LARYNGEAL CASES.—When the laryn gitis appears as the extension of a pre vious process in nose or throat, except in the case of measles or scarlet fever, we can safely put it down as diphtheritic. The pseudomembranous throat inflam mations of measles and scarlet fever often involve the larynx, trachea, and bronchi, although the processes are not diphtheritic. In any other case such extension is almost conclusive evidence that we have to do with diphtheria. The greater difficulty is prevented by the primary cases of laryngitis in children. The characteristic feature of diphtheria of the larynx is its progressive, unre mitting dysprnea with aphonia. The disease steadily advances to laryngeal stenosis and death from strangulation, unless relieved by treatment. Simple catarrhal, or non-diphtheritic, pseudo membranous laryngitis, on the other hand, usually shows frequent and de cided remissions—its crises belonging to the night, the day showing decided remission of all the symptoms. As in the pharyngeal cases, early high tem perature belongs rather to the pseudo diphtheria. If laryngeal examination be possible and we can see and determine the character and extent of the mem brane in the larynx, we ought to be able to reach a positive diagnosis; but, un fortunately, such examination is not practicable among young children, who furnish the great majority of the cases of acute laryngitis. Of 2S3 cases of acute laryngitis subjected to bacterio logical examination by the New York Board of Health, 229—or SO per cent.— proved to be true diphtheria; so that in the city, at least, the diagnosis in any such case would incline to diphtheria.
While it is true that, as many authori ties maintain, in 95 per cent. of the cases which an expert after careful con sideration would pronounce diphtheria, cultures will show the presence of the specific bacillus, it must be frankly ad mitted that there are many cases in which the most careful observation can not determine positively the question whether a given case is true diphtheria or pseudodiphtheria. Thus, in Scien
tific Bulletin No. 1, of the New York Board of Health, we find it stated that "Baginsky, in Berlin, found the diph theria bacillus in 120 out of 154 sus pected cases; Martin, in Paris, in 126 out of 200; Park, in New York, in 127 out of 244; Janson, in Switzerland, 63 out of 100; and Morse, of Boston, in 239 out of 400. Thus, from 20 to 50 per cent. of the cases sent to diphtheria hospitals did not have diphtheria." If these figures approximate the truth, it is evident that we cannot trust with safety- to clinical observations to de termine the specific relation of cases of throat inflammation. On the other hand, the routine use of cultures from all cases of sore throat regularly shows the presence of the diphtheria bacillus in a considerable number of cases in which there were few or none of the features regarded as characteristic of diphtheria, and in which there was, therefore, little or no suspicions of the presence of the specific bacillus.
While so far as the individual case is concerned, it may be remarked that the cases in which the diagnosis is most dif ficult are the mild cases, those least likely to be attended with grave conse quences to the patient himself, the fact should also be recognized that these mild cases are quite as dangerous to others as severe ones, and should, for the sake of the community, be subjected to strict quarantine. It is, therefore, essential to accurate work and proper care, as well as proper prophylaxis, that cultures should be made from all cases of sore throat. In no other way can we stand upon solid ground with relation to treatment, or hope to eventually gain control of the wide-spread and dangerous infection.
[Scientific Bulletin, No. I, Health De. partment of the City of New York, is the source from which the great part of the material of this section is drawn. W. P. NORTHRUP and DAVID BOVAIRD.]