which, impairing the digestion and vitiating the secretions, increase the nervous irritability and render it dangerous. As long as the infant is suckled by its mother, and breathes a pure air, there is little -risk of this disease. When trusted to a wet-nurse, who probably feeds it, or when an attempt is made to bring it up by hand, the stomach becomes overloaded with improper food; the natural nervous irritability of the system is seriously aggravated ; convulsions come on ; and the patient is often gone before danger is even suspected. This risk is inseparable from bringing up by hand ; but it is much increased by nurses, who, from prejudice and a desire to save themselves trouble, Stuff the infant with solid food. The statistics in public institutions are Well known to show a terrible rate of mortality in hand-rearing; but private attempts seem very nearly as bad.
a On Infantile Laryngismus : with Observations on Artificial Feeding as a frequent cause of this complaint, and of other Convulsive inseam of Infants. By James Reid, 111.D., &c. ac. Published by Churchill. " It clearly appears, then, with what ill success the attempt to rear children by hand in public institutions is followed; and if further inquiries are made in other directions on the subject, the same unsatisfactory result will be discovered. Thus Dr. John Clarke, from his investigations, gives the average proportion of infants who live beyond their first year, when fed by hand, as one in ten. " Dr. Merriman, after careful inquiry, says that one in eight survive; ac. cording to Dr. Marshall Hall, the average mortality of infants dry-mused is seven in ten in London, but rather less in the country; whilst Dr. H. Ley gives as the result of his own observations, that four-fifths of infants who are fed by hand die. "If we inquire into the ultimate fate of those beautiful, well-developed, healthy infants, brought for our inspection when the mothers are seeking for the situation of wet-nurse, we shall find most frequently that a few months after, these children, transferred to a dry nurse, are either dead; or have dwindled down into emaciated, unhealthy beings, ready to fall a sacrifice to the first acute dis• ease which may happen to attack them. "Dr. J. Clarke states that in one family alone he knew of a succession of six wet-nurses whose children had all died whilst being fed by hand; and in another family eight who had lost their infants under similar circumstances. So great is this evil, that the late Dr. Denman, and some others, endeavoured to establish an institution for the reception of the infants of wet-nurses; but the benevolent attempt failed. Improper food, with close, ill-ventilated, small apartments, will readily explain the great mortality."
In hand-rearing there would appear to be no resource but country air; which is also highly beneficial when the infant has been weaned, or, from delicacy of organization in the mother or child, is obnoxious to laryngismns.
" On change of air, in many cases of laryngismns, the symptoms have imme- diately ceased, but recurred when the infant was brought back to its former re- sidence. In more than one of my cases this circumstance will be remarked. " The rare occurrence of this complaint in country districts, as compared with its prevalence in crowded towns, is another proof that atmospheric influence is con. corned in the majority of cases as one of the exciting causes. Medical friends who had resided for upwards of twenty years in agricultural districts, have as- sured me that they never saw during that period a single instance of bsryngismos, but that since they had removed to London several such cases had fallen under their notice.
" Dr. Merriman has informed me of a striking illustration of the effect pro- duced by change of air in this malady. The infant son of an eminent hanker was attacked by laryngismus; and as all the usual remedies failed in subduing the symptoms, the child was removed to the country, with an immediate good result: A return to town after a short time brought back the paroxysrais, which were again checked by country air; and after a third unsuccessful trial of a residence in London, the child was kept away from it for a considerable period, and then had no recurrence whatever of the complaint.
" This fact may be readily explained by the great irritability of the motor nerves of the glottis in cases of laryngismus: a predisposition to the disease already exists, perhaps, arising from irritation of the bowels; whilst the constant entrance of an atmosphere loaded with smoke and other noxious particles through the sensitive aperture, will naturally still further increase the local excitability, and thus tend to the more frequent aggression of the spasmodic paroxysms.
"The disease is often thus maintained after the original exciting cause has disappeared; and it is in such instances, most likely, that a removal into pure country air is attended by an immediate cessation of all the symptoms.
" This is the mechanical' explanation of atmospheric influence on the local spasmodic affection: but we must also take into consideration the good effect often produced by change of air,' not only upon those who are labouring under dis- orders of the respiratory apparatus, but in as marked a manner on individuals suffering from functional derangement of the stomach or of the nervous system.'
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