Drugs have been of late years steadily falling into disuse since the introduction of the serum treatment. Iron, however, which is usually well borne in the disease, is undoubtedly of great value, and especially in the cases complicated with streptococcal or other septic infection; where there is much offensive discharge, the drug affords an adjunct to treatment which should never be omitted. The following is a good routine formula suitable for a child of about 4 years of age: R. Tinct. Ferri Perchlor. 3j.
Potassii Chloratis gr. xxxv. Glycerini 3vj.
A qu-ce Chlorof. ad 5i.v. Misce.
Fiat niistura. paths howls.
Basham's Mixture, or 3o mins. Tr. Ferri Perchlor. with t dr. Liq. Ammon. Acet., may be given with water every four hours to adults.
Of the host of internal antiseptics from Euchlorine to Biniodide or Perchloride of Mercury there is little to he said; the writer has long satisfied himself that all are inferior to Iron. Strychnine, however, stands alone as an internal remedy in cardiac failure, and it should be administered hypodermically once the symptoms of heart weakness show themselves, and as a preventive of this r min. of the liquor may be added to each dose of the above iron mixture, and small quantities of Brandy may be added to the milk.
Gargles or sprays will probably continue to be used in all cases where the discharge is profuse and offensive, but the established rule has no exceptions—that a caustic agent should never be applied with the view of destroying the bacilli in the false membrane. Serum therapy has also done away with the application of Papain, Pepsin, Lime Water sprays and other agents formerly used to cause disintegration of the membrane. In all mild and most severe cases the use of a spray of Carbolic Acid, in 'co, with 4 per cent. Boric Acid, is the most harmless and efficient flushing medium for the throat and nares. Swabs, syringes and douches are a source of terror to young patients, and the excitement which their use inspires often does much more harm than their employment does of good. The spray, on the other hand, when gently brought first under the child's notice as a plaything by the nurse using it to her own open mouth, need be the cause of no alarm. With older patients the nasal douche or syringe may be used with a weak Perchloride of Mercury, i in 5,000, but warm saturated Boric Acid solution is safer. Swabs of the mercurial preparation may be used in r per cent. strength, or Peroxide of Hydrogen, to vols., may be employed in the same manner or as a spray. Recently
swabbing with Hypochlorous Solution is highly recommended by several authorities both in the active disease and in the case of carriers. The solution is made by passing a strong electric current through a 3 per cent. solution of common salt, using graphite plates. There is scarcely an antiseptic substance from the crude Flowers of Sulphur and Garlic to the latest Iodoform substitute which has not its but the r per cent. Carbolic spray answers all requirements both for the mouth, throat, nostrils and nasopharynx, and it may be easily used while the patient lies upon his side with his head thrown backwards till the spray condenses in the mouth, after which it may be permitted to flow out on depressing the chin.
Laryngeal Diphtheria.—Though the author in his " Practice of Medi cine " has pointed out good reasons for believing that the serious disease formerly known as " True Croup " is not always of diphtheritic nature, nevertheless from the standpoint of treatment all cases from the moment that laryngeal symptoms begin to show themselves should be dealt with as if the result of the Klebs-Loeffler bacillus, the simple spasmodic croup from its peculiar invasion being easily excepted.
In addition to the isolation, general environment and feeding arrange ments necessary for ordinary diphtheria, the warm air of the sick-room should be saturated with moisture by means of the bronchitis kettle, or a curtained cot into the canopy of which steam or the vapour of boiling water may be introduced is better. For very young children and infants, screens may he so arranged as to answer the same purpose, but which will permit the infant being kept on the lap of the nurse, as the recumbent posture is impossible when there is much dyspncea.
A dose of io,000 to 15,000 units of antitoxin should be administered without delay, and repeated in 12 hours should the symptoms not show signs of improvement. One of the most remarkable results of the serum treatment of diphtheria is seen in the small percentage of cases which will require operative relief when the injection has been promptly resorted to, and another result is equally striking in the almost entire absence of the supervention of laryngeal trouble in ordinary faucial diphtheria after the use of the serum has been commenced on the first day. Should, however, the breathing continue to be laboured and recession of the thoracic walls be noticeable, the trachea must be opened or the operation of intuhation must be performed.