DIPHTHERITE:     tfM<e*
ITS PREVALENCE IN ALBANY.
Read before the Medical Society of the State of New York,


                February 2, 1859.
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BY  SYLVESTER D.  WILLARD, M. D.
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       ALBANY:          ,, as a modifi-

PRJNTED BY C. VAN BENTHUYSEN. j6 influence> there

          1859.
                     . small estimate. 
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DIPHTHERITE.
   Within a few months past, Albany has  been visited by an epi-
 demic sore throat malady, recognized as the distinct disease diph-
 therite.
   In my  present  remarks, it is not my design to  enter into an
 elaborate consideration of the subject, but rather to present a few
 facts,  Avith  such statistics of fatality from the prevalence of the
 disease in this city, as I have been able to gather.
   There are tAvo diseases  to Avhich diphtherite bears marked sim-
 ilarity ; one is cynanche  tonsillaris, the other is  croup; but it
 exists independent of both of these, variously modified by the
 epidemical influences that produce it.
   Just as in the prevalence of cholera, there is a tendency to a
 disturbed condition  of the  mucous  coat of the boAvels, Avhich is
 produced by the modified action of Avhatever agent causes chol-
 era, so co-existent Avith the  prevalence of  diphtherite, and doubt-
 less induced by the  same atmospheric condition, there prevailed
 among our adult population, in a mild form, a diffusive inflamma-
 tion of the throat.
   In some of these cases,  and I estimate them to have been more
 than two* thousand, there Avas but a simple blush upon the fauces,
 in others  the  palate,  uvula  and tonsils Avere in a high degree of
 vascularity.  The general health and appetite of  these Avere un-
 disturbed.  The only sensation experienced, Avas that of dryness
 and roughness  of the  parts  affected.  This  morbid condition
 yielded readily to the application of nitrate of silver, an astrin-
 gent gargle, or in a feAv days  resumed  its normal state  without
 any aid Avhatever.  Many such  cases came under the observation
 of every physician.
  Simultaneous Avith  the  appearance of diphtherite, as a modifi-
cation of that  disease, and produced by the same influence, there
*It has been suggested to me that this is a small estimate. 
4
occurred also cynanche  tonsillaris.  This  form  of the  malady
prevailed in the  recent epidemic, among children and young per-
sons, being mostly confined to those  under tAventy years of age.
Upon looking into the fauces, it Avas  at once observable, that the
tonsils were so swollen as nearly to touch each  other.  The high
degree of inflammation comes on suddenly, and is folloAved by
the suppurative process, becoming more extensive, and involving
the whole tonsils, which are in some  instances, entirely throAvn
off in the suppuration ;  aftenvard resolution  may  ensue.  In  a
few cases, the tonsils have  had from  the  very outset,  a dark,
mahogany color, and the  ulcers on their surface assumed a green-
ish cast.   These have  been  followed by gangrene, mortification,
and consequently  death.  But  the disease diphtherite has pre-
vailed among children, mostly under  the  age of tAvelve years.
Its onset is sudden and insidious, the false membrane ha\Ting been
formed to  some extent,  when the first symptoms  of illness at-
tracted the attention, and occasionally when  the attention Avas
directed only by the alarming condition of other members of the
same family.  The membrane rapidly  extends upon  the  palate,
tonsils, rima glottis, into the larynx, and  trachea,  producing
mechanical  obstruction to  respiration,  and the patient dies in
precisely the same manner as in croup.  In some instances  the
first examination of the  patient showed the tonsils swollen  and
covered with a pseudo membrane of a pearly or oyster-like ap-
pearance ; such were almost uniformly rapid in progress, and ter-
minated fatally in two or three days.   Those more slow in their
progress, developed a blood poison,  and after  several days, the
mucous membrane  of the nose,  fauces  and bronchi, throw of a
thick offensive acrid secretion, as  so often exists in  scarlatina.
The congestion extends to the cellular tissue and skin about the
throat and chest, the parotid  glands become swollen, and there
follows before death, incipient mortification and decomposition.
In the progress  of the disease, where it advances less decidedly
to an unfavorable termination, there is a strong effort on behalf
of nature to separate  and  throw off the pseudo membrane from
the the fauces, and to expel it from the breathing passages.   The
line of demarkation forms in four or  five days, and the separation
may often be hastened by seizing portions of the membrane with
forceps, and gradually and gently detaching it; but the tendency
on the part of the disease is to reproduce  it, so that when large
patches of it have been expelled  by expectoration or otherAvise, it
has been speedily reproduced, and life destroyed. 
5
   Diphtherite, like influenza, is doubtless a  zymotic disease, and
 the formation of the membrane upon the fauces one of its mani-
 festations.
   In  its  pathology it  is nearly allied to scarlatina.   Depm-e a
 case of scarlatina maligna of its efflorescence, and such cases  do
 occur, and it Avould require a delicate diagnosis to distinguish it
 from some of  the modifications of diphtherite.
   But these  are points  upon  which I  hope gentlemen  of the
 society, Avhose observations have been more exteudedthan my own,
 Avill take occasion to express fully their views.
   During the last week I made an effort to get  the mortuary sta-
 tistics from this disease in Albany, and for  this purpose called
 upon nearly every practitioner in the city.  With only three excep-
 tions,  the  information Avas  promptly and  kmdly  afforded me.
 There are reported as having died one hundred and eighty-eight,
 nine of A\diich Avere Avithout  the  limits of the city.  Within the
 city one hundred and seventy-nine cases.   The first case occurred
 in the south part of the city, as early as the second  of April, and
 the second case is reported on  the tAventieth of the same month,
 in the same section of the city.   The last cases occurred on the
 26th of February and 15tli of March,* showing that the disease is
 not yet extinct.  From April, no cases  are reported until June ;
 the epidemic  then increased sloAvly, there being but  few cases
 until  September.  The greatest number of deaths took place  in
 November.
   But three adults are reported as having  died; the  remaining
 number are children, and mostly under the  age of twelve years.
 In fifteen families there were in each two deaths;  in four families
 there were in each three deaths; in one  family there were four—
 the whole number of children died.
   I add  the  monograph of a single case.  It  occurred in the
 family of D*.  L. G. Warren, A\ho has kindly placed the account  at
 my service.  " On Monday, January 24thr my son, aged nine years,
 was in his usual health; showed no symptons of disease, and went
 to bed well.  He a.voke about three o'clock in  the morning  of
 Tuesday, the  25th, Avith nausea;  after  vomiting  he fell asleep.
At eight o'clock,  I discovered celling on the left side of the neck.
He complained of pain and  stiffness in the back of his neck.  On
examining his throat  I found the tonsils  enlarged, and  on each a
spot of thick  membraneous deposit as large as a quarter of a
• Twelve of these casus have been reported since this paper was read, on Feb. 2. 
(i
dollar;  it extended doAvn behind  the velum.   There Avas fever
present Avhich continued  for  thirty-six  hours, Avith  pulse at one
hundred and thirty.  Afterwards the frequency of the pulsations
diminished to one hundred.   The skin  became  moist; the mem-
braneous  deposit increased, completely filling  the  passage,  and
the child died on the  fourth  day of the disease."   The termina-
tion of this case was more than usually rapid.
  I have not been able to ascertain at this late day, accurately in
relation to the sex,  but so far  as the statistics  I  have  procured
extend, they shoAV  the fatality to  be one-third greater Avith the
girls.
  The population  south of State  street is  as  30  to  27.    The
fatality  in  this disease  Avas  three-fifths greater south of State
street.
  The average duration of the disease in fatal cases is from seven
to ten days. The  period of  convalescence  is uncertain, usually
extending through tAvo or three Aveeks; but in some cases, after a
longer interval than this, inanition may supervene as a sequel of the
disease, and destroy..- life.   Without full statistics, it appears  that
about half of the cases die  croupy.
  I shall offer but a word in relation to the treatment of diphthe-
rite.  The local remedies indicated are such as  shall prevent the
further extension of the psuedo membrane, and  hasten its detach-
ment Avhen formed.  It is  a disease affecting the whole system.
The strongly marked tendency to  debility and prostration calls
early for  stimulating and invigorating treatment.   The prompt
administration of tonics is clearly called for, and the one AArhich I
regard as  most to  be  relied on is quinine,  in  conjunction with
some preparation of iron.
  Local treatment is palliatiATe.  The application of nitrate of silver
or a mineral acid to destroy the secreting surface, or Labarraque's
solution of chloride of soda, as  a gargle, to  dissolve the forming
membrane, have been severally used with various degrees of  suc-
cess ;  but with young children they are all to a great extent imprac-
ticable.