Hiccups

HICCUPS (singultus), a symptom from the realm of respiratory spasms, expressed as a clonic spasm of the diaphragm. This spasm causes a sudden, strong inspiration, accompanied by a characteristic, well-known sound phenomenon. Hiccups can be of central or peripheral origin, depending on the cause triggering irritation of either one or another part of the nervous apparatus of the diaphragm or directly of the muscle itself, and represents an affliction of varying severity. Occasional, short-lived irritations occur frequently, and such hiccups have no significance. Hiccups acquire the character of a persistent affliction during central irritations (disease of the cervical part of the spinal cord, apoplexy), as well as during peripheral ones, when various pathological processes act on the trunk of the phrenic nerve (n. phrenicus); thus, hiccups can be persistent in diseases of the cervical vertebrae, in tumors of the cervical region, in meningitis of the cervical part of the spinal cord, as well as in diseases of the pleura, pericardium, mediastinum, and in aortic aneurysm. Furthermore, reflex hiccups are observed in diseases of the gastrointestinal tract, reproductive organs, and peritoneum. Hiccups in uremia, when ammonium carbonate is formed from urea in the stomach cavity, also belong to this category (however, in uremia, the possibility of a central origin of hiccups is not excluded). Hiccups in dysentery, cholera, and typhoid fever must be considered a phenomenon of the same order. It is necessary to keep in mind that direct irritation of the diaphragm (pleurisy, peritonitis, abscess in purulent inflammation of the liver) can also cause hiccups. During psychic excitement, hiccups can appear as a prolonged phenomenon (hysterical hiccups). In severe cases of organic diseases, hiccups may yield only to causal treatment. Symptomatic treatment is carried out by the use of narcotic agents (chloroform, morphine). In mild cases, convulsive phenomena yield to electrotherapy (galvanization of the phrenic nerves with the anode), rhythmic respiratory gymnastics, and also suggestion (in hysteria). - Epidemic hiccups - see Encephalitis. Lit.: Mering I., Handbook of Internal Diseases, vol. III, L., 1927; Loeb S., Singultusepidemien, Deutsche med. Wochenschrift, 1921, No. 9; Reichmann E., Uber Ursachen und Behandlung des Singultus, Zeitschrift fur arztliche Fortbildung, B. I, 1904.