Notes and Queries.

DISCUSSION on DiphtherIA ANTITOXIN.-A certain reaction from the excited interest with which the discussion on diphtheria antitoxin had been followed on the two previous evenings was noticeable when the discussion was resumed on the final evening. Julius Ritter, the bacteriologist, was the first speaker. His arguments followed those of Hansemann, and the addition of carbolic acid to the serum he pronounced dangerous. Dr. E. Meyer, Assistant at the University Clinic for Diseases of the throat, said that in numerous cases of rhinitis fibrinosa he had found the Loeffler bacillus. Prof. E. Hahn, Director of the Municipal Friedrichshain Hospital, said that from the year 1880 up to the end of November, 1894, his hospital had had 4,571 cases of diphtheria. During the first years the number of cases had only been about 180 or 190 a year; this year the number would reach about 600. At first the hospital had a diphtheria mortality of 54 per cent, but of late years it had been reduced to 38 per cent, and the years 1888 and 1889 only showed 32 per cent and 33 per cent respectively. In this year, from February up to November 22d, he had had 430 cases of true diphtheria, with 33 per cent deaths. Of these 430 cases, 205 had been treated with serum; of these only 24 per cent had died, but it should not be forgotten that during the first few months only cases that did not seem hopeless had been treated with serum. Afterward all the diphtheria cases had been so treated. He had not noticed disagreeable after effects, with the exception of erythema. He thought the result might be more satisfactory if the treatment were begun early enough in every case. At present the cases brought to the hospital were generally two or three days old. Dr. Hans Aronson gave an account of his observation of horses who had undergone the injection of the Loeffler bacillus culture. He had observed subsequent paralysis of the heart and the extremities similar in every respect to those following human diphtheria. He said that, where the therapeutic action of the antitoxin was not apparent, the doses given had probably been too small. Dr. Schiemmann warned general practitioners against employing the antitoxin, which he said should be left to the hospitals for the present. Prof. O. Liebreich, Director of the Pharmacological Institute of the University, criticised the published serum statistics. He said that the Berlin hospitals had always had a much higher percentage of deaths from diphtheria than the Berlin town practice. This was of course because, broadly speaking, only serious cases were brought to the hospitals. But since the introduction of the serum treatment, a far greater number of cases and cases of all sorts-had been brought to the hospital, and so it was quite natural that the percentage of deaths had fallen considerably.

He considered the serum treatment to be based on fallacies very similar to those which had formed the foundation of the tuberculin treatment. It would be interesting to find out, he added, what action on the organism injection of pure indifferent serum would have. Dr. Hansemann, in a few last words, stood to his view that antitoxin is not to be regarded as a specific for diphtheria.-British Medical Journal.

THE PHYSIOLOGICAL TREATMENT OF DEATH.-Dr. Laborde has so styled the treatment of the newborn asphyxiated by rhythmical tractions of the tongue. M. Touvenaint reports two cases where traction of tongue failed completely, and insufflation and artificial respiration were completely successful. The first case was at seven months, the child livid and without appreciable heart pulsations. On account of smallness of mouth and shortness of frenulum it was impossible to properly practice tractions without seizing tongue with forceps. This he feared to do on account of possible injury to parts. So after some delay in making these efforts insufflation and artificial respiration were resorted to with the result of completely establishing respiration. The second case was one of forceps delivery at term, with heart pulsations appreciable, but no effort at respiration. Tongue tractions were tried for twenty minutes, but with no success. The heart pulsations were now much feebler, so insufflation and artificial respiration were resorted to, the child promptly responding by establishment of respiration. Journal de Médecine de Paris.

ARTHUR LOXTON, in the British Medical Journal, No. 1775, reports a fatal case of gonorrhea due to absorption of septic material from an uninjured inflamed urethra. The trouble had been of four weeks' duration. No bougie was passed, and apparently no abrasion to the mucous membrane had resulted from the syringe. On account of depression the patient had persistently continued to take alcohol, and four days previous to death had gotten very drunk.

METHYL BLUE IN TREATMENT OF PRURITUS VULVA.-Parts must first be washed thoroughly with warm water and then with a solution of bichloride of mercury, 1-1000, and then with a saturated aqueous solution of methyl blue. The action is rendered more efficient by internal administration of same, two grains in capsule twice daily. This treatment is very effective, its only drawback being the unsightly discoloring of the parts.Journal de Médecine de Paris.

ON December 27, 1894, Mr. Braxton Hicks held five inquests on the bodies of children who had died while sleeping with their parents, the cause of death in the majority of cases being suffocation. It is estimated that over a thousand infants are overlain in London alone every year.

Special Notices.

PASKOLA.—It is doubtful if the medical profession have ever witnessed a more furious attack than that which has been urged against Paskola, the new pre-digested food. It has been maligned and misrepresented right and left, but the fact is now clearly established that the animus of these attacks sprang from the manufacturers of competing preparations who were startled by the phenomenal success and popularity of a comparatively new claimant for favor. Paskola was attacked because of its success not because of its failure. Its success stood in the way of rivals. Within the short space of one year Paskola has come to be one of the most largely sold and generally used medicinal foods on the market. We venture to say that more voluntary letters of commendation have been received by its manufacturers within this period than have ever fallen to the lot of a house similarly engaged. The best way for the reader to learn of the merits of Paskola is by actual experience, and the manufacturers offer to send a supply, express prepaid, to any physician who may request it.

ONE HUNDRED Points of PERFECTION.—It is only a few years since the Pabst Brewing Company's malt extract was first placed on the market. It was introduced as the "Best" Tonic, and through its excellence soon became a general favorite. At the great Columbian Exposition at Chicago, the Pabst Malt Extract was examined by the Government Chemist and the Board of Judges, and the result was the highest flattery that could be bestowed. Of all the host of malt productions they examined, coming both from this country and from Europe, the "Best" Tonic was selected as the only one thought worthy of the highest rank. It was marked with the 100 points of perfection. Such a distinction has never been conferred in the history of expositions. It recognized the Pabst Malt Extract as the head of scientific malt foods, and in advance of the highest previous attainments in the production of malt extracts.

PULMONARY TROUBLES.-After a practice of nearly thirty years, and quite an extensive one in regard to pulmonary troubles, having used all of the emulsions, maltines, and different preparations that are recommended for said troubles, I find Terraline one of the most efficient and pleasant preparations that I have ever prescribed. CLAY, KY., February 8, 1895. W. I. MOORE, M. D.

ON and after April 1st we will again reduce the price of Diphtheria Antitoxin (Behring) as follows: No. o, yellow label, 200 antitoxin units, 60 cents; No. 1, green label, 600 antitoxin units, $1.50; No. 2, white label, 1,000 antitoxin units, $2.75; No. 3, red label, 1,500 antitoxin units, $3.75. Supplied direct upon receipt of price.

SCHULZE-BERGE & KOECHL, New York.

CYSTITIS AND METRITIS.-W. Warwick, M. D., King's Coll. Aberd., M. R. C. S., Eng., 1851, L. M. Roy. Coll. Belf. 1849, etc., Belfast, Ireland, says: "I have given SANMETTO a very good trial in cystitis and metritis, and the results have been most satisfactory. I do not know another remedy which I can rely on for such uniform good results in affections of the genito-urinary organs."

I HAVE used two bottles of Phytoline (Walker), and reduced my weight fifteen pounds, and three inches in size around the waist; breathe freely and can walk with ease, something I have not been able to do in four years. I can now walk up a flight of stairs without stopping. H. L. HENSLEY, M. D.

MARION, O.

CELERINA and Aletris Cordial, equal parts, teaspoonful every four hours, will relieve ovarian neuralgia.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.-RUSKIN.

Original Articles.

THE LOCAL TREATMENT OF DIPHTHERIA.*

BY J. MORRISON RAY, M. D.

Since Bretonneau, in 1826, described a form of throat inflammation characterized by the formation of a false membrane upon the mucous surfaces of the upper respiratory passages, to the present time the name diphtheria has been the dread of the people as it has always been the scourge of childhood. In France it has destroyed more lives under three years of age than all other acute diseases combined.

Discussions as to the etiology, pathology, and treatment of diphtheria are at all times of interest in medical societies and the consulting-room. For a long time etiology of the disease was unknown and its treatment empirical, some going so far as to deny its contagious nature.

How exceedingly interesting would it be, if we had the time and inclination, to look backward and review the various remedies that have been in vogue in the treatment of diphtheria, in fact almost the entire materia medica, and every combination possible of drugs has been recommended. But to quote a recent writer: "The mist has cleared away, the darkness has had its dawn, and in the clear, strong light of modern research we are able to positively assert that diphtheria is due to the presence of a definite specific micro-organism that can be isolated and detected in the very earliest hour of the disease."

The investigations of Welch and Abbott show that diphtheria is

*Read before the Louisville Academy of Medicine.

without doubt primarily a local disease, the Löffler bacilli, the now well-known and easily demonstrated organism, being found in the superficial parts of the membrane, and the constitutional symptoms being due to absorption from this surface of a chemical substance, a poisonous toxin produced by the bacilli. These furnish the strongest possible indications for early local treatment by some germicidal agent that will destroy the organism at the seat of infection. Upon the proper appreciation of these facts rests the modern rational treatment of the disease. Asepsis and antisepsis are as important here as in any capital operation undertaken by the surgeon.

Such investigations as those just quoted seem to have settled beyond all cavil that the false membrane is the place of formation of the poison that later is sure to overwhelm the sufferer. The time for interference is in the beginning before great extension has taken place. It makes no difference if the practitioner be skeptical upon these points, he should not allow it to control his treatment. While accepting the modern teaching as to the importance of early local treatment we find that no one known remedy cures all cases. General therapeutic principles are as important here as in any other disease. Proper local treatment must aim to accomplish, first, destruction of the germ of the disease; second, neutralization of the toxic products formed in the membrane; and third, limitation, if possible, of extension and softening of the membrane. In a review of the therapeutic methods of accomplishing these ends I shall confine myself as near as possible to measures with which I have had more or less personal experience, or those that have been highly recommended by those whose authority we have learned to appreciate.

That the cures are not in proportion to the remedies vaunted is the experience of us all.

Before taking up the local treatment of the disease, when once established, a reference to local prophylaxis seems to be opportune. Jacobi has stated that in order for diphtheria to develop there must be a local lesion, some abraded surface or broken epithelium; therefore of first importance is the maintenance of a healthy condition of the throat and All conditions of enlarged tonsils, of the presence of adenoids in the naso-pharynx, must be guarded against, and removed when found to exist. Further, when diphtheria is prevailing, or after exposure, the local use of some germ-destroying agent has unquestionably gone far toward lessening its extension.

nose.