throat and inoculated to guinea pigs killed them in from few hours to fourteen days after injection (see pages 28-30 "Scientific Bulletin," No. 1, issued in 1895 by the Bacteriological Laboratory of the Health Department).

Escherich, Morse, Tobiesen, and the Board of Health contribute statistics in positively proving this fact. Furthermore, Tobiesen, who made extensive studies, admits that the existence of throat lesions renders the conditions more favorable for the persistence of bacilli (page 29, same bulletin).

Dr. Hennig, of Köenigsberg, at the recent congress held at Weisbaden, standing against the use of anti-toxine in diphtheria, concluded that any treatment based upon the assumption that true diphtheria is directly due to Loeffler's bacillus must be erroneously founded. That in his experience he found cases of true diphtheria in which bacteriological examination was negative, and yet subsequent development of the diphtheritic paralysis confirmed the diagnosis.

Rielliez, Barthez and Sanne, in their work on "Diseases of Chil dren (Vol. III., 1891, page 428,) of the pseudo-membrane, they say: The evolution of the pseudo-membrane may end in two manners: Either by disintegration or falling. The former mode of termination may result from changes occurring in the composition of the exudate. Distinctly fibrillary at the onset, the fibrine, within four to five days, passes into a granular state; it may be transformed into mucine, which explains how the pseudo-membrane may become softened, pulpy, used up, disintegrated, and fall, piece by piece. The second termination; that is, the falling in toto of the pseudo-membrane may occur when with the subsidence of the inflammation of the mucous membrane, the vascular walls become firm, resistent, and thus prevent any transudation. We clearly see that changes in the composition of the exudate in the former and absence of the exudate in the latter instances are all necessary for the membrane to disappear and clear the case.

The use of belladonna by my eminent friend, Dr. P. Jousset, of Paris, in every occasion, as a prophylactic of diphtheria, and, not witnessing any contamination, fully supports this theory. Belladonna, we all know, has no germicidal power whatever, but prevents inflammation, as it produces it, and, preventing inflammation,. it prevents exudation: the culture medium. In an opposite direction we find other eminent pathologists and bacteriologists who admit that the primary ætiological factor in diphtheria is

a specific micro-organism, which, coming in contact with the mucous membrane or the cuticle, deprived of its epidermis adhere to it, and, multiplying rapidly, act as an irritant and produce the characteristic formation of that membrane. They further state that pure cultures made and inoculated to animals have produced false. membranes containing the same bacilli and even paralysis similar to that occurring in men affected with diphtheria.

Roux and Yersin have demonstrated that the liquid of the culture filtered through porcelain and consequently rendered free froni these micro-organism contains a poison, which, when inoculated to animals in doses more or less strong kills them, causing also paralysis. Hence the unanimous belief that general phenomena of diphtheria and death are due to toxæmia caused through the agency of chemical products or ptomaines produced by microbic action and absorbed into the system. False or pseudo-diphtheria is usually caused by a streptococcus pyogenes of Rosenbach and never by diphtheria bacillus.

The marked difference in mortality between true and false diphtheria shown by the tables of the Board of Health have given striking evidence of this fact.

The diagnosis then is of prime importance, especially when the New York Board of Health admits that combined clinical and bacteriological investigations of over 25,000 cases has clearly demonstrated the fact that many of less characteristic cases of diphtheria and pseudo-diphtheria are so similar in local lesions, symptoms, and duration that it is impossible to separate them except by the bacteriological examination.

The Report of the Bacteriological Section of the New York Board of Health for the year ending December 31, 1896, shows that 10,293 suspected cases were examined and only 6,211 found to be true diphtheria. (Annual Report, 1896, p. 214.)

Croup or membranous croup should be regarded as a term merely indicating the location of the lesion and not as describing the nature of the disease whether diphtheritic or pseudo-diphtheritic. Bretonneau, in 1826, first accurately described diphtheria, and asserted that croup was merely laryngeal diphtheria. Dr. Alphonse Teste, in his work on "Diseases of Children" (second edition, 1856) speaks of croup alone. For him even then both were the same thing. Whatever may be the correct value of these theories in regard to the origin of diphtheria, the fact is that we physicians are not called to correct a diathesis or to administer a prophylactic

treatment; but to treat a more or less widespread invasion, the disease diphtheria itself, when, for one or another reason, KlebLoeffler bacilli are present and without them, with our present knowledge, no case could be called true diphtheria. Rilliez, Bathez, and Sanné describe three forms: Benign, infectious, and malignant, due to the combination of the local and general elements in various proportions. In, the first they say that the local state predominates, although in a very moderate manner. It does not show itself in distant regions. The septic element remains in a lat

ent state.

In the second, the local manifestations assume a very marked spreading tendency and land simultaneously, or in a short time, in a more or less distant region. Toxic accidents, when absent at the onset, soon manifest themselves.

In the third, toxæmia is present from the very onset, the local condition may not be very marked; or in a very short time assume a fearful development.

Death may occur usually from:

1. Toxæmia, systemic infection by the specific principle.

2. From asphyxia, due to diphtheritic pseudo-membraneous laryngotrachetis: Uremia, sudden heart failure, sudden passive congestion and oedema of the lungs, are all due to the septicæmia.

I shall not speak of its course, symptoms and complications. shall try to briefly mention the treatment.

I

Late Prof. Lewis Smith said: "He will be the most successful practitioner who fully recognizes the fact that he has to deal with a malady which has both local and systemic character."

In treating then this terrible disease we should use means to modify both the local and systemic disturbance.

In analyzing the various remedies, we shall see that all point to that end.

Sanné has made experiments with different reagents in order to find their action upon the membrane and particularly upon the fibrine, and in his "Traiteé de Diphthérie" he concludes as follows: Bromine in aqueous solution hardens, renders friable and disintegrates the membrane.

Dilute sulphuric acid contracts, blackens, softens and dissolves. Lactic acid has an energetic and rapid action. A piece of the false membrane, left in a solution of 5 per cent. lactic acid, is dissolved in a few minutes. Carbolic acid has also a marked dissolving power. Salycilic acid also dissolves, but not so readily. Solutions

of potash, of soda, of ammonia quickly change the character in rendering soft. Lime water, whose dissolving power was brought to our notice by Kuchenmeister, is the most energetic and prompt in its action. It is even better than lactic acid. Saccharate of lime may be next to lime water. Potassium chlorate dissolves the membrane, but slowly. Sodium chlorate is twice more active than the former. Sodium bicarbonate, in powder shape, has more dissolving power than when in aqueous solution. Hydrobromite of soda has a strong dissolving power equal to that of lime water. Sodium chloride has

no action whatever. Perchloride of iron acts indirectly. When in contact with organic matters it changes into hydrochloric acid and oxide of iron, which precipitate. Mercurial salts, calomel, red precipitate, cinnebar, etc., possess, in powdered form, a mild dissolving action. Naphthol, especially when mixed with camphor, easily disintegrates the pseudo-membrane.

I have purposely mentioned the results of Sanné's experiments, which will clear the path and explain the reason why some of them are even now used by both schools with reliable results.

In studying the list of remedies preferred in diphtheria by certain homoeopathic practitioners, I almost uniformly found it to be apis, arum triphylum, baptisia, bell, bromine, calc. chlorata, carbol. acid, one grain to fluid ounce of water, ignatia, kali bich. kali perm. lachesis, lycop, merc. cyan, merc. corr., phytolacca, salycilic acid.

A detailed account of these agents, with their sources, clinical testimonials are found in an excellent pamphlet entitled "Therapeutics of Diphtheritis," 1877, compiled from German and American literature by Dr. Gust. Oehme, of Staten Island, New York.

Eucalyptus, tincture fifteen drops in half tumbler of water, has been spoken of very favorably.

Lately echinacea held good in the malignant form. Complications, of course, will call for other indicated remedies. Locally, alcohol, aqua calcis, peroxide of hydrogen, and kali perm, all have their advocates, as all are germicides and antiseptics.

As clinical assistant at the New York Homœopathic Medical College Dispensary for a period of four years, I have met hundreds of cases of follicular tonsilitis, but I am sorry to say I had only two cases of true diphtheria bacteriologically diagnosed.

In the first case I used internally merc. cyan. 3 trit. alone with the local antiseptic spray, and in the next case I combined later bromine I c. with merc. cyan. 3, and both recovered.

Dr. Boyer read a valuable paper on the bromo-mercurial treat

ment of diphtheria before the French Homœopathic Society of Paris, at their meeting, February 12, 1896, and showed, clinically, with six illustrative cases that bromine, I c., dilution, 4 to 6 gtts. in a spoonful of saccharated water and merc. cyan. 3 x dil. gtt. I in a spoonful of water given in alternation every quarter of an hour in grave cases and at longer intervals, according to the gravity of the case, have proven entirely satisfactory. Merc. cyan is a standard remedy, and has been used by many, particularly by Dr. Villers, of Dresden, who, during ten years, treated hundreds of cases with no death; even his own child, in a hopeless condition, was saved by his friend, Dr. Beck, with the same remedy.

Dr. Hale, in his therapeutics, says that he used bromide of mercury in a few cases of diphtheria, with the great painfulness of the inner throat, white deposit and a dusky redness of the fauces and tonsils. It acts, he says, very satisfactorily in the third x trituration.

Viller's indications for merc. cyan. are: "Presence of exudate which may be white, yellow, gray, or any shade between. The accompanying fever has the adynamic character and the collapse shows itself in the commencement of the disease; therefore, this drug should be used even before the exudation. Frequently the exudate is in places which cannot be seen."

The pathogenesis and the clinical records of this drug show that it is perfectly homoeopathic in its action, besides it acts as an internal antiseptic agent.

Bromine was first introduced by Ozanam and Attomyr, from whom my venerable friend, Dr. Teste, of Paris, became acquainted with and employed it successfully. This remedy is not only his favorite one, in his treatise on "Children's Diseases," but a couple of years ago, when I tried to induce him to rewrite his book so that I could translate it into English, he wrote me that, although much of the therapeutics in his former book might be altered, yet his treatment with bromine in diphtheria would be maintained. This dogmatic statement was made after forty years of experience.

Bromine is also perfectly homœopathic, and its pathogenesis confirms its action.

As a local spray, I have used borolyptol because, besides its active antiseptic constituents, non-toxic qualities, delightful odor, it contains o.1 per cent. of formaldehyde.

Formalin is the latest positive non-toxic antiseptic preparation which has extensive usefulness whenever a reliable non-injurious germ-killer is wanted.