two distinguished physicians, Sir William Jenner and Dr. George Johnson, have recently pronounced in favor of the identity of these affections, as has also Prof. Jacobi of New York, whose reputation as a physician and pathologist, secures for his views marked attention. Sir Wm. Jenner and Dr. Johnson argue that a membraneproducing inflammation is a specific inflammation, and inasmuch as diphtheria and membranous croup have pseudo-membranes which are alike, they conclude that these diseases are identical. Jenner also finds in the clinical history of membranous croup additional evidence of its diphtheritic character, viz: that the urine may sometimes contain albumen. He admits that membranous croup is not contagious, but explains that this fact "should no more separate a single case from diphtheritic croup, than should a single case of scarlet fever, because it did not spread, be separated from other cases of scarlet fever."-Lancet, January 16, 1875.

On this point Dr. Johnson is somewhat ambiguous. He says nothing of contagion till closely interrogated by Dr. Moxon, when he says:

"Everyone who is engaged in private practice must know that a single sporadic case of unquestionable diphtheria in a family is of common occurrence. To assume that a disease cannot be diphtheria when it shows no tendency to spread to other members of a household, is to ignore the plain teachings of daily experience."-Lancet, March, 1875.

When asked by Dr. Moxon whether in meeting with a case of sporadic croup he would "enforce the same precautions as when a case of sporadic scarlet fever appears in a family?" he answered:

"Not the same precautions, certainly; but if I am called to a case of sporadic membranous croup, which I hold to be synonymous with laryngeal diphtheria, I of course isolate the patient, believing that the disease, though much less infectious than scarlet fever, is in a perilous degree infectious, and I cause a most careful search to be made for the insanitary conditions in and around the house, which, in the absence of infection from a previous case, I know must have been the exciting cause of the case."-Lancet, March 20, 1875.

But (and we wish to call particular attention to the fact,) Dr. Johnson does not mention one single instance in which a case of sporadic membranous croup communicated either membranous croup or diphtheria to others. His views as to the contagiousness of sporadic croup, seem therefore to be deduced from his theory respecting the nature and cause of this disease, rather than from the actual observation of cases.

These two physicians, therefore, base their belief in the identity of membranous croup and laryngeal diphtheria, chiefly upon the fact that the membranes are alike in both; and Jenner finds additional evidence for his belief in the occasional occurrence of albuminuria in croup.

That the membranes in these two diseases are alike, or very similar, is now quite generally conceded; but it is not so generally conceded that the inflammatory processes of croup and diphtheria are therefore of the same character; or, as it has been expressed, that identity of result necessarily implies identity of cause.

Since no anatomical grounds of distinction exist, appeal must be had to the clinical manifestations of these two diseases; and as we have nowhere seen these better given than by Dr. J. Solis Cohen, of Philadelphia, we will reproduce them as they appeared in the Medical Record, February 19, 1876.

To this list of clinical differences, three important additions may be made, as follows:

Cutaneous pseudo-membranes al- Cutaneous pseudo-membranes someways absent.

times present.

Most prevalent in the cold months Little influenced by weather and the of the year.

Larynx principal seat of membrane.

seasons of the year. Membrane usually situated above the larynx.

In explanation of the fact that in membranous croup the lesion is seated in the larynx, Prof. Jacobi offers the following:

"The vocal cords are deserving of special mention. They form the borders of the narrowest entrance into the lungs. Foreign substances, no matter whether of benign or malignant character, will be retained by them. They are supplied with pavement epithelium, which is the principal seat of diphtheritic degeneration. They have no muciparous glands, nor have they lymph-vessels. Thus, if there is any organ predestined for diphtheria, it is the vocal cords. Where there is not poison enough for a thorough infection, there is still enough for a local deposit. When diphtheria has died out as an epidemic, the stray cases with limited infecting power will be known for years or decennia as socalled sporadic membranous croup, as you would speak for a generation of an occasional case of sporadic cholera, or a stray case of variola. There is not infection enough to poison the throat and larynx and blood, but just sufficient for the most favorable place, the vocal cord."-Journal of Obstetrics, February, 1875.

The insufficiency of this explanation will become very apparent from the following question: If the vocal cords are so sensitive to the diphtheritic poison as to become affected when "diphtheria has died out as an epidemic," how does it happen that the larynx usually escapes when the diphtheritic poison is at its height? for in the same paper from which we quote, Prof. Jacobi has occasion to point out that laryngeal diphtheria is fortunately rare in protracted epidemics of this disease.

There remain, therefore, clinical differences between membranous croup and diphtheria which can neither be ignored nor explained away, and which justify the belief that these two diseases, though having points of contact, are nevertheless far from being identical.

CENTENNIAL ANNIVERSARY

OF THE NEW LONDON COUNTY MEDICAL SOCIETY.

BY ASHBEL WOODWARD, M. D., OF FRANKLIN.

Read at the annual meeting of said Society, April 6th, 1876.

The Centennial Anniversary of American Independence is at this time turning the thoughts of our people not only to the early history of our country, but also to those institutions, which, born with the Republic, have grown with its growth, and strengthened with its strength. It is a matter of general interest, as well as of local pride that the physicians of New London County were the first in the Colonies to take the initial step toward the organization of a medical society for mutual improvement and good fellowship. The efforts in this direction began in 1763, were fully consummated a dozen years later.* So that our society is at this time about to enter upon the second century of its existence. At that time the pure mathematics with the departments of astronomy and natural philosophy were the only branches of science which had made any very material progress. Chemistry had but lately been rescued from the hands of the alchemists. Just a century ago oxygen was discovered. This was the first step in the series of brilliant discoveries which have since made chemistry the basis of many of the exact sciences and the science of medicine possible.

Though the physicians of that period possessed but a modicum of the exact knowledge enjoyed by the physicians of to-day, their

*The Society was organized on the voluntary principle, in the month of September, 1775. At the first meeting Dr. John Barker was chosen president. To this office he was annually re-elected to the time of his death in 1791. It is said that at the earlier meetings, which were held monthly, Dr. Philip Turner gave lectures on military surgery. The exciting scenes at Bunker Hill, the perils of which he witnessed, might have hastened the organization of the association as one of the means employed to meet the pressing needs of the medical department of the army. Two years later Dr. Turner was appointed Surgeon General of the Eastern department of the American army.

successful efforts to associate for mutual improvement indicate that they were animated by the right spirit. Their petition was preferred to the Colonial legislature in 1763, prior, as already stated, to any attempt at medical organization elswhere on this continent.* This movement made in advance of the age was negatived in the lower house. Still it indicates one of the most important crises in the history of the profession. The presentation of that unpretending memorial from the physicians of New London County, was the initiative proceeding in a series of efforts which have since resulted in the permanent establishment of many flourishing State Societies, and within a few years of the National Association, which has contributed in a high degree to purify the ranks, elevate the aims, and make a real unit and fraternity of the profession in America.

In the attempts alluded to, it was not the object of the petitioners to secure any immunities or exclusive privileges for themselves, but to protect the health of the community by additional securities. They were not insensible to the great truth that if they were in their associated capacity to become honorable, and extensively useful, the elements of their greatness and prosperity must be found to exist inherently within themselves. At that time there was no authority in the State legally qualified to confer degrees in a way to discriminate the man of solid acquirements from the ignorant pretender. Our memorialists wished to strike at the root of the evil. To shut down the flood-gates through which their ranks were inundated by incessant streams of ignorance and charlatanry, and to establish a standard of education by making a respectable amount of attainments an indispensable pre-requisite, they asked for the appointment of a committee, legally authorized to examine, and approve candidates if found qualified.

Thus the physicians of New London County, though unsuccessful in their first attempt, were the pioneers in the cause of American medical education and organization.

Of the transactions of this Society subsequent to its organization we know but little. The medical libraries in the hands of our predecessors of that period were meagre, and confined to a few elementary works. There being neither schools nor hospitals, beginners were compelled to depend, to a great extent, upon the oral in

*The State Medical Society of New Jersey, and the County Medical Society of Litchfield County in this State, were both organized in 1766. It will thus appear that the physicians in each of those localities were three years later in their original movements than those of New London County.