scopical examinations, have, however, proved the pathological identity of diphtheritic and croupous pseudo-membranes. 2nd. That in croup the exudation affects primarily the larynx, and in diphtheria the pharynx.

It is true that the throat is the elective organ in diphtheria, particularly in its epidemic form. The same rule does not exist, however, with regard to croup. While in some countries where no epidemic of diphtheria had occurred for many years, croup was not observed to commence in the pharynx (Vogel, in Munich); in other places, under the same conditions, sporadic croup made its first manifestations in the throat, and invaded from there the larynx (Förster, in Dresden; Steiner and Neureuter, in Prague); also Gerhard generally saw the pharynx first affected in sporadic croup. These testimonies are the more valuable as their authors favoured rather the distinction in question; our own observations are in accordance with these statements. The circumstance that diphtheria of the fauces often exists without causing great inconvenience to children, and medical advice is only called for when the larynx becomes involved in the exudative process-the exclusive attention which has, even by physicians, been paid to the prominent symptoms of the vocal organ-neglected investigation of its commencement-make the affirmations of the primary localisation of croup in many cases more than doubtful.

It is therefore impossible to establish a distinction between croup and diphtheria on the priority of exudation in the one or other part, the less so as we remember the many diagnostic errors which have been committed between laryngitis catarrhalis and membranacea.

3rd. That in croup the exudation is localised on the larynx, in diphtheria on a greater number of organs.

This objection remains to be proved. In sporadic diphtheria, as well as in epidemic, the affection happily is frequently localised to some parts of the throat; but the divers forms of localisation are often simultaneously observed not only in the same town or village, but in the same family when several members of it are affected. Moreover, it is not

seldom that in sporadic croup other organs are at the same time the seat of diphtheritic exudation (Förster, Steiner and Neureuter, Bouchut, &c.). It is but natural that, as in epidemics the disease and the infection of the system created by it are more intense, so there exists also a greater tendency to multilocular manifestations of the morbid process.

4th. That the swelling of the lymphatic glands and fœtor oris which accompany diphtheria are absent in croup.

The lymphatic glands in communication with the buccal cavity, or in the vicinity of the throat, are constantly more or less swollen when the latter is the seat of a diphtheritic exudation. The swelling of the glands is proportionate to the intenseness and gravity of the local and general symptoms. The same is not the case where the larynx alone is the seat of exudation. The reasons for this may be, that none of the glands are in so immediate anatomical connection with the larynx as with the different parts of the mouth and throat; and, on the other hand, the course of the disease and its fatal issue are too rapid to allow much time for the development of other secondary symptoms. The fœtid smell from the mouth is not a constant symptom, and depends often on the decomposition of the false membranes in the throat induced by the continual contact of air and the passage of aliments. 5th. The epidemic and contagious* character of diphtheria, and the sporadic one of croup.

There are very few epidemic or contagious diseases which are not occasionally met with in a sporadic form; typhus, scarlatina, measles, hooping cough, &c., have all been observed when no epidemic of any kind was prevailing. The same is also the case with diphtheria. In the winter of 1860–61, we had an epidemic of the latter in Nice; since then, seven cases I had to attend-two of them adults-were sporadic. It is, moreover, not difficult to find in literature that sporadic croup has shown a tendency to become contagious, or at least to affect a great number of children at the

*We employ the term contagious in the most general sense, without entering for the present on any controversy whether diphtheria be contagious or not.

same time: this is frequently the case in institutions for infants. The epidemic and sporadic characters change oftener one for the other in diphtheria than is observed in any other disease.

6th. The frequency of diphtheria in adults, and their immunity from croup.

This objection rests on a confusion of different conditions. Diphtheria in general, and particularly the most frequent form, pharyngitis diphtheritica, attacks both children and adults. It is true the latter show less predisposition, and are therefore less subject to the sporadic form; though this is not without exception. The number of adults affected by this disease is always smaller than that of children, unless an epidemic breaks out in barracks, workhouses, prisons, &c.; and sporadic croup is beyond comparison more frequent before the age of ten years than after it. The younger the child, the more rapid the progress of the disease towards its fatal issue. This depends, no doubt, on a greater plasticity of the blood, and the narrow rima glottidis; as the older the children, the slower is the exudative process, and its invasion from the throat into the larynx. Age has therefore evidently more influence on the course of the disease and the localisation of the false membranes than the nature of it.

7th. The constitutional character of diphtheria, and the local one of croup.

Certain peculiarities which accompany diphtheria are considered as characteristic signs of the latter, and consequently as distinctive ones from croup; as, for instance, the epidemic and contagious character of diphtheria, and the multilocular appearance of the exudation. This objection has already

been considered.

It is further urged that, the intensity of the symptoms and the issue of the disease are in a much higher degree directly connected with the local anatomical alterations of the larynx in croup than in laryngitis diphtheritica; that the symptoms of dyspnoea in the latter are much less distressing than in the former; that in croup the fever corresponds to the intenseness of the local disorder, while in

diphtheria considerable exudation in the larynx may exist with little or no dyspnoea and insignificant febrile reaction. These distinctions are, however, based on very superficial observation. There is no doubt that in epidemic, contagious diphtheria, the infection of the organism seems to be more general and more intense, and death may come without the larynx being affected; but it is just in the epidermis that we meet most frequently with the various forms under which this disease appears. Croup, diphtheritis pharyngealis, palpebralis, vaginalis, &c., occur not only at the same time, but often in the same family, showing thereby the identity of the cause. The febrile reaction can be very intense in mild cases of diphtheria, while sporadic croup often assumes an adynamic form (Elb, Trinks, Bouchut, Guersant, Trousseau), and the dyspnoea in the latter is not always so prominent a symptom as it is usually described; in some cases the anesthesia of the skin gives a more correct idea of the degree of asphyxy than the functional disorder of the respiratory organs. Epidemic and sporadic diphtheria take divers forms and characters as well as other diseases, according to the peculiar medical constitution: if we add to that, differences of climate or other cosmical influences, local conditions, drainage, &c., -further, constitutional disposition, lymphatism, scrofulosis, and other diatheses, we may well be most careful before we establish distinctions which, on the whole, are but the result of an infinity of modifications of the same disease, caused by the great variety of conditions in which it manifests itself. The presence of albuminuria in diphtheria, and the absence of paralytic symptoms in croup, have also been urged as distinctive features; but albuminuria is as frequent in the latter as in the former. As to the absence of paralytic symptoms in croup, the moment is not yet come to decide on that point; the study of diphtheritic paralysis is too recent, and death in croup too frequent, to permit from its presence or absence any induction.

As the treatment of croup according to the homœopathic principle offers incomparably better results than that of any other therapeutic system, the representants of it may, in

time, be expected to throw some light on the last point in question.*

A FEW NOTES REGARDING THE CAUSES AND TREATMENT OF SPINAL CURVATURES.

By DR. ROTH.

WITH reference to spinal curvatures, medical men can be classified into a very large majority who pay no attention to spinal curvatures, except when the deformity has obtained such a degree that it cannot remain unobserved, and into a very small minority who pay more or less attention to this class of complaints. Amongst these latter we find those who ascribe all nervous complaints and painful symptoms to a spinal curvature, without taking into account all the general and constitutional as well as local causes which in numerous cases are frequently and simultaneously followed by curvatures, and by various kinds of pains and other symptoms. In mentioning these practitioners I wish not to be understood to say that there are not various symptoms and pains produced by spinal curvatures, especially when they are in a more advanced stage. There is a further subdivision of specialists, usually called "spinal doctors," some of whom, with their auxiliary corps of orthopedic mechanicians, find everywhere a spinal curvature, which, even when only commencing, is represented to the patient or to his relatives as of such a grave character that there is no time to be lost if the fearful consequences of the worst deformities are to be avoided; for which purpose the orthopaedic aide-de-camp who is in attendance during the consulting hours is commanded to take measures for a supporting apparatus (with crutches or a waist-band, and laterally pressing pad), the great and only panacea for spinal curvatures, and which has, besides, the advantage of not being able to be, as it is called, scientifically adjusted except by the spinal doctor, who performs the operation of tightening or loosening some screws, according to the material cir

*We owe an apology to our valued contributor for having misspelt his name in the paper at page 360.