Age is still a very important factor, but prompt treatment with antitoxin must be considered of far greater im portance in modifying the prognosis.
Treatment.--The efficacy of the anti toxin treatment of diphtheria has been too fully established to permit of doubt or argument. It is more effective in croup than in any other form of diph theria. An injection should be given on a clinical diagnosis without waiting for a bacteriological examination. Its early use will, in a large proportion of cases, prevent the necessity of operation. Next to the antitoxin treatment, calomel fumi gations have, in my experience, proved most efficacious.
[Vaporization of calomel: A powder consisting of from 15 to 30 grains (1 to 2 grammes) of calomel is placed upon a tin plate, and heat applied until all of the pow-der has been vaporized; this should be done under a tent erected over the patient's bed, the curtains of which should be kept closed for ten minutes to a half-hour after each fumigation. Dense, white fumes are evolved, which are not, however, irritating to the pa tient, and the change in the respiratory sound, after the first burning of the calomel, is sometimes very marked. There have been no eases of salivation reported as yet in patients, but nurses and people who have to be in the room during sublimation of the calomel have, in several instances, been salivated; so due care must be exercised. J. LEWIS SMITH and FREDERIC WARNER, Assoc. Eds., Annual. '931 Calomel fumigation in the treatment of croup is the most valuable means of medication in this disease possessed at present (1893), and will save a larger percentage of cases without the aid of surgery than any other method of treat ment. It is also capable of doing much harm. From 10 to 20 grains may be used. according to the size of the tent in which the patient is placed, every two hours during the first day, increasing the interval to three hours on the second day, and so on, according to the prog ress of the disease. The patient should be left in the tent for fifteen minutes at each sitting and the flame of the spirit-lamp so regulated that the calo mel all evaporates within this time. Nurses or atte»dants who remain much in the same room soon become ptyalized and older children occasionally show constitutional effects. In order to obtain the best results, the fumigation should be resorted to early, or before the mu cous membrane becomes lined with a layer of psendomembrane. George Mc
Naughton and William Maddern (Brook lyn Med. Jour., Aug., '93).
Case of a child with true croup in which intense dyspnaea was present; be fore resorting to tracheotomy, inhala tions of vaporized calomel, 30 grains, were resorted to, with entire success; in ten minutes the patient was quiet and comfortable and without dyspncea. The next day the same symptoms reappeared, and like treatment was resorted to with equal success; on the fourth clay the child was convalescent. Rothn (Der Kinder-Arzt., Mar., '90).
Intubation should be performed promptly when indicated.
The following are indications for the performance of intubation: Given a case of membranous laryngitis, with hoarse ness increasing to whispering, with cough short and explosive, becoming high pitched and prolonged, diminution of or absence of the vesicular breathing, over the lower posterior lobes of the lungs, beginning recession of the epigastrium and beginning restlessness, the call is for immediate removal of the obstruction. Note especially the character of the voice and cough; if these become pro gressively worse, the child's best interests will be served by delaying no longer the necessary intubation. Cround (North western Lancet, Sept. 1, '91).
[There are only two impediments to the introduction of a tube of proper size in any form of acute stenosis of the larynx, viz.: entering one of the ven tricles or a subglottic stenosis. Neither spasm of the glottis, nor pseudomem brane, nor (edema, when sitnated in or above the chink, ever offers any serious objection to tbe passage of a tube. J. O'DWYER, Assoc. Ed., Animal, '921 Result of a collective investigation on intubation Germany including 1445 cases intubatcd for the relief of croup: there were 553 recoveries, or 38 per cent. One hundred and twenty-one of the cases were secondary to measles, scarlet fever, pneumonia, etc. Secondary trache otomy was resorted to in 250 of tlte cases, with only 20 recoveries, or about 7 per cent. This number proves for it self that the dangers which were for merly charged against this operation must have been greatly exaggerated. Ranke (Miinchener med.'Woch., No. 44, '93).