Diphtheria and croup : what are they? / by Sir John Rose Cormack.

  • Cormack John Rose, 1815-1882.
Date:
1876
Catalogue details

Licence: Public Domain Mark

Credit: Diphtheria and croup : what are they? / by Sir John Rose Cormack. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    11/13 (page 10)
    “It has been with no small amazement,” said Professor Spence, “I have read some of the views recently propagated, that croup and diphtheria are identical. I can hardly conceive two diseases more different, whether we consider them in their causation, symptoms, or sequelae. In one feature, doubtless, there is similarity, because, when in diphtheria the air-passages become affected, the presence of the membrane exuded necessarily gives rise to the same physical symptoms as to sound of voice, breathing, and asphyxiating paroxysms, as the false membrane in simple croup does. But in diphtheria, the exudations in the larynx or elsewhere are the local expression of a special blood-disease, which may and often does destroy life without affecting the air-passages at all; whereas in simple croup, the false membrane is the result of a local inflam- mation. The causes or circumstances in which the two diseases originate are, according to my experience, very different. Ordinary croup almost invariably arises from exposure to cold, or occasionally from some source of local irritation, leading directly to inflam- mation of the mouth, as dentition.”1 Agreeing generally in these remarks, I doubt whether a false membrane is ever formed on the mucous surface of the larynx or trachea in any affection which is not diphtheria. I have never seen an inflammatory false membrane in these situations, though I have long been diligently inquiring after such cases. I may be wrong; but till, by an actual clinical demonstration, the contrary is established, I shall continue to believe, with Dr George Johnson and Dr B. H. Semple, that false membrane is never met with as the result of a simple local inflammation. Some of the best French writers comprise in one name both the nervous and the inflammatory affection—a proceeding which Dr R. H. Semple says is a cause of confusion. To a certain extent it does occasion confusion; for laryngismus stridulus and laryngitis stridulosa are essentially distinct pathological conditions. On the other hand, the French writers, censured for inaccuracy by Dr R. H. Semple, are not altogether wrong, because a case which is pure laryngismus at its commencement often becomes catarrhal, and inflammation of the larynx is a common cause of spasm of tire glottis; in fact, spasm of the glottis occasioned by laryngeal inflammation is the affection sometimes called “laryngitis stri- dulosa ” and sometimes “ inflammatory croup.” Nevertheless, the criticism of Dr R. FI. Semple is well founded. Its bearing on practice is very important. There are many cases of laryngismus stridulus presenting phenomena which are clearly reflex—truly nervous—the pneumogastric nerve being implicated, in which the nervous symptoms cease as if by magic, when the source of irritation is removed. For instance, we often see symptoms ox 1 Address in Surgery, delivered at the forty-third annual^ meeting of the British Medical Association, held in. Edinburgh, August 1875. [Reprint© from the British Medical Journal for 14th August 1875.] Vide p. 21.