of pathologists and practitioners. We wish we could solve. the difficulties, or direct a more scientific or successful method of cure than has hitherto been adopted.

"The angina stridula is also called angina, membranacea, interna, perniciosa, polyposa, catarrhus, suffocativus, and morbus strangulatorius. It is chiefly a disease of children, and is distinguished by a difficult inspiration sounding as through a brass tube, harsh cough, with seldom any tumor in the throat, and no difficulty in swallowing. This definition differs from that of Dr. Cullen, who is a little warped by his adherence to system.

"A cold and a short cough precedes for some days, when the harsh breathing comes on, with little or no fever; sometimes suddenly, at others more gradually, increasing by degrees, till suffocation closes the scene.

"The disease consists of a membranous substance, lining not only the trachea above its divarication, but also its minutest branches, though the large parts of the tube are first affected. It has been considered as a spasmodic disease by some, as it attacks suddenly, and is relieved by warm baths and asafœtida, and as inflammatory by others, who rest with equal security, on the cough preceding, and the utility of bleeding."

John Mackintosh, M. D., "Practice of Physic,” (First American from Third London Edition, A. D., 1834, Vol. I, pp. 277 to 285), gives the usual history of croup of those days. In his reference to the appearance on dissection, he says:

"On opening the trachea, false membrane is found lining the organ in various states; sometimes it is soft and diffluent; sometimes partial; at others extending beyond the bifurcation. Sometimes it is found of very considerable thickness and firmness, of a tubular form, corresponding exactly with the canal which it covers, and extending an inch or two into the bronchi; on some occasions, the first divisions of the tubes are as completely lined as the trachea. Frequently the larynx is similarly affected."

We also give an extract of what he says as to treatment:

"This is a disease of all others which requires promptness of decision, and activity in practice; for if false membrane be allowed to form, not above one case in the hundred will be saved. The worst cases are those in which a sore throat has been neglected, and the inflammation has spread into the windpipe; or those in which patients have labored under bronchitic symptoms for a week, or perhaps more, before the disease has affected the trachea and larnyx, under which circumstances, a recovery is rather to be considered as an escape, than as an event to be expected."

We have thus quoted some extracts from the writings of Dr. William Cullen under the name of cynanche trachealis, and Bartholomew Parr, M. D., who refers to Cullen, and uses the name angina trachealis, but considers the croup under the appellation of angina stridula, etc. Also from the "Edinburgh Practice of Physic," Dr. John Eberle, "Practice," and from John Mackintosh, M. D., "Practice of Physic," and all these authors describe to us in their writings on croup, the disease we call diphtheria in some of its forms.

Morell Mackenzie, M. D., of London, in his very valuable works on the throat, nose, pharynx, larynx, trachea, œsophagus, nasal cavities, and neck, fully describes croup under all its names, and gives a full history of it, and proves it beyond a doubt, to be one form of diphtheria. He quotes many of the most prominent authorities to prove his position.

We find proof of the identity of croup and diphtheria in the practice and writings of such authorities as Dr. Mackenzie, whose opinion is respected and quoted as authority, in all parts of the world; also, Drs. Hillis, Semple, and Virchow, who only yielded to the principle advanced that diphtheria and croup were identical, after a long and thorough investigation.

Dr. George Jackson, British Medical Journal, Feb. 19,

1870, pronounced diphtheria and croup identical. Sir William Jenner, Lancet, Jan. 2 and 16, 1875, gave his adhesion to this doctrine. The renowned Doctor Traube, of Germany, also had accepted the unity theory.

We might quote authorities filling pages to prove the identity; but it is a question that each practitioner can settle in his own mind. My experience in an extensive practice since the fall of 1846, has proved beyond a doubt in my mind, that croup is only a form of diphtheria.

I will here quote an article from the May number of the Medical World, Vol. VIII, No. 5, page 181:

"Croup' is confined to the air-passages alone. A form of croup attacks the urethra sometimes, and is indicated by the excretion of characteristic white membranous structures, mixed with more or less blood and pus. Croup of the bladder is more frequent in females, the membranous substance being reddish in color, and in much larger pieces.

"This statement is correct as to cases of diphtheria. The membrane may be found covering any part of the mucous membrane, mouth, nose, fauces, trachea, bronchia, stomach, bowels, kidney, urethra, rectum, and vagina. I have at this time a small box of the membrane taken from the vagina. I also have had cases where wounds on any part of the body where the cuticle was removed were covered with this fungi. I call these cases diphtheria and not croup. All of which is respectfully submitted."

Dr. J. F. Kennedy, secretary of the Iowa State Board of Health, in a recent issue of the Monthly Bulletin, says:

The Iowa State Board of Health, eighteen months or two years ago, declared officially that for the purposes of quarantine, diphtheria and membranous or true croup, should be regarded as identical. This action seemed eminently proper, and in the interest of the public health. Perhaps all members of the board were not fully convinced

in their own minds that the identity of these diseases had been satisfactorily demonstrated.

In Hare's System of Practical Therapeutics, just issued, is a chapter, the title of which heads this article, contributed by J. Chalmers Cameron, M. D., M. R. C. P. I., of Dublin, Ireland. Professor Cameron was one of the most distinguished members of the late international congress of health and demography, held in London, and his views and opinions, as expressed on several occasions, received marked and merited attention.

On the question of the identity of what was formerly, and is yet by many, regarded as two diseases-diphtheria and membranous croup, he says, page 484, Vol. II:

"Diphtheria and croup are identical. Though their identity has not yet been proven scientifically, yet clinically and practically the balance of evidence is in favor of this view. Those physicians who believe that true croup is diphtheria and contagious, and who base their treatment upon this belief, will succeed in saving life and limiting the spread of the disease, when those will fail who soothe their own consciences and comfort anxious relatives and friends with the declaration that croup is a local inflammatory and non-contagious disease, and neglect isolation and disinfection accordingly. If there is still a doubt we should not allow it to make us careless in our practice."

We are glad to see the action of our board so fully endorsed by one so eminent as a physician and sanitarian, and to have this endorsement a part of a text-book that will be read by thousands and accepted as authority.

The twenty-first annual report of the local government. board (England), for 1891-2, contains a report on an investigation undertaken by Dr. Klein, F. R. S., on the relation of diphtheria to membranous croup.

Assuming that the Klebs-Loeffler bacillus is the true cause of diphtheria, and this fact is firmly established,

Dr. Klein, in selected cases of throat affections attended with membranous deposits, has determined the presence or absence of the bacillus diphtheria.

From this investigation Dr. Klein concludes-1stThat membranous deposits of the fauces occurring in the early stages of scarlet-fever, the so called scarlatinal diphtheria, are not diphtheritic, the bacillus being invariably absent. 2d-That the membrane formed in the throats of scarlet-fever patients following convalescence is diphtheritic, these being cases of true diphtheria; in such cases, either the pharynx or larynx and trachea may be affected. 3d-Membranous croup of the larynx and trachea concurrently with diphtheria of the fauces is true diphtheria. 4th-Membranous croup of the larynx and trachea, without diphtheria of the fauces, may be of two kinds: (a) True diphtheria with the presence of the bacillus, or (b) genuine fibrinous croup without the presence of bacilli, and, therefore, not (from this point of view) diphtheria.

While it may be possible, therefore, that cases of membranous croup may occur which are not diphtheritic, and hence not contagious, other cases are undoubtedly true diphtheria. And, as a biological examination will be required to determine the exact character of each particular case, all cases of membranous croup should be treated as diphtheritic, and the same precautions taken as in other cases of diphtheria.1

The effect of establishing the identity of these two processes will not only aid the physician in a more rational treatment, but recognizing in every case of membranous laryngitis its true cause, and adopting early the precautions necessary to prevent its extension, both individuals and communities will be better protected, and we, as guardians of the public health, instrumental in saving many valuable lives.

1 Monthly Sanitary Record.