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Diphtheria, as it prevailed in the United States from 1860 to 1866, preceded by an historical account of its phenomena, its nature, and homoeopathic treatment online

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■ DIPHTHERIA,



AS IT PRSVAIt.BO



IN THE UNITED STATES FROM 1860 TO 1866,

PRBCBDCD

Bj aa nislflrical Accoiiat of its Pliittoiiieiia,

ITS N^VTURE,

AXD

HOMCEOPATHIC TREATMENT.

BY ^ , ^

C. IS"EIDHAEi);M.D.,

LATE PBUFE3S0R OP CLISICAI. MEDlriXE IN THE HOMCF.OPATHIC MEDICAL COLLEOE
OP PBK.NSYLVANIA, ETC., ETC., ETC.




NEW YORK:
WILLIAM RADDE, No. 550 PEARL STREET.

PHiLADBLPniA: F. E. Bff.iiicKE, 6.35 A EC H Street. BoaTOw: Otw Clapp. St. Loria: H. C.

G. LcTTiE.-*. Cisci.s.vATi: Smith & Worth i.xotow. Detroit: E. A. Lodok, M. D.

Chicaiio: C. S. Halret. Clevelasd: Beckwith & Co. PirrsnrKu, Pa :

J. G. Backofes & Son. Lo.-ido.v, E.vo. : H. TfR.tSR A Co.. 77 Fleet

Street; Jamhs Epph, No. 112 Orbat Kc«bll Strbkt.

1867.



■IOL06Y



Entered according to Act of Congress, in the year 1867,

BT WILLIAM RADDE,

In the Clerk's OfBco of the District Court of the United States for the
Southern District of New York.



79-^ ^f



Kma it Baibd, PRinraiu,

607 Saoioin Street, I'Uilodolpbla.



TABLE OF CONTENTS.



CHAPTER FIRST.

Page

Historical Account 9



CHAPTER SECOND.

Special Description of the Phenomena of the Dis-
ease BY THE MOST PROMINENT AUTHORS, FROM THE
EARLIEST KNOWN PERIOD OF ITS EXISTENCE TO OUR
OWN TIMES 11

Section I.

Diphtheria in the Sixteenth and Seventeenth Centuries.

Spain 12

Italian Epidemic 1-1

Section XL
Diphtheria in the Eighteenth Century.

England 15

Italy -. 22

France 2o

Sweden 24

United States of America 25



4 CONTENTS.

Section* III.

Diphtheria in the Nineteenth Century.

France 27

Eni^land. Epidemic of 1857-60 3-1

Mild form 3-i

A more severe form o5

Dangerous cases of Dii)btlieria 39

Dijilitlieria in the Nares 41

Dijilitlicritic Ophthalmia 41

Diphtheritic Croup 43

Dii^itheria of the Oesophagus and Stomach 45

Dij)htheria of the Mouth 46

Diphtheria of the Pudenda 47

Diphtheria on Wounds 48

Dii)htheria on Blistered Surfaces and Abrasions of the

Skin 48

CHAPTEIl THIRD.

Diphtheria in the United States, 1856-1864.

California 50

^[ilford, Conn 52

Stoubenvillc, Ohio 53

Albany, New York 53



CHAPTER FOURTH.

The different forms under \yhicii Diphtheria
manifested itself in philadelphia.

Maliijnant Canes.

A. Witli predominance of Throat symptoms 56

B. Combined with Croup 59

C. Extension of the Throat Disease to the Stomach

and Alimentary Canal 60



CONTENTS. 5

II. Sliffht Cases.

A. A diglit deposit of the membrane is visible on

the Schneideriau membrane of the nose, on the
tongue, pharynx, tonsils, etc. The glands of the
neck are only slightly swollen 61

B. Diphtheritic Cough, with or without Croup 61

C. Characterized by a mucous diarrhoea and dysen-

tery 62

I). Diphtheria complicated with other diseases 63



CHAPTER FIFTH.

Nature of Diphtheria.

A. Cause miasmatic 67

B. Its appearance in animals 69

C. Locality, cold air, damp air 70

D. Age, strumous constitution, etc 72

E. Chemical examination of the membrane 73

F. Examination by the microscope 76

G. Diagnosis between Diphtheria and Scarlatina 83

//. Diagnosis between Diphtheria and Cruup 87

/. Diagnosis between Laryngitis Stridulous and

Diphtheritic Croup 88

TT. Diagnosis between Diphtheria and Aphthie 89

L. Pathological Anatomy 90

J/. Prognosis 92

X. Sequeke 96

0. Contagion 97

tStalistics of JJeaths from Viphtlieria, Croup and Scarlet

Fever in Fhiladephia, from 1860 io 1864 99



CHAPTER SIXTH.

Treatment of Du'iitiieria.
Allopathic Treatment lUl



" CONTENTS.

CHAPTER SEVENTH.
HoMCEOPATiiic Treatment of Diphtheria.

Section I.
British Physicians. iqq

Section II.
French Physicians n-j

Section III.
German Physicians 120

Section IY.

American Physicians 227

CHAPTER EIGHTH.

My own experience in Diphtheria.

General Bemarks ^^^

Dose of the Remedy 247

Remedies i ,-

i-il

Proto-iodide of mercury 248

Kali bichroraicuni ^^^^

Cantharides ' y^^.

Argentum nitric -,'X

Crotalus horrid ir..

_^ . i O D

Bromine ^^^.

Chlorate of potash ^^^1

Liquor potass, caustic 2dl

Borax in Diphtheritic Fever I(j2

Chlorinated lime iu acute cases 1(^7

Chlorinated lime in Chronic Diphtheria 169

^"^'-quelije -^gp

Summary ; -. ^ -



PREFACE



In January, 1861, I saw my first case of malignant Diph-
theria, a malady then hardly known in Philadelphia. Never
having met with the disease before, I had recourse to the
treatment recommended by the British and French physicians,
and was unsuccessful.

I then determined to make myself, as far as possible,
familiar with the nature of Diphtheria, by examining its
records from the most ancient times. For this purpose I
procured from the Library of the Pennsylvania Hospital all
the works relating to the subject.

Since that time, now over six years, I have attended about
one hundred and eighty malignant or severe cases of Diph-
theria and diphtheritic croup, and at least four hundred and
twenty slighter cases of the disease ; including in this latter
class all where the membrane, or a few patches of it, could
be distinctly seen in the throat.

This treatise is the result of my researches and subsequent
experience.

The more I contemplate this disease in all its details, the
more I am convinced of its identity with malignant scarlatina



8 PREFACE.

and membranous croup, and that tliese diseases are different
manifestations of the same or a similar poison in the blood.

I have contributed my share towards the solution of this
important question, and furnished practical information for
a successful treatment. My labors, I hope, will not have
been in vain.

_ C. NEIDHARD, M.D.

Philadelphia, March, 1867.

[KoTE, — In order to obtain a clear and easy supervision of
the remedies employed, it was my wish to have them printed
in the margin of the text. By a misunderstanding they were
printed as headings. Throughout the chapter relating my
own experience this plan has been followed.]



ox DIPHTPIERTA.



CHAPTER I.



HISTORICAL ACCOUNT.



The historical researches of Ozanan, Fuchs, Ehenmann,
Ilecker, and Bretonneau, show that the malignant inflamma-
tion of the pharynx, now recognized under the descriptive
term Diphtheria,^ was known m its chief features to Aretseus,
Cselius Aiirelianus, and Actins, under the name of Ulcera
JEgyptica Syriaca.

In the beginning of the latter half of the sixteenth century,
the disease appeared epidemically in Holland, and was de-
scribed by P. Forest. Towards the end of that century it
swept a similar march through Spain, terminating with such
general fatality in suffocation, that it received the name of
(jurrotillo. From that period to the present, the disease has
showed itself, at different times, and with greater or less in-
tensity, in most European countries, and in North America,
and has been described by a great number of writers of all
nations, under different names.

The kingdom of Naples and Sicily seems to have been
sadly scourged. In 1641, it is described by Si^verinus as car-
rying ofi" many thousands of children. With such opportuni-
ties for post-mortem examinations, J/oryar/ni blames Severinvs
for the remark that he was not willing to take upon him the
tedious labor of delineating the seat of the disorder itself.



' ^tipSeplrns and Ai^Stpiaj signify, that which is covered with a skin.
2 (9)



10 HISTORICAL ACCOUNT.

From 1745 to 1748, it spread throughout Europe, and
about the same time showed itself in England, when it was
ably described by Dr. Fothergill. As seen by him, the dis-
ease was attendant iipon scarlatina ; but the account published
nearly at the same time (Philosophical Transactions, 1750) by
Starr, refers evidently to a primary diphtheria, and the cases
related by Ghisi as occurring at Cremona during 1747 and
1748, are independent of scarlet fever.

A very able description of the disease was given by Bard,
New York, (1771.) He was the first to point out its resem-
hlance to croup, denying its gangrenous nature. In modern
times, the disease has been most minutely described by Bre-
t07ineau, who himself observed a violent epidemic in Tours,
(1818 to 1820.) From 1818, the date of M. Bretonnea'ah work,
to 1829, diphtheria has annually appeared as an epidemic in
France, and sometimes in Switzerland ; generally in the form
described by Bretonneau, but semetimes showing a low type
with ulceration and gangrene. In 1856 and 1857 it prevailed
in Boulogne in a very fatal form. From Boulogne it crossed
to England, and in the autumn of 1856 attacked various
places, especially towns on the Channel coast. Since this
date it has continued in England, appearing to diminish
during the winter, and to increase in summer and autumn.^
Like most epidemics, the first cases in a locality are the most se-
vere ; as lueeJcs pass, the disease gradually diminishes in severity.

Dr. Brown, of Haverford West, describes an epidemic
which prevailed there in 1849 and 1850. He treated two
hundred cases, forty of which proved fatal. The pharynx,
tonsils, larynx, trachea and bronchial tubes were found to be
more or less, coated with false membranes, and the stomach
showed signs of irritation.^

About the year 1858, the disease appeared in the United
States. It was particularly fatal in Albany and its neighbor-

' In the United States the disease seemed to improve, and even entirely
cease, during the summer months.

* Remarks on Dijjhllieria, by Francis Black, M. D. Br. Jour. Ilora.,
vol. xvi., page G37.



HISTORICAL ACCOUNT. 11

hood, from which circumstance it became known as the Al-
bany sore throat. It afterwards appeared in other parts of
the United States, even as far as San Francisco. The tirst se-
vere cases that fell under my own observation were in the be-
ginning of the year 1860.

According to the Rock Island Argus, diphtheria has been
raging throughout Western Illinois to an alarming extent.
The writer says that it is almost exclusively confined to chil-
dren, and, when once under headway, death is almost certain
to be the result. It will pass through whole towns, missing
scarcely a household, and in some instances lohole families of
chiklren have been sivept aiuay by it.



CHAPTER II.

SPECIAL DESCRIPTION OF THE PHENOMENA OF THE DISEASE
BY THE MOST PROMINENT AUTHORS, FROM THE EARLIEbT
KNOWN PERIOD OF ITS EXISTENCE TO OUR OWN TIMES.

Section I. — Diphtheria in the Sixteenth and Seven-
teenth Centuries.

Aretsens} "Ulcers occur on the tonsils, some indeed of an
ordinary nature, mild and innocuous, but others of an unu-
sual kind, pestilential and fatal. Such as are clean, small,
superficial, without inflammation and without pain, are mild ;
but such as are broad, hollow, foul, and covered with a white,
livid, or black ooncretion, are pestilential. If the concretion
has depth, it is an eschar, and is so called ; .but around the
eschar there is formed a great redness, inflammation and pain
of the veins, as in carbuncle, and small pustules form, at first
few in number, but others coming out, they coalesce, and a
broad ulcer is produced."

' The extant works of Aretceus, the Cappadocian. Book i., chap, ix.,
pp. 253-255. London, 1856. Published by the Orst Sydenham Society.



12 DIPHTHERIA IN THE SIXTEENTH CENTURY.



SPAIN.

Villa Real} The disease appeared in Andalusia and other
parts of Spain in 1590-1591. The Spanish physicians stu-
died the complaint very carefully, and described what they
saw with great fidelity. "The apex of the mouth is at one
time altogether white, at another a certain membranous crust,
of a bluish color, covers the fauces, throat and gullet. The
tongue, from the root upwards, is also either wholly or par-
tially white. It indicates the existence of the white crust in
the unseen adjacent parts, and also that it will presently ap
pear in the oesophagus and throat. Tumefaction in the neck,
behind and below the ears, such swelling being always pres-
ent in tliis disease, but especially in cases where the crust tends
to a livid hue, and resembles a membrane. The swelling of
the diseased parts is not effused into the pores, but external to
the parts, as if it flowed over the surface, which it covered
like a solid membrane."

Hemorrhage from the nose and mouth, which, according to
the experience of Vill'j Real, is invariably a fatal symptom,
is so only in the more malignant cases. In the slighter cases
it is often beneficial.

I)e Fontecha? The disease described by this writer pre-
vailed in an epidemic form in Spain, 1599-1600.

"Garrotillo sometimes began with little, sometimes with
much pain. There was always more or less swelling of the
throat, both external and internal. At one time large, whitish,
scabby ulcers appeared ; at other times only a white color.

' Joannisde F/7/ai?eaZ, deSignis, Caiisis, Essentia, Prognostico, et Cu-
nitione, morbi siiffocatis. Compluti, 1611. Not having access to these
authors, I quote from the work of Dr. CJreenhow.

* Dispiitationes mcdica; super ea quai Hippocrates, Galenus, avienas,
nccnoii et alii Grajci, Arabes et Latini, do aginarum naturis, speciebus,
causis et curationibus, Scripserc diversis in locis, et circa aflectioncm hisce
temporibus vocatam garrotillo. Opus Doctoris Johauuis Alphonsi de
Fontecha, etc., Compluti, IGll.



SPAIN. 13

Tliere was also at the beginning a blackish crust, inclining to
a bluish or greenish hue. Fever often accompanied the dis-
ease, but was also frequently absent, particularly in certain
epidemics. The disease was unquestionably present when,
although there was little pain, a color like flour appeared in
the throat and fauces/ accompanied by some difficulty of
swallowing, by fever, and by a small, weak and irregular
pulse. These signs denoted not only the presence of this
throat affection, but likewise its intensity."

llerrera? Herrera describes eight varieties or stages of this
destructive disease.

The first two varieties closely resembled common sore
throat, and were characterized by inflammation of the throat
and surrounding parts, unaccompanied either by exudation
or ulceration. Herrera places them in the same category,
seeing that they may pass into it. The third variety had ad-
vanced a stage farther; there was excoriation attended by
slight soreness. For the fourth, there was ulceration with
purulent secretion and severe pain. In the fifth, a spreading,
sanious ulcer, with still intenser pain and an offensive smell,
but without the crust. In the sixth variety, the characteristic
crust, from which the disease derives its modern name, diph-
tlteria, was plainly observable upon the ulcer. In this variety,
which was more dangerous than any of the preceding, the
crust was of a white color. In the seventh variety, the crust
was livid ; and in the eighth, which is the worst variety of
all, the crust was black. Lastly, he mentions the occurrence
of a diarrhoBa, as an unfavorable sign, at whatever stage of
the illness it appeared.



' This symptom, so louc^ ago observed by Fontecha, is with me at \.\\\»
day one of the most certain and characteristic diagnostic symptoms of
the disease.

* De Essentia, Causis. Notis, Pra'sagio, Curatione et Precautione Fau-
cium et tiutturis Anginosorum ulcerum morbi siiffocatis, ijdrroltllo His-
pano appellato de aulhorc Doctore Cristophero Perez de Herrera, etc.
Matrili, 1G15.



14 DIPHTHERIA IN THE SEVENTEENTH CENTURY. '

ITALIAN EPIDEMIC.

Cortesius} "Redness and inflammation of the surface of
the palate and mouth, the tonsils remaining unaffected ; more
frequently, these glands were swollen, and sometimes so
much so that they touched each other, thereby interfering
with deglutition and respiration. In the beginning, there was
usually swelling, heat and redness ; afterwards, pain, and diffi-
culty of swallowing. When there was only inflammation of
the parts about the throat, the sick easily recovered ; but
sometimes a certain pituitous substance, (exudation,) descend-
ing from the head, so speedily and unexpectedly followed the
inflammation, that the patient was suddenly suffocated. Very
often a white substance, which soon became liquid and after-
wards black, unaccompanied by pain, appeared on the inflamed
surface. This material could be readily torn away from the
subjacent parts, either by the finger or an instrument; but,
although the operation caused no pain, the patient invariably
died a short time afterwards, as happened, among others, to
the son-in-law and the grandchild of Cortesius. Sometimes
mortification, accompanied by fetor, quickly invaded some
part of the throat; and when this occurred, whether fetor
were present or not, remedies proved unavailing, and the
patient died about the fourth day, or even earlier, rarely so
late as the seventh day."

Cortesius notices the frequent occurrence of several fatal
attacks in the same family. There was reason for supposing
the disease to be contagious, and a case reported by Cortesius
strengthens the opinion. A monk being attacked by the dis-
ease, constantly complained that he observed a foul odor pro-
ceeding, as he supposed, from his mouth ; so to assure himself
of the truth, requested a friend to verify the fact by smelling.
Not many hours after doing so, in the presence of Cortesius
and others, the friend was laid up with inflammation of the
fauces and tonsils, and, remedies proving useless, died on the
fourth day of his illness.

' .(uiinnis Hiiptistic Cortcsii, Misccllanconiiu mcdiciiialium. Decades
J)l-ii;l' .Mussauaj, 1G25.



ENGLAND. 15

Section II. — Diphtheria in the Eiguteentu Century.
ENGLAND.

Dr. Father gill} "Children and young people were more
liable to the disease than adults, girls more than boys, women
more than men, the delicate more than the robust. The illness
usually began with giddiness, chilliness or shivering, followed
by fever, acute pain in the head, stiffness of the neck, soreness
of the throat, and sometimes vomiting and diarrhoea. The pain,
heat and restlessness increased towards night, and were often
mitigated by the breaking out of a sweat towards morning.

" If the mouth and throat be examined soon after the first
attack, the uvula and tonsils appear swelled, and these parts,
together with the velum pendulum palati, the cheeks on each
side near the entrance into the fauces, and as much of them
and the pharynx behind as can be seen, appear of a florid red
color. This color is commonly most observable on the poste-
rior edge of the palate, in the angles above the tonsils, and
upon the tonsils themselves. Instead of this redness, a broad
spot or patch of an irregular figure, and of a pale ichite color,
is sometimes to be seen, surrounded with a florid red ; the
whiteness commonly appears like that of the gums immedi-
ately after having been pressed with the finger, or as if matter
ready to be discharged was contained underneath.

" Generally on the second day of the disease, the face, neck
breast, and hands to the fingers, are become of a deep, erysipel-
atous color, with a sensible tumefaction; the fingers are fre-
quently tinged in so remarkable a manner, that from seeing
them only it has not been difficult to guess at the disease. A
great number of small pimples, of a color distinguishably
more intense than that which surrounds them, appear on the
arms and other parts. They are larger and more prominent

' An Account of the Putrid Sore Throat, by John Fulhergill, M. D.
5th edition, Luiulon, 17G9.



16 DIPHTHERIA IN THE EIGHTEENTH CENTUKY.

in those subjects, and in those parts of the same subject, where
the redness is least intense, which is generally on the arms,
the breast, and lower extremities.

" These white places presently became more of an ash color,
when it was discernible that what at first might have been
taken for the superficial covering of a suppurated tumor, was
really a slough, concealing an ulcer of the same dimensions.
All parts of the fauces were liable to be affected, but the
disease generally first appeared in the angles above the ton-
sils, or on the tonsils themselves, on one of the arches formed
by the uvula and tonsils, on the posterior wall of the pharnyx,
on the inside of the cheeks, or on the base of the tongue.

" In the milder forms of the disease, an irregular, superficial
ulcer, scarcely to be distinguished from the sound parts but
by the roughness of the surface it occasioned, appeared on
one or more of the above-mentioned parts. A thin, pale,
white slough seems to accompany the next degree ;' a thick,
opaque, or ash-colored one is a further advance ; and if the
parts have a livid dk- black aspect, the case is still worse. The
sloughs are not formed of any foreign matter spread upon the
parts affected, as a crust or coat, but are real mortifications of
the substance ; since, whenever they come oft' or are separated
from the parts they cover, they leave an ulcer of a greater or
less depth, as the sloughs were superficial or penetrating.

" In one case these sloughs were separated by a surgeon's
probe without much difficulty, but the same parts were cov-
ered the following day with thick, dark, ash-colored sloughs,
penetrating deep into the substance. The eruption was not
always present, and especially in the winter of 1754, it either
did not appear at all, or its appearance was retarded. There
was commonly much swelling of the parotid glands and
neighboring parts, and the tonsils and uvula were sometimes



' During the winter of I8G2-63, diphtheria in Philadelphia was charac-
terized by this appearance. The same white membrane was observed in
the ulcers, sores, and even whitlows of dii)litheritic patients. It seemed to
mingle with all kinds of diseases and modify them.



ENGLAND. 17

80 much swelled as to leave but a narrow entrance to the
gullet, which was also frequently surrounded with ulcers and
sloughs. Yet, although food was sometimes forced back
through the nose, patients often swallowed with little diffi-
culty or pain. An olYeusive putrid discharge, and a corrosive,
sanious discharge from the nostrils often accompanied the
complaint; it was also sometimes attended by an excessive
faintness, the greater or less urgency of which seemed to in-
dicate the degree of danger. There was less thirst than usual
in other acute diseases, and the tongue was moist and seldom
furred. Hemorrhage from the nose and mouth sometimes
suddenly carried oft" the patient."

Dr. Fothergill distinguished the disease from scarlet fever,
for which one of his cases was mistaken by the persons about
the patient, but several of the symptoms he describes, partic-
ularly the appearance of a red rash on the second day, are
rather those of scarlet fever than of diphtheria. It seems
probable, as has happened in more recent epidemics, that
scarlet fever and diphtheria were intermingled ; that the cases of
scarlet fever had a diphtheritic character, and that, while in all
probability Dr. Fothergill saw some cases of uncomplicated
diphtheria, especially of that kind in which the exudation re-
mains until the subjacent surface sloughs, he nevertheless
confounded the two diseases. Indeed, we have other evidence,
both that scarlet fever sometimes presented unusual features,
and that diphtheria, complicated with scarlet fever, prevailed
in England about the time when Dr. Fothergill observed the
particular form of sore throat described in his book.'

Dr. Nathaniel Cotton, St. Albans, 1748," describes the same
peculiar form of scarlet^ fever. " Upon looking into the



' During the recent epiJemic in Fiiiladelphia. I have observed this in-
termingling of scarlet fever and diphtheria in twenty cases. In fact I am
more convinced every day, that the two diseases are the product of the
same miasma in the blood.

* Observations on a particular kind of scarlet fever, that lately pre-
vailed in or about St. Albans, in a letter to Dr. Mead, by Xathan.Cullun,
M.D.



18 DIPHTHERIA IX THE EIGHTEENTH CENTURY.

mouth, there were frequently seen, especially after the disease
was a little advanced, ulcers scattered up and down the
fauces, pretty broad upon and about the tonsils, superficial,
and covered with a whitish slough. The scarlet efflorescence dif-
fered as to extent and time of appearance ; there was high fever,
intense thirst, a moist and but slightly-furred tongue, frequent
cough, sudden loss of strength, and great dejection of spirits,
especially towards evening, which continued for some time
after the patient was convalescent."

Dr. Starr, Cornwall, 1748 or 1749.^ "Swelling of the ton-
sils, parotid and submaxillary glands ; gangrenous sloughs
(which were evidently false membranes) often formed in the


1 3 4 5 6 7 8 9 10 11 12 13 14 15

Online LibraryC. (Charles) NeidhardDiphtheria, as it prevailed in the United States from 1860 to 1866, preceded by an historical account of its phenomena, its nature, and homoeopathic treatment → online text (page 1 of 15)