Croup; its history, nature, and treatment. Fiske fund prize dissertation of the Rhode Island Medical Society.

  • Newman, Albert.
Date:
1855
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Licence: Public Domain Mark

Credit: Croup; its history, nature, and treatment. Fiske fund prize dissertation of the Rhode Island Medical Society. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    two varieties of eroup, one characterized by the presence of false membrane, and the other by its absence, and both presenting the most positive evidences of inflammation of the mucous membrane of the larynx and trachea, shows conclusively that inflammation of that membrane does occur in the child without the formation of a false membrane. Indeed, such a result is found to occur in only a small proportion of all the cases. And it is well esta- blished that inflammation of the same membrane in the adult is sometimes— though much more rarely—followed by the formation of a false membrane also. It becomes, then, an important point in the pathology of this disease, to determine whether the false membrane, in cases in which it occurs, is due to a peculiar and distinctive form of inflammation, characterized by a peculiar and plastic exudation; or, whether it is altogether the result of accident, or a combination of fortuitous circumstances, the same exudation, essentially, oc- curring in all the cases. The former of these opinions has been generally maintained; but the latter we consider most consonant, both with facts and analogies. If we examine the facts in the case, we find, :1st. That many cases not at all distinguishable for any practical purpose frpm membranous croup, and which are diagnosticated and treated as such, fun their whole course, either to recovery or a fatal termination, without presenting any posi- tive evidence of the presence of a false membrane at any period of tbeir course. We attended a case of croup a short time since, during almost the whole course of which there was complete loss of voice. Convalescence com- menced during the third week, but the child was not able to speak above a whisper till some time later, and a considerable degree of hoarseness remained for several weeks. There was no appearance of false membrane either in the expectoration or matters vomited during the course of this case. Moreover, post-mortem examinations of fatal cases sometimes fail to reveal the presence of a false membrane in the air-passages. It is, therefore, at least probable that, in some cases not distinguishable from membranous croup during life, no false membrane at all is formed. On the other hand, it is well known that cases not considered membranous, when terminating fatally, present not un- frcquently, upon examination, more or less extensive patches of false mem- brane. Dr. Wood says, in describing the anatomical characters of catarrhal croup, that occasionally patches of adhering false membrane may be detected, but, he adds, insufficient to have had any agency in the fatal result. And M. Guersent fouud, on dissection, in the larynges of young children who had died of what had been considered spasmodic croup, (i albuminous concretions, sometimes extensive, but more frequently consist- ing of small isolated patches.1 2d. Where expectoration occurs, it is essentially the same in both classes of cases; being, in the earlier stages of both, stringy, glairy, and adhesive, and not unfrequently tinged with blcodj and becoming generally, except perhaps in cases of very slight duration and severity, purulent as the disease proceeds. In relation to the post-mortem appearances of cases in which no false mem- brane is found, Copland says : In the very few opportunities I have had of examining the state of parts in the more purely spasmodic cases of croup, an adhesive, glairy fluid, with patches of vascularity, were observed in the epi- glottis and larynx.2 There can be little doubt, we think, that this adhe- sive, glairy fluid, is present upon the inflamed membrane in all cases of croup; and that it is the same plastic exudation as that which in some cases 1 See Copland's Dictionary of Practical Medicine. Article Croup. 8 Copland's Dictionary of Practical Medicine. Art. Croup.