SOCIETY OF MICROSCOPISTS. 
101 
MICROGRAPHICAL CONTRIBUTION.-THE VEG- 
ETABLE NATURE OF CROUP. 
Ephraim Cutter, M. D., New York City. 
January 21, 1879, Clarence, aged four years and six months, child 
of Major E. F. and Abby F. Wyer, of Woburn, Mass., (near Boston), 
was taken with croup at supper-time. Always well before, save a 
lung fever in December, 1878, whooping cough in July, 1878, and an 
attack of simple croup on the 14th of January, 1879. The promi- 
nent symptoms were dyspnea of a dreadful character, aphonia con- 
stant; air exhaled readily, but inhaled with difficulty; body-surface 
not hot or feverish, and pulse not much quickened; respiration hur- 
ried. He was vomited and put on the ordinary means of relief, 
including the sub-sulphate of mercury. Though there was no mem- 
brane visible in the throat, still he grew rapidly worse, and on the 
23d, while I went for tracheotomy tube, he died. 
The parents were unusually willing to have all possible light 
thrown upon the case, so a post-mortem examination was readily 
granted, and performed on the next day in the presence of Drs. S. W. 
Kelley, G. W. Graves, A. P, Woodman, G. P. Bartlett and J. M. 
Harlow, all then of Woburn. I found the larynx filled with a thick, 
tenacious mass, that appeared to be distinct from anything else above 
or below it. On removing this plug it was found to be only about 
half an inch in length and thickness. Microscopically examined, 
the physicians assisting were unanimously of the opinion that it was 
made up of a true animal membrane, and was decidedly not vege- 
table in its nature and structure. On this ground it was reasoned PROCEEDINGS OF THE AMERICAN 
102 
that we were dealing with croup and not diphtheria. The larynx 
and trachea were removed, and with a clincial microscope of the 
Boston optical works, which embraced a | inch objective, three sys- 
tems of lenses, 1800 of angular aperture, and a one-inch eye-piece, 
making an amplification of about 400 diameters, I examined the plug* 
and its membrane, with scrapings also from the trachea and second- 
ary bronchi. In all I found mycelial fungus filaments, single and in 
skeins of beauty. From this examination I was led to change my 
opinion as to the animal character of the membrane. The gentle- 
men present, not being experts in the use of the microscope, of 
course had no opinion to express different from that already 
announced. 
Hence, in view of the great importance, in a clinical point of 
view, of settling the real nature of the membrane, I employed the 
eminent algologist, Prof. Paulus F. Reinsch, of Erlangen, then tem- 
porarily sojourning in Boston, to study the pathological products 
found in the larynx and trachea, botanically and histologically. 
Immediately, he detected the mycelial filaments, and then went to 
work to cultivate the fungus, so that he might be able to identify it 
by the fructification. He also examined the tissues of the post-mor- 
tem specimen. It will be seen by his report that he agrees with me 
in my examination; so that there are two witnesses to testify to the 
nature of this apparently animal membrane being a vegetable structure. 
If this is the case in all instances of croup, the importance of this 
contribution is at once apparent. 
Report by Prof. P. F. Reinsch. 
The larynx and trachea bear a remarkable fungoid vegetation, 
belonging to three, or at least two, different fungi. In the upper part 
of the larynx are prevalent cells of more rounded form, doubtless 
different states of evolution belonging to one or two different species 
of Hyphomycetes. The lower part of the larynx, as well as the tra- 
chea, was found overgrown with filamentaceous cells, inclosing short, 
rounded cells, resembling very much the mycelium, with interspersed 
spores characteristic of the Mucorinece. The parasitic vegetation is 
found to be composed as follows: 
First-Isolated spherical cells of .015 m-m- diameter, with con- 
stantly one nucleus; the plasm densely granulated. SOCIETY OF MICROSCOPISTS. 
103 
Second-Two celled bodies, composed of smaller transverse 
elliptical cells, inclosed in the same involucrum ; sometimes one cell 
is larger. 
Third-Cellular bodies composed of four elliptical cells, form- 
ing short, rounded filaments. 
Fourth-Spherical, four-celled bodies, composed of elliptical 
cells, mostly irregularly connected. 
Fifth-Larger, irregular or tetrangular cells, with thick, lam- 
inated covering, with densely granulated plasm of reddish brown 
color. 
Sixth-Short filaments, composed of short elliptical cells, on 
both sides, shortly angulated, with distinct nuclei ; short two or 
more celled branchlets, of different shape and size, are mostly 
attached to them. . v 
Seventh-Irregular, lancet-shaped cells, attenuated on both ends, 
constantly one distinct nucleus ; plasm with larger transparent gran- 
ules. 
Eighth-Smaller elliptical cells, connected with hair-like fila- 
ments; several cells sometimes are accumulated together on short 
branchlets. 
Ninth-Curved, lancet-shaped cells, three to five attached to- 
gether, connected with filaments, the whole body resembling very 
much, budding two or more celled spores of Hyphomycetes. 
Tenth-Undivided, long mycelial filaments, with distinct mem- 
brane and densely granulated contents, forming a tissue-like stroma, 
spread out all over the surface of the trachea, the lower part of the 
larynx, as well as within the mucous membrane, so that a transverse 
section of the lower part of the larynx shows the peripherical dis- 
colored stratum of nearly 2 m-m- height, to be composed only of 
entostromatic filaments and elliptical spores, intermixed with fibular 
epithelial elements'belonging to the mucous membrane. Spores of 
0.013 m-m-diameter and ovoid circumference are frequently found 
interspersed between the fungoid filaments ; spores and filaments, 
without any doubt, biologically connected. 104 
PROCEEDINGS OF THE AMERICAN 
EXPLANATION OF FIGURES. 
Fig. i. Isolated spheroid cells imbedded in the mucous mem- 
brane of the larynx. Diameter, 0.015 m m-; 2f3. 
tig. 2. Two-celled chroococcoid body of the mucous mem- 
brane. Long diameter, 0.018 m-m-; 2f3. 
fig- 3- Two-celled chroococcoid body ; cells of unequal size. 
Long diameter, 0.022 m-m-; 2f3. 
Fig. 4. Four-celled filamentaceous body. Long diameter, of 
one cell, 0.016 m-m-; 2f3. 
Fig. 5. Four-celled spherical body. Diameter 0.0266 m-m-; 2|3. 
Fig. 6. Irregular tetrametrical cell, with thick, laminated cov- 
ering. Maximum diameter, o.oig m-m-; 5f6. 
Fig. 7. Short, undeveloped filament, with adherent, small, 
rounded cells. Long filament, 0.0269 m m-; diameter of sporangia, 
0.0072 m- m-; 2y3. 
Fig. 8. Filament composed of irregular-shaped cells, produc- 
ing two sporoid cells ; one with one nucleus, the other with two 
nuclei. Diameter of sporangia, 0.0198 m- m-; 2f\ 
tig. 9. Short filament, producing on the top, lancet-shaped, 
curved cells. Long diameter of cells, 0.018 m m-; 2f3. SOCIETY OF MICROSCOPISTS. 
105 
Fig. io. Another filament of the same formation, more devel- 
oped ; three developed cells on the top. Long diameter of cells, 
0.0254-0.028 m m-; 2|3. 
Fig. 11. Another filament of the same formation; four devel- 
oped, curved, lancet-shaped cells on top. Long diameter of cells, 
0.0216-0.028 m-m-; 2|3. 
Fig. 12. Isolated, irregular, lancet-shaped cell, with attenuated 
ends; distinct nucleus; 2f3. 
Fig. 13. Part of the mycelial stroma with interspersed spores, 
embedded within the mucus membrane of the upper part of the 
trachea, *f°. , 
Fig. 14. Single sphero-elliptical shaped spore with attached 
filament, doubly mangnified.* 
Fig. 15. Part of one mycelial filament. Diameter transverse, 
0.003 m-m-; 7!0. 
Fig. 16. Budding ovoid spore from the same part of the trachea; 
the short filament connected there with incrassated micro-spores on 
the curved end. Diameter of spores, 0.013 m' m'> 3f°- 
Fig. 17. Part of the mycelial stroma with one embedded 
spore,3fn. 
♦See Gaillardi'vs Medical Journal, May, 1882, for like cells found in diphtheria and scarlet fever, on 
skin, in throat, urine and blood.-Dr. Salisbury. 106 
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REMARKS. 
The most important point in this expert report is that the vege- 
table nature of the substance of the membrane is clearly made out. 
To be sure, some of the epithelial elements are distinguished in con- 
nection with the vegetable growths. Still it must be remembered 
that the host in this case is an animal, to-wit, man. So that it would 
be expected to find some animal tissues in the membrane. While it 
would not be safe to say that all croupal membranes are vegetable, 
still these examinations go to show that when examined by those 
who are acquainted with the subjects of micrographical botany, they 
may prove to be vegetable, as here. 
The present was a rare opportunity to have such an authority 
study the morphology of the membrane in croup. As far as it 
goes, we can see no reason to doubt his decision and the satisfactory 
nature of the report. We conclude then: 
First-That the inflammatory processes were secondary to the 
vegetation. 
Second-The report shows that the vegetation penetrated the 
tissues of the larynx and trachea below. SOCIETY OF MICROSCOPISTS. 
107 
Third-Regrets were expressed at the post-mortem examination 
that tracheotomy was not performed, but the fact that the vegetation 
was imbedded in the parts below the point of obstruction, shows that 
tracheotomy might not have been a success. 
Fourth-If anything can be learned from this teaching, it shows 
the necessity of attacking the disease from the vegetable point of 
view. It would rather prohibit the pushing of anti-phlogistic 
measures, since the inflammation must be secondary, not primary. 
Fifth-We should then perhaps rely on parasiticidal means, such 
as inhaling the fumes of burning sulphur, sprays of salicylic, carbolic 
and thymic acids, putting into the system as much food as possible, 
that is good chemical, physiological and nerve food, easily assimi- 
lated and digested, so that the system can bear up in the fight. Or 
the sulphate of quinine might be sprinkled on the tongue-one grain 
once an hour or two hours, as shown with much success by Dr. Salis- 
bury in diphtheria and scarlet fever.- Vide essay. 
Sixth-The expert results were not indicated by any " leading 
strings." Indeed it was rather a surprise to the medical gentlemen 
present that their decision as to the nature of the membrane should 
be so summarily upset, and yet they are a good average represen- 
tation of the talent that has to handle such cases in the clinical point 
of view, on whom human lives depend, medically speaking. 
Seventh-This case shows up how much we have to learn as to a 
disease that is so fatal and dreadful and the need of more use of the 
microscope. 
Finally, it is to be hoped that Prof. Reinsch may have other 
opportunities to study this disease further.