This treatment should be employed every two or three hours during the height of the disease, less often as the amount of secretion lessens, but it should not be given up until the bacteria have disappeared from the throat.
Instead of this apparatus, we may em ploy a simple nasal syringe. The best form in our judgment is the "bulb nasal syringe with hard-rubber pipe" made by Whitehall, Tatum & Co., of New York. It consists of a simple rubber bulb, re sembling that of a Davidson syringe, fitted with a blunt hard-rubber tip adapted to the nose. Being emptied by compression, it is much more easily han dled than piston-syringes. With one or the other of these apparatuses, nose and throat can be washed in practically all cases. The greatest care should be taken not to injure the mucous membrane in this treatment. Every abrasion affords a new site for the action of the diph theria bacilli.
Severe nasal licemorrhage may be a contra-indication to the continuance of this measure. Cardiac weakness may also forbid it, if the child struggles affainst it. A well-trained and skillful nurse should be able to carry out this treatment with very little tax upon the strength of the patient. In some cases, however skillfully it is done, the chil dren fight against it so fiercely as to render its continuance inadvisable.
In diphtheria cases which have been subjected to frequent irrigation with antiseptic solutions from the beginning of the disease, the bacilli disappear far more rapidly than in those in which such irrigations have not been employed. Occasionally, when culture-tubes are in oculated immediately after irrigation of the throat with antiseptic solutions the cultures do not show any Loeffler bacilli, although subsequent examinations may demonstrate their presence. 1\T. Y. Health Board (Annual, '9a).
In one series of cases irrigation with warm salt solutions every one to three hours was employed; in a second series same treatment plus spray every three hours of pyrozone, from 5- to 25-per-cent. solution; in a third series irrigation by 1 to 3000 or 4000 solution of bichloride of mercury. Warm salt-water irrigation
best to remove membranes, but bacilli disappear most rapidly under corrosive sublimate, or, what is equally good, a solution of boric acid, a tablespoonful to a pint of water; latter solution used without salt-water. Berg (Med. Record, Jan. 12, '95).
Case of faueial, nasal, and aural diph theria in a child, aged 3 years, in which autoreinfection of the fauces took place from the ear, which continued to run after the first attack of faucial diph theria, in which the diphtheria bacilli were found after recovery from second faucial attack. The ear lost all symp toms of disease under the instillation of formalin solution (1 to 1000). C. H. Burnett (Phila. Polyclinic, May 21, '98).
Sodium sozotodolate successfully used as an insufflation in a particularly severe case of diphtheria. The insufflations were made half-hourly, and usually con sisted of equal parts of flowers of sul phur and sodium sozoiodolate. During the hoarseness, a mixture containing 0.025 gramme of pilocarpine hydrochlo rate in infusion of digitalis (3 to 1000) was administered in teaspoonful doses. 'Neumann (Aerztl. Rund., viii, p. 523, 'DS).
Where there is much swelling of the cervical lymph-nodes, hot or cold appli cations may be used. Heat is preferable in infants; in older children the ice-cap may be used. Flannel pads or spongio pylin wrung out of hot water, or poul tices, may be used in the former case.
General Treatment. — With the ad vent of antitoxin most of the remedies for diphtheria have passed from use. A few still occupy a position which war rants some attention. In the treatment of pharyngeal or tonsillar diphtheria the tincture of the chloride of iron has long been regarded as of great value. Jacobi commends its use, advising a daily allow ance of 1 drachm for a child 1 year old, 2 or 3 drachms for children from 3 to 5 years old. It is to be given diluted with water and glycerin. He admits that it cannot be tolerated by some patients and that alcohol is to be preferred in septic cases. Under present conditions its use must, therefore, be very limited.