Correspondence. Examination, I Found That the Throat Was Dematous, and the Seat of Severe on the Mouth, Which Was "Audi Alteram Partem." Pain
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592 voice ; full, hard, rapid pulse ; the neck so stretched as to be almost rigid ; and difficulty in deglutition. By digital Correspondence. examination, I found that the throat was œdematous, and the seat of severe On the mouth, which was "Audi alteram partem." pain. opening not an easy operation, I found that the mucous membrane of the fauces was red and swollen. I observed two ulcera- DIPHTHERIA AND CROUP IN THE LOWER tions, one of which was on the veil of the palate and the ANIMALS. other on the right tonsil ; the latter was of some size and To the Editor of THE LANCET. depth, and had elevated edges. A conjunct view of the symptoms and appearances led me to conclude that the SIR,-Before are dismissed "diphtheria" and "croup" disease under which the dog was suffering was diphtheria, discussion in I from present your columns, may be allowed, or to use a better form of expression, laryngo-pharyngeal with the view of eliciting information, to direct attention angina of pseudo-membranous or croupal character. The to a very interesting and important branch of the subject, dog died, on the third day, from suffocation, after having had some convulsive movements. At the the regarding which, so far as I can discover, the amount of necropsy, mucous membrane of the fauces was found in a is small? I refer to the pulpy state, existing knowledge exceedingly and denuded of its epithelium. Here and there, the mem- occurrence of and in the lower "diphtheria" "croup" branous exudation presented the appearance of compact, animals. thick, adherent excrescences. The ulcerations were blackish, I must first of all briefly state the meaning which I and very deep. The inflammation extended to the mucous attach to these two very familiar but very variously em- membrane of the pharynx and larynx. The heart and lungs, ployed terms-so variously employed in the current medical which presented a blackish, flabby appearance, contained literature of Great Britain as to shroud a clear and simple pitch-like blood, and several fibro-albuminous concretions." subject in a dense phraseological and pathological haze. It This case is not recorded sufficiently in detail to admit of is, however, satisfactory to notice in recent revisions of its being critically examined with that searching minute- esteemed treatises, and in the outcome of a recent corre- ness which its importance merits. It cannot, therefore, be spondence in THE LANCET, evidence that this haze is now accepted as in itself proving that diphtheria is transmissible at last clearing away and giving place to the views first from man to the lower animals, although it renders it made known in England by Dr. Semple, and originally exceedingly probable that when the subject has been fully developed by Bretonneau in France, and now universally investigated, clinically and experimentally, it will be found adopted in France, chiefly as the result of the masterly that the disease is transmissible from the human subject to clinical expositions of Trousseau. To-day, in Paris, by the the lower animals. To clear up the subject, a well-planned term 11 diphtheria" is meant a general disease, one of the series of experiments on dogs and other animals is called leading characteristics of which is the formation of false for; and also a careful observation of the diseases of the membranes on mucous surfaces and on the surfaces of lower animals occurring within the geographical area of cutaneous lesions ; by " croup" is meant the laryngeal epidemics of diphtheria in the human subject. membranous manifestation of the same general disease. If Bossi’s narrative be reliable, it supplies a strong argu- The French appropriation of the old Scotch word "croup" ment in favour of the germ or fungus theory of diphtheria as the designation of laryngeal diphtheria has had a -a theory which is maintained by most Italian and by mischievous confusing reaction upon the literature and many German physicians. clinical study of diphtheria in Great Britain. This has I am. Sir. vour obedient servant. arisen from the term croup having been employed one JOHN ROSE CORMACK. hundred and ten years ago in the classical treatise of Dr. Francis Home, of Edinburgh, and by his numerous copyists P.S.-No confusion in clinical discussions need arise from down to the present day, as a general name for essentially the use of the unfortunate term " croup," if it be always different laryngeal affections, membranous and non-mem- employed in the following manner, with a descriptive prefix;- branous, diphtheritic and non-diphtheritic - a name em- 1. "Diphtheritic Croup: ’ -The laryngeal or pharyngo- bracing all laryngeal affections characterised by "croupy"" laryngeal membranous manifestation of the general disease (crowing) respiration.* In the subjoined remarks, the " diphtheria." terms 11 diphtheria " and "croup" are applied to the same 2. " Simple Membranous Croup."-The membranous exu- disease, the former to the general affection, and the latter dation on the pharynx and larynx, the manifestation of acute to the laryngeal manifestation. Without risk of being mis- inflammation, herpes, and other non-diphtheritic causes. understood, I may now ask whether any of the readers of (This genus includes the angine couenneuse simple of French THE LANCET can supply, from their personal experience or authors.) Trousseau has elaborately and conclusively shown reading, any facts tending to establish or discredit the that, besides the diphtheritic membranous sore-throat, there occurrence of diphtheria and croup in the lower animals. is the genus simple membranous sore-throat—a genus con- There is some reason to believe, but it has not yet been taining many species. (See Lecture XVII., p. 436, and proved, that diphtheria is communicable from man to the Vol. II. of the Translation of the New Sydenham Society.) inferior animals. A very remarkable case was observed by 3. " Spasmodic Croup." - The strangulatory laryngeal Professor Bossi. It is thus described by him in the Giornale affection in which there is no formation of false membrane. di Medicina Veterinaria Pratica d’Agricoltura :-" A friend," (This is the faux croup of French authors.) says Professor Bossi, "who had lost a little boy by diphtheria, after a few days’ illness, requested me to visit a very beau- tiful small-breed greyhound, about one year old, which had DR. SANDERSON’S SPEECH ON THE GERM fallen ill a few days after swallowing some of the child’s THEORY OF DISEASE. excrement, and some remains of food which had been served to him.† On making a careful examination of the dog I To the Editor of THE LANCET. found that it was in a state of great prostration; that it had Sir.,-Will you allow me a few lines to reply to Dr. a mouth, languid look; lachrymant eyes ; open copiously Beale’s strictures on my remarks at the Pathological Society discharging a viscid fluid; quick, sibilant breathing; hoarse on April 6th. * Dr. Francis Home’s "Inquiry into the Nature, Cause, and Cure of Let me assure Dr. Beale that he is quite mistaken in Croup" was published at Edinburgh in 1765. Although the progress of imagining that I am in the slightest degree disposed to science has shown that it contains views medical fundamentally erroneous, the scientific work of any and that, as it is still a book of sterling value to the clinical student, who will always ignore Englishman, own I never read with pleasure and profit the recorded experience of shrewd, con- regards his histological researches, omit any scientious, truth-seeking physicians of the olden time. opportunity which occurs to me of expressing the opinion I translate Bossi’s case from the Italian as t original quoted-apparently which, in common with all other persons who are verbatim-by Dr. Leopoldo Nesti, at p. 230 of Lo Sperimentale for 1872, in competent his admirable "Istoria Clinica della Difterite osservata nella citta di to judge, I entertain of their importance and value. For Firenze e Contorni nel decennio dal 1862 al 1872." The manner in which many years Dr. Beale was almost the sole representative of the dog received the diphtheritic contagium is thus described in the original and systematic histological investigations relating Cane levriere ...... che si ammalo dopo aver original:-" quattro giorni to medicine in this Nor can there be a moment’s trangugiato alouni escreati emessi dal ragazzino, non che degli avanzi di country. alimento dello stesso." doubt in the mind of anyone that by those investigations 593 he has contributed to the advancement of Jackson, Robert Alexander, Notting-hill-square. pathological Leander Earl’s-conrt-road. in a directions. Jameson, Starr, knowledge great many important Martin, Samuel Edgar, M.D. Queen’s Univ. Irel., Newry, Ireland. From the terms employed in Dr. Beale’s letter, I imagine Miller, Frederic Daniell, L.S.A., Streatham. that he must have had before him some very imperfect Nankivell, Frank, York. of in some other If he will take Newton, George, Neweastle-on-Tyne. report my speech journal. Orchard, James Stuart, M.B. Aberd., Salford. the trouble to read over the very accurate short-hand Parker, George Roger, Lancaster. report printed in THE LANCET, he will find that the word Potter, Henry Percy, Denmark-hill. to which he takes does not . Rawlings, Alfred, L.S.A., Plympton, Devon. "insurmountable," exception, Rees, John, L.R.C.P. Edin., Dover. occur in it ; that in using the expressions about 11 shrugging Rees, David Valentine, Carmarthen. of the shoulders " I did not make the most distant reference Richardson, Arthur, Rusholme. Frederick W. Brazil. either to his facts or views ; and that, on the whole, I did Romano, R., L.S.A., Smith, Charles Edwin.