*[Read before the American Institute of Homoeopathy at its Sixteenth Annual Meeting June. 1859.]

BY HENRY D. PAINE, M.D., ALBANY, N.W

During four or five months from September 1858 to February 1859, sore throats have prevailed as an epidemic, in Albany and its neighborhood, to an extraordinary extent- many of the cases being of an unusual character, very severe, often intractable and in many cases rapidly fatal.

Some idea of the grave nature of this sickness may be gathered from the fact that, since the breaking out of the disease, few if any less than two hundred and fifty deaths therefrom have occurred in the city and its immediate neighborhood. Dr. S. D. Willard who industriously undertook to collect the statistics of the fatal cases for the N. Y. State Medical Society, (Allop.) reported 188 such cases previous to the 15th of March. Doubtless some cases escaped his scrutiny and others are known to have occurred since the publication of his report. It is therefore probably within the truth, to estimate the number of deaths already at 250. The victims have been almost exclusively children and young person Dr. Willard reports the deaths of only three adults. The desolation that has followed in the train of this sickness is further illustrated by the statement contained in the same report, that in fifteen families there had been in each two deaths in four families there had been, in each, three deaths, and in one household four children had been swept away by this pestilence. (Other instances similar to these have come to the knowledge of the writer more recently.)

As to the whole number of persons affected by the epidemic since its first appearance, it would be more difficult to arrive at satisfactory conclusions. Sore throats of some description have been exceedingly prevalent in Albany during the entire winter. Many cases slightly affected and soon relieved; and still others of every degree of gravity up to the most violent and rapidly fatal, have come under the observation of every physician. Very few families in which either I or my associate. Dr. J. W. Cox, are in the habit of prescribing, have cutirely escaped, while it has been not at all unusual to find many or most of the younger members of a household affected with some form of throat disease.

If the experience of other practitioners has been similar to. ours, the total number of cases of every kind and degree, must have been immense, not less perhaps, than a fourth part of the entire population.

Nor has the sickness altogether disappeared from our community even now, although it does not prevail to the same extent as during the winter, especially in the months of November and December. During the month of April, the number of cases coming under our observation diminished very greatly, and there were two weeks (the last of April and the first of May) in which, I believe, no now patients were prescribed for by us. But during the last three weeks the disease seems to have broken out afresh, and with much of to original severity. Within a week I have lost two patients under most affecting circumstances, in which the attacks were as violent and the course of destruction more rapid than any other cases that have occurred before in our experience.

A remarkable feature of this epidemic is the circumscribed limits to which is has been confined during almost its entire course. So far as I can learn, it has been almost exclusively restricted to the city of Albany, very few onsets having occurred in any of the neighboring towns, and those principally in one direction. I am not aware that any cases exhibiting the peculiar phenomena that have characterized the Albany sore throat have originated in Troy. Lansingburgh, or Schenectady-the most populous places in our vicinity, and be tween which and Albany, intercourse is constant and uninterrupted. It may be stated in this connection that it has been remarked, that persons from a distance; visiting the city, who have been affected by the local influences, whatever they are, that excite the distemper, are much more. liable to severe. attacks than those who habitually reside there.

How far it is the case that particular parts of the town, and which parts, have been disproportionately affected, the collected data are not yet sufficient to determine. It does appear, however, that there has been a manifest tendency in the epidemic to make itself felt chiefly in comparatively circumscribed localities, successively showing itself in different sections of the city in an apparently fitful, arbitrary and uncertain manner. It certainly has not been confined to otherwise unwholesome sections, or to uncleanly, ill ventilated neighborhoods, but has visited, in turn, the more comfortable and well ordered portions of the town, as well as tin poorer. Though I believe it in true that the earliest cases occurred among the latter, and the disease, did not extend to better quarters for some time after its existence was recognized.

It is understood that a distemper similar in ifs character to the “Albany sore throat,” has of late broken out in some other parts of the country. If this is the case, it is to be hoped that the combined observations of physicians in different places will elucidate more satisfactorily than has yet been done, the sources and origin of the disease and the laws which regulate its propagation, as well as the most reasonable plan of counteracting the evil and the most appropriate treatment for its cure.

As a contribution to the general stock of information, it is proposed at the present time, to give a brief account of the epidemic as it has appeared in Albany chiefly derived from the personal observations of myself and my associate, and the course of management that has appeared to be the most efficient in the cases we have had to treat.

The cases that have come under our notice, although exhibiting great variety in the manner of attack, symptoms, course and termination, may be conveniently arranged for description in two or three groups.

In the most severe and strongly marked cases, there is violent inflammation of the fauces, tonsils and uvula, extending as far back as can be observed, accompanied by a more or less extensive formation of false membrane, of a dull white, or ashy color-sometimes deposited in small, irregular patches, and at others covering a large part of the mucous lining of the throat on one, and occasionally on both sides. There is? also in these cases, very frequently, a viscid discharge from the nostrils and a most fetid breath.

The rare phenomenon of a membraniform exudation accompanying inflammation of the mucous tissues, except in the case of true croup, gives a peculiar interest to the study of this epidemic, in which it is a frequent and characteristic feature.

The attack is often ushered in with rigors not infrequently amounting to a positive chill, pains in the head and limbs with a general feeling of malaise and depression. If, as is often the case, the child is stricken in the full vigor of health, having, till the moment of attack, enjoyed his accustomed appetite, there will be, very likely, vomiting of the ingesta and some subsequent retching.

Sometimes the throat symptoms manifest themselves almost simultaneously with the general disturbance, but not always. Occasionally they seem even to proceed it. It has happened several times in our experience, that the patient has made no complaint of difficulty of swallowing, or soreness previous to the chill or vomiting, when an inspection revealed the fact that the membrane was already forming. Except in those cases, the symptoms at the beginning of the attack are not dissimilar to those of ordinary inflammation of the throat. There is generally some complaint of stiffness of the neck, the cervical glands are somewhat enlarged and there is sonic pain and heat in the throat.

The appearance of the throat before the occurrence of the membranous deposit is generally indicative of intense inflammation, not always equally diffused, but in spots of erysipelatous redness, or with streaks of a deeper redness irregularly scattered over the inflamed surface. Deglutition is generally very painful and difficult from the first, indeed often more so at the beginning than in the later stages, but instances have not been rare, in which, notwithstanding a highly inflamed appearance of the throat, the patient manifested no difficulty at all in swallowing.

The fever runs high, but is generally brief-seldom exhibiting much activity except in the early stage of the disease, and is followed by a stage of depression and debility, apparently disproportionate to the amount of the preceding excitement. In many, even serious cases, the febrile symptoms have scarcely been observed at all, but the tendency to an asthenic state of the system is evident from the first. Probably this depends much upon the previous health and condition of the patient himself, and something perhaps upon the locality in which he lives. As a general thing, the more vigorous and healthful the subject, and the more salubrious the surrounding air, the more decided will be the period of excitement, while in confined and illy-ventilated places and among the ill-fed and poorly nourished, the typhoid character of the affection will be more strongly marked, and at an earlier period of the attack.

The appearance of the pseudo membranous deposit, which is the distinguishing feature of this form of the epidemic, also presents several varieties.

As already intimated, the first examination of the throat shows in some eases an already existing pellicular exudation on some part of the mucous lining, and that too where neither the degree of febrile excitement, nor the complaint of the patient on account of throat symptoms would have led to such an expectation. But more frequently its visible appearance is preceded by some of the symptoms already mentioned. Generally within 24 or 36 hours after the attack, upon the inflamed mucous surface are seen a number of white spots, irregular in outline, and of various sizes, from that of a pin's head to that of one's finger nail. The first impression is likely to be that they are ulcerations which have destroyed, in those places, the mucous membrane, and it is quite common to hear them spoken of as ulcers or canker, by non-professional persons. .But a more careful examination, shows its true character-that it is a deposit upon, and not a corrosion of, the inflamed surface. If the disease progresses, these distinct spots increase in number and size, till they unite and form a continuous layer of various extent and thickness.

Sometimes the membranous stratum is a mere film and quite transparent, at first, which may perhaps cause it to be overlooked, but it soon becomes thicker and opaque, and the color is usually of a dull white or grayish hue.

It appears to be of it fibrous structure, quite tough and firm. Specimens of it have been detached and thrown off as thick as kid leather, and I have seen some that was as thick as thin calf-skin. When loosened and separated from the surface to which it was attached, the underlying membrane very rarely exhibits any evidence of ulceration or other disorganization, but the plastic exudation is liable to form again, if the process of detachment is prematurely hastened.

The space covered by the false membrane is subject to the greatest variation. In slight cases there may be perhaps a few dots of it here and there, or one or two spots a line or two in diameter, while in the more aggravated examples the palate, tonsils and fauces present to the eye an unbroken coating of this substance, at the same time that the other unmistakable indications prove its extension into the pharynx and trachea.

In the latter case, if the disease is not speedily arrested, the patient dies with all the symptoms of croup.

Between these extremes, there may be every variety of development, and the symptoms and the danger will be modified according to the parts that happen to be involved.

As the disease progresses, and sometimes at an early stage of the attack, the breath becomes exceedingly offensive, so much so as to affect the atmosphere of the room where the patient lies with an almost intolerable fetor. At the same time the inflammation may extend to the nostrils, accompanied with a more or less abundant discharge of an acrid, foul smelling secretion from the nose, not unfrequently mixed with shreds of membrane.

In addition to these symptoms there is more or less swelling of the parotid glands, upon one or both sides. These swellings are sometimes very considerable, but seem not to be very painful, nor do they manifest any disposition to suppuration.

The most frequent cause of death appears to have been the extension of the false membrane into the air passages, producing the same mechanical obstruction to respiration, and terminating precisely in the same manner as in ordinary croup. In a portion of the cases however, the fatal remit seems to depend less upon the obstruction of respiration than upon a general prostration and exhaustion of the vital forces. The process of throwing out this plastic exudation appeal; to draw so heavily upon the system as, with the low typhoid character of the constitutional symptoms, to imperil the life of the sufferer from sheer exhaustion.

In one or two cases that have come under our observation, the inflammation has so affected the organs concerned in deglutition as to make the act of swallowing very painful and well nigh impossible, the half lethargic patient preferring to die of starvation rather than undergo the distressing effort of taking the simplest nourishment into the stomach.

So far I have attempted to describe, as briefly as possible, only one class of cases that have occurred during the prevalence of the Albany epidemic. They include however, all those that from their unusual character and alarming tendency are calculated to excite the greatest interest.

Epidemics exhibiting similar characteristics although of rare, perhaps unexampled, occurrence in this country are not altogether new elsewhere. For two years past something; very like it has been observed in parts of England, particularly in the coast counties opposite to France, and for a stilt longer period it has prevailed at intervals in the neighborhood of Bologne on the other side.

The most complete account of a corresponding epidemic that has yet appeared, was written about forty years ago by Bretoneau, a physician of Tours in France, in which he describes very minutely the disease as it prevailed in that city and some other towns for three years. He considered the formation of a concrete membranous exudation under such circumstances to be so remarkable and peculiar a feature as to deserve a special designation. To him accordingly we are indebted for the term Diphtherite or Diphtheritis, by which this form of disease is getting to be generally recognized, especially in France where it has occasionally appeared since the time of Bretoneau.

Objection has been made to this name on account of the incorrect pathology implied in its termination. The Registrar General of England alluding to the appearance of the disease in that country has adopted the term Diphtheria as the preferable form of expression, for as he properly remarks “the termination itis, as in gastritis, is used in medical language to designate pure inflammation of the organ which the root of the word expresses; hence ia has been substituted for itc (the French form of itis), as this cannot with any propriety be placed after Diphtheria,. designating a product of disease and not an organ of the body.”

The disease is not, as the term “Diphtheritis” would imply, according to the usage of medical writers, an inflammation of this new formation, but the membranous deposit is the consequence of a disease already existing; With thus, modification the term seems to be significant and appropriate and has been accepted by the Brit. Jour, of Hom. and some other foreign publications; notwithstanding its introduction was at first decidedly contested as tending to an unnecessary multiplication of new names for old diseases. But in this case the disease, if not positively new, has by its intenser form and its increasing prevalence acquired an importance which entitles it to a special designation.

The mistake made by Bretoneau was not so much the addition of a new name to pathology, as the attempt he made to extend the name to other affections quite distinct from that under consideration. When the epidemic began to prevail in Tours, and many children died from it, these fatal results were naturally referred to Croup, from the suddenness of the attack and the similarity of many of the symptoms; and Bretoneau consequently takes the ground that there is no essential difference between the so-called Diphtheritis and ordinary membranous croup, that in fact croup is only a variety of Diphtheritis.

Now, although certain of the most serious forms of Diphtheria present many symptoms strongly simulating Cynanche Trachealis, and fatal results are not unfrequently produced by a process precisely analogous to that which carries off the little patient in that disease, yet that is by no means the case with all. It is only in a certain number of cases that Diphtheria takes on the characteristics of croup, while in other important particulars the difference between the two diseases is clearly defined. In croup the inflammation and membranous exudation commences in and is confined to the trachea, and the symptomatic fever is inflammatory throughout. In Diphtheria the plastic deposit originates in the pharynx, and in many cases does not extend to other passages, but in some the inflammatory action involves not only the pharynx but dips into its several apertures, and thus it may happen that false membrane of greater or less extent may be formed in the trachea and give rise to most distressing dyspnea and other alarming symptoms of true tracheitis; but unlike croup, as before remarked, the inflammation tends to assume a gangrenous and putrid character and the accompanying fever is typhoid. In a large number of instances the membranous deposit consists of a few small patches upon one or both tonsils, the palate, or the fauces, without even affecting in the slightest degree the larynx or trachea. Nor does it always extend to those organs, even when the deposit covers a much greater extent of surface.

As yet I have described only that form of the Albany epidemic which is characterized by the formation of false membrane. But a still larger number of cases of sore throat have presented themselves in which no such deposit was detected, and which by many persons have been looked upon as ordinary sore throat and not having any relation to the proper diphtheria. Many of these cases, it is true, were very mild, exhibiting a slight diffusive inflammation of the mucous membrane, without very marked peculiarities, and not likely to attract particular attention in ordinary times. Other examples, more severe, presented the same local and general symptoms as those first described, with the exception of the diphtherous exudation, the same erysipelatous looking patches of inflammation-the same swelling of the glands, and the same disposition to a low state of system, and occurring as they have done in the same localities and in the same families where proper diphtheria prevailed, it is but reasonable to suppose they were imperfectly developed cases of the same affection, originating from the same morbific influences.

Adults appear to have been particularly liable to this form of affection, while the membranous variety has been most apt to develop itself in children.

The sequelae of this remarkable sickness, as exhibited in some cases of slow or partial recovery, would form an interesting subject for discussion in this connection, but additional observations are required to make the history complete, and the time does not admit of their full consideration.

A few words upon the treatment pursued and I will conclude Upon the first appearance of the disease among our patients, we were of course without the advantages of any previous experience of our own or of others. No recorded cases of its treatment by physicians of our school had yet been seen by us, and it was evident that, if the distemper should extend itself, the advantages claimed for Homoeopathic treatment would be put to a severe test.

Nevertheless, relying upon the general efficacy of the law of cure propounded by Hahnemann and abundantly confirmed by the experience of thousands of his followers, we did not doubt that among the articles of our Materia Medica having the most apparent relation to the symptoms presented, some would be found that would exert a powerful controlling effect even upon this formidable disease.

If we had been less confident, even of the resources of our system, we should have still felt that our safest way would be to follow the course we adopted, as the evident imperfect success of the usual Allopathic treatment afforded little encouragement for imitation.

In the simplest forms of diffusive inflammation, in which no marked peculiarity was observed, a few doses of Belladonna in solution, sufficed to effect a revolution in a short time. Or if with some swelling of the tonsils there was a bright scarlet redness uniformly extended over the mucous membrane Belladonna was still prescribed.

If however the inflammation was of a dark red, or if there were dark crimson patches scattered over the inflamed surface Rhus tox. was found the more effectual remedy.

As soon as the least appearance of membranous deposit was observed, or there was any swelling of the glands of the neck, the Iodide of Mercury was freely administered and generally continued until there was a complete obliteration of those symptoms. The immense value of this remedy in this disease will be easily understood by those who have experienced its efficacy in analogous diseases. We have given it mostly in doses of the 1st. trituration, and the effect in arresting and detaching the false membranous formation has been in many cases most gratifying.

Generally the Bell, or Rhus have been continued at intervals during the stage of febrile excitement-the choice between the two being affected by the character of the fever as well as by the appearance of the throat. The more the fever approached an inflammatory type, the better the indications were for Bell., while a tendency to an adynamic condition required Rhus.

Arsenicum was given when with the fetid breath the lining of the nostrils became affected and discharged a viscid foul secretion and there was great and increasing prostration of strength. It has also proved very useful after the separation of the false membrane in relieving the extreme tenderness which remains, as well as in keeping up the vital energies.

When the inflammation and consequent deposit extends to the trachea and threatening to carry off the patient with the usual symptoms of croup, the remedies, besides those already mentioned, that have been most successful in combating this alarming state of things have been Stibium and Spongia, given according to indications sufficiently well understood.

In regard to local adjuvants, we have found but little advantage from any, except water. The cold water cravat has constantly been found to produce an agreeable impression upon the feelings of the patient and has appeared to assist very sensibly in producing a favorable effect from the internal remedies.

A solution of yeast as a gargle has helped to relieve something of the fetor of the breath and tendency to gangrenous disorganization.

Of course the utmost attention to cleanliness, pure air, &c has been insisted on.

The necessity of keeping up the failing strength by suitable nourishment was forced upon our attention at an early period of the epidemic. Indeed the utter prostration which often attends the disease, is a most noticeable feature in its history and requires the most careful consideration.

Under the treatment briefly and imperfectly sketched above a large number of patients have recovered, and of those who have had the advantage of it from an early period of the attack (as well as some less favorably situated) the losses have been very few indeed. We trust at least that neither the interests of our patients nor the reputation of Homoeopathy have suffered at our hands.

So obvious have been the advantages of this plan of cure, both for the ease with which it is carried out, and the large number of recoveries resulting from it, in contrast with the painful, difficult, and persecuting course recommended and generally adopted by the dominant school and its evident want of success, that an impression has been made upon the community favorable to Homoeopathy such as never has been made before, even by the results of treatment in the Cholera or any other epidemic.

The treatment almost solely relied upon by the Allopathic practitioners in Albany, as far as I can learn, has been that of local cauterization by Nitrate of Silver, to the utter neglect, it would appear, of the constitutional condition, the blood poison, of which the local symptoms are but the most obvious manifestation.

How partial a view of the true nature of the disease that must be, upon which is founded such an imperfect and feeble, though distressing treatment, has been sufficiently tested by the large proportion of fatal results.