In the treatment of laryngeal diph theria the best results previous to the use of antitoxin were attained by the administration of mercury. The drug was given internally in the form of the bichloride, or the patient was treated by calornel fumigations. The bichloride was given in hourly doses to the amount of 1/8 to V, grain in twenty-four hours, each dose being preceded and followed by copious draughts of water. This treatment was continued for from four to eight days, and good results were claimed for it.
Calomel fmnigation was a more elab orate process. A tent or canopy was rigged over the patient's crib. Beneath this tent 15 grains of calomel were vola tilized every two hours for two days and nights, then every three hours for the third day, every four hours for the fourth 'day, and thereafter three times a day :according to indications. The patients :sometimes suffered from stomatitis and diarrhcea and developed pronounced arrzemia; not infrequently the attend ants were salivated; but this form of treatment gave better results in intu bated cases than any other employed be fore the introduction of antitoxin.
Among other remedies that have been recommended, pilocarpine, guaiacol, ci tric acid, sodium hyposulphite, and myrrh have received the greatest atten tion; but the fact must be borne in mind that, in the majority of cases treated, the diagnosis has not been established by bacteriological examination.
Pilocarpine a precious auxiliary; less dangerous for children than for adults. Degle (Wiener med. Presse, Dec. 9, 16, '94).
Pilocarpine a specific in diphtheria. C. F. Howe (Med. Brief, Aug., '95).
In severe eases of diphtheria a begin ning may be made by injecting a quarter of a syringeful of a 2-per-cent. solution of pilocarpine, and then, to keep up the action of the drug, it may be given by the mouth. If there is no improvement at the end of twenty-fotir hours, another inject ion is given. .11. S. Barsky (Wratsch, Nos. 45, 4S, '95).
Gnaiacol used early seems to destroy the bacilli and prevent the spread of the pseudomembrane. Bacteriological ex amination of cultures taken from the same throat before and after its applica tion has shown in the first instance the bacilli, and in the second none have been found. The formula is guaiacol, 10; menthol, 1; sterilized olive-oil, 10. The same application is of service as a proph ylactic against diphtheria by , applica tion to the throat of the healthy inmates of the house in which the disease has ap peared. This has been proved in two epidemics. In folliculous tonsillitis it is capable of cutting short the disease if early and thoroughly applied, and even in parenchymatous tonsillitis mitigates considerably the severity of the affection.
S. Solis-Cohen (Phila. Polyclinic, No. 16, p. 157, '96).
One hundred and fourteen cases of diphtheria, treated with a 10-per-cent. solution of citric acid given by the mouth. Eleven deaths occurred: a mortality of 9.6 per cent. Fifty-six of tbe cases were mild, 27 were of very doubtful prognosis, and 31 were de cidedly grave. Four of the deaths were due to sepsis, 1 patient died after trache otomy, and 1 died of paralysis of the heart during convalescence. Of the 11 who died, as many as 5 were not brought to the hospital until the disease had been running for from four to seven days. According to the patient's age a teaspoonful to a tablespoonful of the solution was given evei7 two hours, In the beginning and in severe cases smaller doses are given, but more fre quently, as often aS every half-hour day and night. Bloch (Ugeskrift for Litger; Deutsche med.-Zeit., Aug. 10, '96).
A solution of sodium hyposulphite as a local application in diphtheria gives good results, three or four applications generally being sufficient to clear away the false membrane. The solution i3 prepared for use by mixing equal parts of pure glycerin and a saturated soh'. tion of hyposulphite of sodium in water, and is applied with a brush to the exu dation and inflamed fauees once or twice daily, or as often as may be deemed necessary. II. A. \Vickers (Lancet, June 6, '96).
The internal use of tincture of myrrh in diphtheria recommended. E. Graetzer (Allinchener med. Woch., No. 47, S. 1164, '96).
Tincture of myrrh in diphtheria very strongly recommended. The mixture is composed of tincture of myrrh, 4 parts; glycerin, S parts; and distilled water, to 200 parts. This is given very fre quently,—every hour or even every half hour in the day-time and every two hours at night,—infants up to the age of 2 years taking a large teaspoonful (75 minims), older children double that quantity and adults three times as much. This is continued until the membrane has nearly disappeared, when the doses are only given every two hours. After all the membrane has gone the treat ment is continued for a couple of days, the interval between the doses being in creased to three hours. In the case of older children and adults a gargle con taining 'A-per-cent. resorcin may be em ployed every hour or oftener in the day time and where it is desired the tonsils may be painted every hour with the tincture of myrrh undiluted. Where the larynx is involved the myrrh-and glycerin mixture in an inhaler or spray to be used every half-hour. By this method only one case out of eighty has been lost, and reports collected from sev eral other practitioners show 182 cases with 22 deaths. Stroll (Lancet, Jan. 1, '9S).