ON THE DIAGNOSIS AND CURE OF ANGINA MEMBRANACEA.

(BY DR. ELB, DRESDEN.)

ABOUT ten years ago, Dr. Koch was induced to publish the results of Iod. in croup. As I could not, according to my own observations, acknowledge Iod., as Koch at that time believed, to be in all cases the only applicable remedy, I thought it necessary that the circumstances should be mentioned under which other remedies are required. While I had this only in view at the beginning, I soon found that the indications to be given could not be made clear without a consideration of the pathology of croup: to treat of this, therefore, in advance, appeared indispensably necessary.

May this first attempt at a pathologic-therapeutical essay, based upon individual experience, and adapted, as I believe, to the wants of homoeopathy, meet with a favorable reception by the reader!

Before we enter upon the description of croup itself, it may be advisable to give a short historical sketch of this disease from its origin.

Though we find no disease mentioned by any of the older physicians in the slightest degree similar to croup, it is nevertheless the opinion of several modern inquirers into its history, that it must have occurred in the practice of the ancients, but was not recognized, partly on account of the obstacles to post-mortem examinations, partly in consequence of the deficient means of diagnosis; and that it was then taken for asthma, or paralysis pulmonarum.

Notwithstanding these circumstances, it is difficult to believe, that the old physicians, as good observers, could have totally overlooked the expectoration, though rarely occurring, of tube-like membranes, and not have recognized the existence of a peculiar disease. It is known, however, that croup is not the only disease which has, until a comparatively recent date, developed itself; and it is therefore reasonable to inquire why this development, made possible by various changes of circumstances to which reference will be made, should of late be disputed. It was only until the beginning of the 17th century that we find a disease mentioned, seemingly identical with croup, by Bailou, a Frenchman.

He stated that he had found in children, who had suffered from difficulty of breathing with slight fever, on post-mortem examination, a tenacious hard mucus, like a membrane, in the trachea, whereby the entrance of air was rendered difficult, and suffocation produced. Though it appears that after him Rhodius also in 1660, Horris in 1691, Ridley in 1703, Starr in 1744, Ghisi in 1749, Nobleville in 1750 (the last two having seen the first true croup epidemics, the former at Cremona, the latter at Orleans), and Bergen in 1764, have, according to their communications, observed this disease, we find nevertheless the first distinct description given by Home in 1765, under the title of " An Inquiry into the Nature, Cause, and Cure of Croup;" soon after, in 1771, came Crawford with his "Dissert. Med. Inaug. de Cynanche Stridula," and in 1778, Michaelis, with a still more valuable essay, " De Angina Polypora seu Membranacea."

From that time until the present, croup seems to have occurred more and more frequently, and have been more widely extended, since not only many English, French, and German physicians have given us valuable monographs, but later authors have also had much more frequent opportunities of observing croup than had previously occurred. Though in almost all cases of croup the same image is exhibited, there are nevertheless some modifications, relating as well to the presence or absence of some symptom, as to the duration or the cessation of the more important ones.

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