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its Pathology and Therapeutics, upon which there seems to me to be at present a great confusion of opinions.
For several reasons I have not thought it necessary to discard the already naturalised name, “ Diphtheritis,” in favour of the one more recently proposed by Dr. Farr on the part of the Registrar-General, viz., “Diphtheria."
In the first place I object to the right, assumed by Dr. Farr (valuable a public officer as he is), to impose upon the medical profession a term which he has coined and circulated without the courtesy of previously submitting it for their approval or rejection.
Had there been any urgent necessity for a new name, or had the new title been more practically convenient or scientifically accurate than the one it displaced, I should still feel bound to enter this protest ; but the procedure has not either of these grounds for excuse. The inconvenience of frequent alterations in medical nomenclature is known to those only who have endeavoured to study any disease historically. The uninitiated in nosological history may in vain study indices and pore over tables of contents, he will often miss the object of his research under the cacophonic titles which startle his eye. All this is particularly true of the disease under consideration—no other, I think, has received so many different appellations. Dr. Farr should, therefore, have pondered ere he added another to the gloomy list.
In spite of these reasons Dr. Farr has effectuated a change of name: the question, then, now is, has he done this judiciously?
The editor of the Medical Times and Gazette* has the following remarks upon the two names adopted respectively by Bretonneau and the Registrar-General : “ Bretonneau gave the name to the disease from its most obvious characteristic--the exudation of false membrane on the mucous membrane of the fauces, after the Greek diodépa, membrane. But the suffix, itis, used to denote inflammation, is clearly objectionable ; it leads to the false notion that the disease is of a sthenic or inflammatory type, and is etymologically incorrect, as it implies that the pellicle or membrane—the diphthera -is inflamed: an obvious absurdity.” I do not care to inquire whom “the suffix, itis, used to denote inflammation," would lead astray, but probably only those few whom the suffix, eria (from its resemblance to the termination of hysteria) may lead to suppose that the disease is a trifling or an imaginary one. But, seriously, an explanation of Dr. Farr's views on the Pathology of this complaint would have been sufficient, and ought to have been substituted for the change of name.
* May 1, 1858.
But these objections are both urged against a shadow.
Bretonneau and Dr. Farr have both adopted, as nearly as possible, the same name; but the former had the advantage not only of priority but of propriety, and ought to have remained unmolested.
A1p0épa, the Greek word signifying a skin, has given origin to three other words : Alpbepias, a male who wears a skin (vestment); Διφθερίτης, another form of Διφθερίας ; and Διφθερίτις, & female who wears a skin (vestment).
Now, as vóoos morbus is of the feminine gender, it is clear that Alp@spíris, the feminine noun, is the only word which could be used correctly as the metonym of ή διφθεριστική νόσος. And this word Bretonneau (whatever he may have purposed to do) chose. Dr. Farr, on the other hand, has most infelicitously chosen the masculine noun. Had this incongruity of gender no terrors for him, it would have been wiser, on the principle of avoiding change of name as much as possible, to have selected Alpeepirns, which would have avoided “the suffix, itis," difficulty, and have produced a word similar to others (tympanites, ascites) now in use.
Further, as Dr. Farr's designation is always pronounced Diphthēria, whereas it should be Diphthěria, he must be held responsible for the constantly repeated false quantity-a fault which is no less indecorous in a man than (according to a witty author) a faux pas is in one of the opposite sex.
One other inconvenience remains to be noticed. Many persons, who scrupulously adhere to the use of the word “ Diphtheria,” and thus by implication condemn “Diphtheritis," do nevertheless employ the old adjective“ diphtheritic," derived from the latter substantive, instead of “ diphtheric ” or “ diphtherical ” - adjectives corresponding to the former noun. They are obliged to choose between the inconvenience of stultifying themselves or of still further multiplying words; and, perhaps not unwisely, they select the former alternative. This difficulty might have been obviated by the selection of “ Diphtherites."
My object in the following remarks is to elucidate the pathology of this formidable disease, to explain some parts of its history and character which are at present mysterious, and, upon a more perfect knowledge of its nature, to base a plan of treatment which may render it, at least, somewhat less terrible. I say, terrible, for so it indeed now is both to parents and practitioners; the former understand, pretty generally its deadly nature, and the latter have so often experienced the inefficacy, even of the most lauded nostrums (for the treatment of it has been essentially empirical), that some within my own knowledge, and probably many more besides, look upon the summons to a case of diphtheritis as nothing less than a professional calamity: the reason for this feeling will appear presently.
In order to avoid any misunderstanding as to the identity of the disease, I shall, in the first place, give a brief description of its symptoms, and afterwards examine the accounts which have from time to time been published; this plan, although somewhat tedious, will enable us to obtain a more comprehensive view of the disease, and, I think, a better insight into its nature: some new observations which I have myself made, both upon cases during life, and on dissection after death, will, I trust, throw some further light upon its pathology and treatment.
An impression, which may as well be removed in limine, is prevalent, that the disease is a new one, and that consequently but little is known or has been written upon it. So far is this from being the case, that there is good ground for believing that this disease was described by Aretæus, if not by Hippocrates; and its literature is almost as extensive as that of any other medical subject : it is true that its present fashionable denomination “Diphtherite" is of modern origin, but even this is now some thirty-odd years old.
It is a curious fact, that in each successive epidemic this has always, at least at first, been looked upon as a new disease, and by each succeeding writer has been treated of under a new name: this peculiarity still cleaves to the complaint. While writing these pages I observe that one author, in a weekly journal, expresses his decided opinion that the disease is a new one, and the name “ Diphtheria,” “ adapted from the French,” has lately been applied to it. It may not be uninteresting to append a list of some of the numerous names under which it previously appeared—viz., Angina epidemica, Angina gangrenosa, Angina maligna, Angina suffocativa, Angina ulcerosa, Angina strangulatoria, Angina membrancea, Angina pestilentialis, Apthetic ulcer, Apthæ malignæ, Febris epidemica cum anginâ ulcusculosâ, Prunella alba, Ulcus Syriacus seu Ægyptiacus, Pestilent tonsils, Cynanche maligna, Cynanche gangrenosa, Garotillo (Spanish), Male in canne (Neapolitan), Angine couenneuse, Angine membraneuse, Pedanchonia, Mal de gorge gangreneux, Passio anginosa, Affectus suffocativus, Putrid sore throat, Malignant sore throat, Phlegmone anginosa, Morbus gulæ, Morbus Puerorum, Tonsillæ pestilentes, Laqueus gutturis, Morbus strangulatorius, Præfocans pueros abscessus, Pestilens faucium affectus, Epidemica gutturis lues. .
The invasion of diphtherite is announced by malaise, often amounting to an insupportable feeling of depression and muscular debility, objectively announced by the anxious countenance, rigors, which are often slight and unnoticed, occasionally well marked, a pallor or unhealthy hue of the face, in many cases headache, which however, is not often severe in the onset, disturbance of the abdominal viscera, denoted by sickness and purging and slight yellowness of the conjunctivæ, nocturnal delirium of a mild description occurs very early, often during the first twenty-four hours, it is not, however, of a character to alarm the attendants, and is consequently frequently overlooked, unless particularly inquired after by the medical man; at an early period, generally within twenty-four hours, sometimes much less, after the invasion of the disease, the patient, if old enough, will complain of more or less discomfort, rarely amounting to pain, in swallowing; this is commonly enough the first