me that the forehead was entirely well. After stopping the medicine the discharge showed no perceptible change for ten days, when he noticed a lessening of its amount and continued diminution, until in about three weeks from the last does of Silicea he awoke one morning to find the sinus closed and no swelling about it. He had meantime done From that time until this

nothing and taken nothing for it. it had remained perfectly well. I met him on the street in a neighboring city about a year ago, nine years having elapsed since the healing of the opening, and he informed me that he had never suffered the slightest inconvenience from it since 1872.

In suppose thst there is no doubt in the mind of any homœopath that Silicea cured this case; that to it and to it alone the recovery was attributable. The mistake was undoubtedly made in too frequent repetition of the doses, especially as they were given dry, and in not letting the case alone, September 3d, when it had commenced to improve. As soon as the patient took himself away from my meddlesome interference, the forces of nature, which had been brought to healthward action by the homoeopathic remedy, carried the case to complete and speedy recovery. My patient, however, never believed that the medicine I gave him had any effect upon his disease, and laughs to-day at the idea of receiving benefit from homœopathy, because he "has tried it and found it of no avail."

The moral of this history is,-never repeat your doses when improvement has certainly commenced, and, when this is the case, fly at once to what an eminent homœopathic physician calls the pest remety in the Materia Medica," Saccharum Lactis.

Thus shall you gain for homœopathy friends and adherents, and for yourself, reputation and shekels.-Hah. Monthly.

DIFFERENTIAL DIAGNOSIS OF CROUPAL DISEASES.

BY C. E. CHASE, MD. UTICA, N. Y.

Various diseases of the larynx, occurring in infants and young children, have at various times been designated by the term croup; a term that to the uninitiated is apt to be misleading, and should either be dropped entirely, or be so restricted in its meaning by common consent as to apply to one particular form of diseased process, as, for instance, membranous croup. The word itself means simply a cry, or hoarse sound of the voice, and to that extent might apply to the several different varieties of laryngeal disease.

The intention in this short article is merely to call attention to some diagnostic difference between three or four laryngeal diseases which frequently occur, and are sometimes confusing, namely: Acute catarrhal laryngitis, spasmodic laryngitis, diphtheritic or membranous laryngitis, and laryngismus stridulus.

Acute catarrhal laryngitis is a disease ordinarily of little moment, though in very young children it may be quite serious; it is of very common occurrence in adults, some persons having an attack from the slightest exposure to drafts of air or sudden changes of temperature; it frequently begins with symptoms of ordinary cold in the head, the hyperemia of the mucous membrane gradually extending to the larynx. The symptoms are hoarseness, pain, and soreness when talking or swallowing, dry hoarse cough at first, gradually becoming looser as resolution sets in; there is some febril irritation, which, howeveris generally sligh; adults usually do not suffer from dyspucea, but young children, owing to the narrowness of the glottis, frequently suffer severely

Differential Diagnosis of Croupal Diseases. 455

from difficulty of breathing, and in some extreme cases, where the inflammation and swelling are extensive, œdema may occur and produce death from suffocation; such cases, however, are rare, the attacks generally being transient, and result in resolution, though from neglect or poor treatment they may become chronic.

Spasmodic laryyngitis, false or catarrhal croup, is a very frequent disease in this country, few children escaping it entirely; and it is not uncommon to be told, many a child has had croup half a dozen times, or "he has croup every time he catches cold." It has indeed a very alarming look at its first outbreak, and is then often difficult to distinguish from true membranous croup, though a little time and careful observation will soon show the difference. Its appearance is usually very sudden; a child who on retiring appears to be perfectly well, or at most to have only a slight cold, wakes up suddenly about midnight, greatly frightened, with a loud hoarse barking cough, gasping for breath, with sensation of suffocation, loud noise during inspiration, slight blueness of the face, great restlessness and more or less fever; after a time the spasm gradually relaxes, the fever and restlessness decline, and the patient finally falls asleep, coughing occasionally, perhaps, but waking in the morning, and playing about the house as usual, apparently as well as ever, with no indication of the alarming scene of the night before. With prompt and careful treatment during the attack and the succeeding day, there will usually be no return of the disease the following night, and the case will progress to complete recovery, though occasionally the pasms recurs for two or three successive nights.

False-membranous laryngitis, true or membranons croup, is one of the most dangerous diseases to which children are liable, and require the most prompt and careful treatment; it usually attacks a child but once, therein differing from catarrhal croup, which may attack the same patient any number of times. Its approach is insidious, presenting some

times for three or four days symptoms of an ordinary cold, until suddenly in the night or even dnring the day it is noticed that the character of the cough has changed and has become hoarse and ringing, respiration is obstructed, inspiration is prolonged, noisy and difficult, the voice becomes hoarse and is lost entirely as the disease advances, the fever persists and increases, suffocative attacks occur such as we have described above, but with only partial remissions, which become less and less marked as the disease advances, and the exudation encroaches more and more upon the capacity of the larynx, until it becomes one prolonged agonizing scene of hopeless struggling against impending suffocation.

There need ordinarily be no difficulty in distinguishing between this disease and spasmodic laryngitis, if it is kept in mind that there is no exudation in false croup but simply a catarrhal condition associated with spasm. False croup appears suddenly with no or very slight previous catarrhal symptoms, while the membranous form is preceded for several days by cough, slight fever and symptoms of a cold. The difficulty of breathing of catarrhal croup passes away with the paroxysm, but in true croup persists between the attacks; there is comparatively little and but transient fever with spasmodic croup, but with true croup it persists and increases.

The voice is hoarse in false croup, but is lost entirely in true.

The sound of the breathing is constantly loud and croupy in membranous croup, but only during the paroxysms of the spasmodic variety.

Laryngismus stridulus, or spasm of the glottis, is purely a nervous disease, and generally symptomatic of some constitutional dyscrasia. A large proportion of cases occur among children of a rickety diathesis, a nutritive disease which is attended by various forms of convulsive disorder; it is also sometimes a symptom of chronic hydrocephalus. It may occur, too, in children of a very sensitive nervous

organization, as a result of sudden fright, the irritation of dentition, ete.

The exciting cause is frequently not apparent, the attack coming on suddenly, often in the night, waking the child from sleep. The first intimation is a loud crowing sound, when the glottis closes, and breathing is impossible, the head is thrown back, the face becomes blue, in severe cases convulsions set in, and suffocation seems impending, when, after a few seconds, the spasm relaxes, and the child breathes again as usual. As the disease increases in severity, the attacks become more and more frequent, the convulsions become general, and death occurs in one of the paroxysms.

The diagnosis from the other spasmodic diseases of the larynx is not difficult, if it is remembered that with spasmus glottidis there are no inflammatory symptoms whatever; that the attack is sudden, neither preceded nor followed by cough or other catarrhal symptoms; the suspension of respiration is complete while it lasts, and followed by entire relief; while in catarrhal forms the breathing is continuouly oppressed, and not entirely suspended, and there are cough and other symptoms of hyperæmia.

The remedies, too, are entirely different, as laryngismus stridulous is relieved by such typical remedies as Cuprum, Chlorine, etc., and the croupal inflammatory diseases by Acon., Aell., Kali bich., etc.

THE ARKANSAS HOT SPRINGS.

A NASHVILLE PHYSICIAN ON THEIR CURATIVE PROPERTIES.

HOT SPRINGS, ARK., Nov. 12.

Having spent two weeks recently at Hot Springs, Ark., with my son, Dr. Charles Dake, who has become a resident physician there, and having paid more attention than ever