ON CROUP,

BY J. JACKSON M. D.

IN

N some fatal cases of croup which I have seen, the appear. ances on examination of the dead body, did not accord with those commonly noticed. It may be useful to record the facts, although we should not be in haste to form inferences from them.

In the cases to which I refer the mucous membrane of the larynx has been found inflamed, but without any false membrane, or lining of coagulable lymph. In the first of these cases the peculiar sound of croup was exceedingly evident, so that when entering the room where the child was, before shutting the door, I was satisfied of the nature of the complaint. A few hours before death I performed the operation of bronchotomy without affording any relief. It was the first fatal case of croup which had ever occurred to me, and I was extremely anxious to examine the larynx. With difficulty I obtained permission to do this, on condition that I would not extend the dissection beyond the neck. Dr. J. C. Warren accompanied me in the examination. We found the mucous membrane of the larynx much inflamed, and smeared over with a quantity of loose mucus, but without any false membrane. The inflammation extended into the trachea as far as we could examine. This case occurred nearly ten years ago and is given from memory, but of the accuracy of the important facts I am perfectly satisfied.

The second case happened about three years afterwards, and resembled that above described. The appearances in the larynx were the same. The lungs were more full of blood than usual. The pa

The third case occurred in the winter 1810-11. tient was a strong healthy boy, about five years old. I was called at 1 o'clock, P. M. when he had been sick twenty four hours. At that hour Dr. Bigelow visited him, and I saw him at 3 o'clock. He died at 4 o'clock. He had all the symptoms of croup exceedingly well marked, and I was particularly solici

tous to examine the body, as I was then giving clinical lectures, and wished to exhibit the parts to my class. I removed the larynx and carryed it immediately to my lecture-room, where I demonstrated to the students precisely the appearances I have described in the first case. There was not any coagulable lymph, the mucous membrane was highly inflamed and swollen, and the rima glottidis was thus very much narrowed. The membrane was smeared over with a thick mucus.

The fourth case is of very recent date. I was called to this on Sunday, the 5th of July, 1812, at 3 o'clock, P. M. The disease had commenced twenty hours before, and was very strongly marked. The symptoms were considerably mitigated after vomiting. I tried in vain to take blood; the child was very fat, and the veins were all hidden, even the external jugular. The respiration grew bad again before morning, but the patient lived till the next morning, the 7th, so that the disease continued two days and a half, or sixty hours. In eight hours after death, Dr. Bigelow examined the body, and the following is his report of the appearances. "The trachea with the larynx was removed. The whole tube was pervious as usual excepting the presence of a large quantity of mucus of the ordinary consistence. On dividing the larynx and trachea at the posterior side, and exposing the internal surface, the mucus being removed, a number. of distinct red spots were discovered, of considerable size, on the lining membrane. One of these was immediately below the glottis. Between the mucus and the lining membrane there was no factitious substance whatever, nor any appearance the least resembling the membranes which I have seen formed in some other cases of croup. The lungs were not examined."

In the other cases I had thought it possible that the disease had not continued long enough to allow the effusion to take place, as the patients all died in less than forty-eight hours from the attack. But in this last case such a supposition cannot be admitted; for I have in my possession a preparation in which the false membrane is exhibited in great perfection, and this came from a patient of Dr. Channing's which I had seen with him, and in which death occurred in about thirty hours after the seizure. Boston, July, 1812.

REVIEW.

ARTICLE. IX.

Observations on Hydrophobia, produced by the bite of a mad dog or other rabid animal, with an examination of the various theories and methods of cure existing at the present day, or an inquiry into the merit of specific remedies. Also a method of treatment best adapted to the brute creation. In a series of letters addressed to a friend. By James Thacher, M. D. Soc. Am. Acad. Art. et Scienc. etc. etc. Published by Joseph Avery, Plymouth, Mass. 1812. pp. 301.

A Dissertation on the Bite of a Rabid Animal, being the substance of an essay which received a prize from the Royal College of Surgeons in London in the year 1811. By James Gilman, F. L. S. member of the Royal College of Surgeons in London. London; printed by Richard Taylor & Co. She Lane, for J. Callow, Medical Bookseller, Crown-Court, PrincessStreet, Soho. 1812.

IT

T is unnecessary for us here to search for the early history of Canine madness. The first authentic case which we find recorded, in which the characters of the disease are clearly stated, in the present state of our knowledge, is all that we require.

The subjects of hydrophobia have fallen victims under almost every treatment, and if the genuine disease has been ever cured, such cures are merely insulated facts, from which no general principles can be deduced, for perhaps the means of cure in all of them have been different, and the very next case that occurred has been fatal under apparently the same treatment, and with apparently the same symptoms.

But if the early history of this disease does not furnish us with principles, or plans of cure, we learn from it the effects of civi

lization on the practice of medicine, and though the same fatality attends it, as always has done, it is not brought about now by the same means, for the ancients smothered its subjects in their beds, we must however lament that the inefficacy of medicine does for the subjects of the disease now what the barbarous compassion of friends effected in earlier times.

The characteristics of this disease in dogs are as follows. There may be observed a very marked deviation from accustomed habits. Mr. Gilman considers depraved appetite as most peculiarly to mark this complaint. It, however, makes a stage of the complaint, in which the rabid animal seldom bites any one unless provoked to it.

The greatest caution is however to be observed in this stage of the disease, when the animal fauns upon us we may be bitten, and when they seem to demand our care and regard from apparent indisposition, we may become subjects of a disease as fatal as horrible. "As the disease advances his eyes sometimes become inflamed, and a purulent discharge issues from the lids," Gilman. Instead of barking the animal is heard sometimes only to howl; he laps water freely, and frequently eats with a voracious appetite. If restrained, or closely confined, the dog, in the advanced stages of the disease, becomes still more furious; he gnaws every thing that comes in his way; discovers a most marked antipathy to cats; he endeavours to bite every animal he meets, if at large; and will still lap water, though at times he is observed not to be able to swallow it. Inflammation of the bowels, which frequently attends this stage of the disease, is indicated by the animal sitting in apparently great pain. In the last stage of the disease, the changes are only for the worse; the jaw falls as if paralytic, saliva flows from the mouth, he staggers about unable to bite, and generally dies on the fourth or fifth day from the commencement of the disease. Dissection of subjects, who have fallen victims to this disease, has, as it does in various others, discovered various diseased appearances in various viscera; and different authors have determined on one or other appearance to be pathognomonic as it suited any before settled theory. The stomach has however been inflamed, and Mr. Gilman almost thinks this a pathognomonic sign of the disease.

Such appear to be the symptoms of this disease in dogs. We conceive an attention to them will be of great practical importance. For experience has most unquestionably proved, that this disease may be communicated to the human species by the immediate application of the poison, producing the disease by bite or wound; and we have sufficient evidence to warrant the conclusion, that its application to the skin merely will also produce it. But at what stage of the disease in the rabid animal the disease may be communicated, we are ignorant; for at so early a period when the disease was not suspected to exist in the dog from any symptoms present, a bite has produced it. Knowing then the previous habits of the dog, any change should be immediately noticed, and caution imposed, and no man in his senses can be delighted with the snappish regards of a strange cur.

In the human subject this disease is attended with most distressing and fatal symptoms. The habits of the person are almost destroyed; he seems no longer the being with whom we have been acquainted. His mind is vigorous on most subjects, on many unusually strong. But he is suspicious of his best friends, and alarmed at the approach and attentions of strangers. His physician is frequently looked on as his executioner, and, by the most persuasive eloquence, he requests him to leave him, that terror at sight of his own species may not be superadded to his other horrible causes of misery. Very often a burning pain of various tensity is felt in the part bitten, and "oppression of the præ cordia is one of the constant symptoms of the disorder; it begins, increases, and ends with it." The secretions of the glands in and around the mouth is astonishingly increased, and the patient is found to be constantly spitting or frothing at the mouth. The approaches of this disease are at times slow, at others very rapid; sometimes slight febrile symptom, as shivers, slight headach, loss of appetite, are premonitory; at others, great depression of spirits, great restlessness, violent headach, and vertigo, warn us of its approach; and at other times sudden fright at the sight of water has been the first circumstance to excite alarm.

Dr. Thatcher does not think this last circumstance a pathognomonic sign of the disease, in the human subject. On this subject, page 57 of his work, he observes, "The patient expires in