nizing something which I had never seen nor heard of before, did the most rational and honest thing I could do-namely, confessed my ignorance and asked for a consultation. An old physician was at once sent for-a man quite eminent in his profession-especially in the branch of surgery, and who had had not only large experience in this country, but the advantages and prestige of foreign study-not so common a privilege at that time as at present. I do not know that he was any wiser than I, but he declined to be interviewed even by me upon the nosology of the case, and sententiously and dogmatically decided that the membrane must be removed from the throat by the scalpel and forceps, which at my instance and request he proceeded to do-and lunar caustic was to be applied, which he left me to do. Our little patient died, of course, the next day from passive hæmorrhage and asthenia.

I had a sort of presentiment, in spite of youth and inexperience, that we were not exactly on the right line of treatment, and began to hunt around for some information in reference to this strange disease, which neither my honored preceptors nor my copious text-books had noted or described. I soon found, in one of the "Publications of the Sydenham Society," I think, an account by Brettoneau, of Tours, of an endemic of sore throat, which had prevailed in that city and vicinity about the years 1821-1822, and which was characterized by the exudation on the fauces of a peculiar membrane, similar in appearance to buckskin, and which he therefore termed diphtherite-from dépa-a Greek word signifying a skin or hide.

Then I found, in the Medico- Chirurgical Review, an account published by some physician in Glasgow, of a similar disease, or perhaps of the identical disease, which for some years had prevailed more or less extensively both on the Continent and Great Britain, and finally of a fearful outbreak of the same sore throat at Bologne only two years before, in 1855. But I soon discovered that there was no occasion to look back for its history and description. It was with me, and at the present; and sufficient clinical material was soon on hand, in my own section and practice, to

afford abundant opportunity for its study and investigation. For one year it prevailed as an endemic amongst us-the same insidious, miserable, malignant foe, falling upon the best and the bravest, the wretched and the vile with impartial and relentless force. And since that time-twentyseven years ago-if it has ever disported in our vicinage, it left behind an indestructible germ, whose vitality neither the arts of peace nor the ravages of war have been able to destroy. Here and there sporadic cases would spring up in the practice of one physician or another almost every year, whilst repeatedly, as at the present, and for the past twelve months, a newer life would seem to animate the great garoter, and the pall of his presence would darken the brightest and happiest homes.

What is its nature-its etiology? What morbific force is it which determines to the faucial region such peculiar conditions of nerve and capillary and cell that an excrementitious membrane should be generated there, whose presence proves a clog upon the ways of life, and whose reaction and infection are felt and shown in a hundred protean forms of functional innervation or organic disorder? Why follow upon that speck of amorphous matter-often not larger than a dime deposited upon the tonsils-amaurosis, aphonia paraplegia, amentia? I cannot tell. This deposit or exudation can only be the local manifestation of some general dyscrasia. The varied sequela which often follow even the smallest local indication are too grave to permit us to believe that the poisoned centres of motion and of sense could have gotten their toxic dose from so insignificant a source. No; the fatal potion has been drunk or inspired or absorbed before that token of its presence in the blood ever appeared upon the fauces. The modern theorist tells us that the bacillus of diphtheria has fixed his tenellæ in the faucial membrane, and that he is making there a nest for his spores a plant-bed for his death bearing seed. But if he is found there at all, it is only after having traversed the circulation and poisoned the centres of life that he is seeking a new place for further elaboration of his fatal virus-a new point from which he may issue on his destructive raid.

But who has seen this bacillus, this accursed progenitor of so many evils, of so much destruction? Who has caught him, harnessed him, driven him? A distinguished microscopist of New York had a specimen individual of the germs sent him by mail; and, shutting himself up in a room with this sole, but cheerful companion, amused himself for days studying his nature, and observing his "manners and his tricks." He was so jealous of his new friend that he would allow no one else to enter the room, and make his acquaintance, but even had himself fed through a broken pane in the window. But all to no effect. This ungrateful bacillus not only repaid his disinterested attention by throttling his host, but escaped from the room and attacked his wife and other members of the family, and inoculated them all with the dread diphtheria. Who can catch or confine so subtle a visitor?

And this leads us to the question: Is diphtheria contagious ? The above account as to how it was carried in a letter to the enthusiastic searcher after microbes, and communicated from the solitary chamber in which he conducted his labors, through a broken pane, to wife and others, would seem pretty conclusive evidence on the affirmative side of the question. But as I propose to testify to that only which I have seen, and to that only which I know, or think that. I know, I cannot accept the conclusion as definite and fixed. · Without entering into any hair splitting definition of the word contagious, let us accept of it as construed by the masses, when they ask of a physician, "is it catching?" is diphtheria "catching?" The many authorities, perhaps most authorities, say, Yes. But if I must answer again for myself only, I am compelled to reply, No-not if small-pox, measles, mumps, typhus, etc., are accepted as types and examples of contagious diseases. A contagious disease having once passed through the system destroys the susceptibility to future attacks of the same disease. Hence, a second attack of small-pox, measles, or mumps, etc., is phenomenal and rare. But is it so with diphtheria? Does one attack give any immunity from a subsequent attack of diphtheria? Does it not really give predisposition to a future attack?

The history of diphtheria then, is not the history of a contagious disease.

But I may be asked: Is not the occurrence of one case of diphtheria in a house or family liable to be followed by another case in the same house or family? Yes; and so one case of intermittent or remittent fever, or of typhoid fever in a house or family is liable to be followed by one or more cases. And yet neither intermittent nor remittent fever is considered contagious. Any person frequenting the locality in which these diseases are prevalent, or, in the words of the modern microscopists, where their germs or microbes abound, is liable to be attacked by such microbes, and succumbs or not, according to his especial susceptibility or insusceptibility. And if he visits such locality a hundred times, he is liable to succumb to the same microbe a hundred times, and have a hundred repetitions of the same disease. Not so of small-pox, or any other typically contagious disease, in which one attack insures against another attack forever.

I saw recently two families, in one of which were seven, and in the other five cases of diphtheria. In the first, father and mother and five children under nine years of age-all had the disease; all were attacked within a few days of each otherthus precluding the idea of their contracting it from one another. Of these, the father died, but no one of the children; and no other person, doctor, nurse or child, in either family (all of whom were constantly exposed to the contagium, if contagium there were) contracted the disease. And in hundreds of families which I attend, I find that only one case will occur, or two, even in a large family, and that without any segregation of the sick, or the nurses.

Is that the history of contagious diseases? I cannot recall a single instance of my personal knowledge (and my experience has been by no means small) where a person having diphtheria, and having removed to a community at any distance from the locality in which it was taken, has carried the disease with him or imparted it to others. I have repeatedly known persons leave a locality in which diphtheria was prevailing, and, removing to a distance, be attacked with the disease, but have never known any one to "catch" the

disease from such patient. I think we must therefore write of it what a recent and most respectable medical author* writes about scarlet fever, viz: That if contagious, "it is very irregularly so." Niemeyer not only holds the disease to be contagious, but considers that the contagium resides in the shreds of the detached membrane, and, of course, that it is inoculable. Yet Trousseau, Harley, Peter, M. Isambert, and others have failed to get any result from inoculationthe two former enthusiastic and courageous physicians having even tested the question on their own persons. I have never had the courage or enthusiasm to go so far, but I have incidentally and repeatedly had the diphtheritic matter coughed and spit into my face and eyes in the course of my treatment of children, and have recently, and in a most malignant and fatal case, had the little patient to eject into my eyes, whilst examining his throat, a particle of the exudation.

I may be asked then: What is the cause of diphtheria? I was once asked, when undergoing an examination before an Army-Board for the position of Assistant Surgeon, "What is malaria?" I replied, "I do not know." The grizzly old officer who was conducting the examination at once said: "That is the best answer I have heard yet." I could have told him what others said; that malaria was a paludal exudation, or that it was an emanation from freshly upturned soil when exposed to the sun and air, or that it was the progeny of decay of vegetable matter when brought into certain relations with heat and moisture. But I had seen the results and manifestations of malaria in so many instances, where I could trace no such conditions, that my regard for the truth would not allow me to commit myself to any theory. And so-of diphtheria.

The pet theory, I think, of the present is: That its microbe finds its most cheerful home, and its most agreeable associations in those damp, dark viaducts of the cities, which make their sewerage, and which are charged with the office of carrying away the noisome drains of the kitchen, the cloaca, and the wash-house. But hundreds of practitioners of medicine meet with diphtheria when not a city or a sewer is

*Bristowe.