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ON DIPHTHERIA.

CHAPTER I.

HISTORICAL ACCOUNT.

The historical researches of Ozanan, Fuchs, Eisenmann, Hecker, and Bretonneau, show that the malignant inflammation of the pharynx, now recognized under the descriptive term Diphtheria,' was known in its chief features to Aretæus, Cælius Aurelianus, and Actius, under the name of Ulcera Ægyptica Syriaca.

In the beginning of the latter half of the sixteenth century, the disease appeared epidemically in Holland, and was described by P. Forest. Towards the end of that century it swept a similar march through Spain, terminating with such general fatality in suffocation, that it received the name of garrotillo. From that period to the present, the disease has showed itself, at different times, and with greater or less intensity, in most European countries, and in North America, and bas been described by a great number of writers of all nations, under different names.

The kingdom of Naples and Sicily seems to have been sadly scourged. In 1641, it is described by Severinus as carrying off many thousands of children. With such opportuni. ties for post-mortem examinations, Morgagni blames Severinus for the remark that he was not willing to take upon him the tedious labor of delineating the seat of the disorder itself. .

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Διφθερίτης and Διφθεριας signify, that which is covered with a skin.

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From 1745 to 1748, it spread throughout Europe, and about the same time showed itself in England, when it was ably described by Dr. Fothergill. As seen by him, the disease was attendant upon scarlatina; but the account published nearly at the same time (Philosophical Transactions, 1750) by Starr, refers evidently to a primary diphtheria, and the cases related by Ghisi as occurring at Cremona during 1747 and 1748, are independent of scarlet fever. A

very able description of the disease was given by Bard, New York, (1771.) He was the first to point out its resemblance to croup, denying its gangrenous nature. In modern times, the disease has been most minutely described by Bretonneau, who himself observed a violent epidemic in Tours, (1818 to 1820.) From 1818, the date of M. Bretonneau's work, to 1829, diphtheria has annually appeared as an epidemic in France, and sometimes in Switzerland; generally in the form described by Bretonneau, but sometimes showing a low type with ulceration and gangrene. In 1856 and 1857 it prevailed in Boulogne in a very fatal form. From Boulogne it crossed to England, and in the autumn of 1856 attacked various places, especially towns on the Channel coast. Since this date it has continued in England, appearing to diminish during the winter, and to increase in summer and autumn. Like most epidemics, the first cases in a locality are the most severe; as weeks pass, the disease gradually diminishes in severity.

Dr. Brown, of Haverford West, describes an epidemic which prevailed there in 1849 and 1850. He treated two hundred cases, forty of which proved fatal. The pharynx, tonsils, larynx, trachea and bronchial tubes were found to be more or less coated with false membranes, and the stomach showed signs of irritation.?

About the year 1858, the disease appeared in the United States. It was particularly fatal in Albany and its neighbor

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In the United States the disease seemed to improve, and even entirely cease, during the summer months.

2 Remarks on Diphtheria, by Francis Black, M. D. Br. Jour. Hom., vol. xvi., page 637.

hood, from which circumstance it became known as the Al. bany sore throat. It afterwards appeared in other parts of the United States, even as far as San Francisco. The first severe cases that fell under my own observation were in the beginning of the year 1860.

According to the Rock Island Argus, diphtheria has been raging throughout Western Illinois to an alarming extent. The writer says that it is almost exclusively confined to chil. dren, and, when once under headway, death is almost certain to be the result. It will pass through whole towns, missing scarcely a household, and in some instances whole families of children have been swept away by it.

CHAPTER 1I.

SPECIAL DESCRIPTION OF THE PHENOMENA OF THE DISEASE

BY THE MOST PROMINENT AUTHORS, FROM THE EARLIEST KNOWN PERIOD OF ITS EXISTENCE TO OUR OWN TIMES.

SECTION I.- DIPHTHERIA IN THE SIXTEENTH AND SEVEN

TEENTH CENTURIES.

Aretæus.' “Ulcers occur on the tonsils, some indeed of an ordinary nature, mild and innocuous, but others of an unusual kind, pestilential and fatal. Such as are clean, small, superficial, without inflammation and without pain, are mild; but such as are broad, hollow, foul, and covered with a white, livid, or black concretion, are pestilential. If the concretion has depth, it is an eschar, and is so called; but around the eschar there is formed a great redness, inflammation and pain of the veins, as in carbuncle, and small pustules form, at first few in number, but others coming out, they coalesce, and a broad ulcer is produced.”

1 The extant works of Aretous, the Cappadocian. Book i., chap. ix., pp. 253-255. London, 1856. Published by the first Sydenham Society. | Joannis de Villa Real, de Signis, Causis, Essentia, Prognostico, et Curatione, morbi suffocatis. Compluti, 1611. Not having access to these authors, I quote from the work of Dr. Greenhow.

SPAIN.

Villa Real. The disease appeared in Andalusia and other parts of Spain in 1590–1591. The Spanish physicians studied the complaint very carefully, and described what they saw with great fidelity. "The apex of the mouth is at one time altogether white, at another a certain membranous crust, of a bluish color, covers the fauces, throat and gullet. The tongue, from the root upwards, is also either wholly or partially white. It indicates the existence of the white crust in the unseen adjacent parts, and also that it will presently ap pear in the oesophagus and throat. Tumefaction in the neck, behind and below the ears, such swelling being always present in this disease, but especially in cases where the crust tends to a livid hue, and resembles a membrane. The swelling of the diseased parts is not effused into the pores, but external to the parts, as if it flowed over the surface, which it covered like a solid membrane."

Hemorrhage from the nose and mouth, wbich, according to the experience of Villa Real, is invariably a fatal symptom, is so only in the more malignant cases. In the slighter cases it is often beneficial.

De Fontecha. The disease described by this writer prevailed in an epidemic form in Spain, 1599–1600.

“Garrotillo sometimes began with little, sometimes with much pain. There was always more or less swelling of the throat, both external and internal. At one time large, whitish, scabby ulcers appeared; at other times only a white color.

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3 Disputationes medicæ super ea quæ Hippocrates, Galenus, avienas, necnon et alii Græci, Arabes et Latini, de aginarum naturis, speciebus, causis et curationibus, Scripsere diversis in locis, et circa affectionem hisce temporibus vocatam garrotillo. Opus Doctoris Johannis Alphonsi de Fontecha, etc., Compluti, 1611.

There was also at the beginning a blackish crust, inclining to a bluish or greenish hue. Fever often accompanied the disease, but was also frequently absent, particularly in certain epidemies. The disease was unquestionably present when, although there was little pain, a color like flour appeared in the throat and fauces, accompanied by some difficulty of swallowing, by fever, and by a small, weak and irregular pulse. These signs denoted not only the presence of this throat affection, but likewise its intensity.”

Herrera.? Herrera describes eight varieties or stages of this destructive disease.

The first two varieties closely resembled common sore throat, and were characterized by inflammation of the throat and surrounding parts, unaccompanied either by exudation or ulceration. Herrera places them in the same category, seeing that they may pass into it. The third variety had advanced a stage farther; there was excoriation attended by slight soreness. For the fourth, there was ulceration with purulent secretion and severe pain. In the fifth, a spreading, sanious ulcer, with still intenser pain and an offensive smell, but without the crust. In the sixth variety, the characteristic crust, from which the disease derives its modern name, diph. theria, was plainly observable upon the ulcer. In this variety, which was more dangerous than any of the preceding, the crust was of a white color. In the seventh variety, the crust was livid; and in the eighth, which is the worst variety of all, the crust was black. Lastly, he mentions the occurrence of a diarrhoea, as an unfavorable sign, at whatever stage of the illness it appeared.

| This symptom, so long ago observed by Fontecha, is with me at this day one of the most certain and characteristic diagnostic symptoms of the disease.

2 De Essentia, Causis, Notis, Præsagio, Curatione et Precautione Faucium et Gutturis Anginosorum ulcerum morbi suffocatis, garrotillo Hispano appellato de authore Doctore Cristophero Perez de Herrera, etc. Matriti, 1615.

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