Instead of quinine, chlorate of potash is often conjoined with the iron ; but this remedy should be given with caution as it has a depressing effect on some children. It is well to begin the treatment with a mercurial purge, such as gray powder with jalapine, but the aperient need not be afterwards repeated.
In the use of local remedies we have to fulfil three indications : to arrest the spread of the false membrane ; to promote its removal, and to prevent from absorption of putrescent matters in contact with the tissues.
Many measures have been employed to prevent the extension of the local lesion in the throat. At one time strong cauterising agents were resorted to to effect this purpose, such as the solid nitrate of silver, equal parts of strong hydrochloric acid sand honey, and the strong solution of perchloride of iron. The repeated use of these agents is now almost universally condemned, but one thorough swabbing of the throat is still advocated by some writers. I have occasionally employed equal parts of strong perchloride of iron solution and glycerine, and have thought that used efficiently, once for all, the application has been followed by benefit. Many writers, however, deprecate the use of these powerful agents ; and certainly, since I have abandoned their employment, I have not found the disease less tractable or more dangerous to life.
To promote the liquefaction or removal of the false membrane many agents are employed. Rough tearing away of the diphtheritic exudation is injurious as well as useless ; but gentle measures to further its destruc tion are decidedly beneficial. To be of service, however, the application must be used repeatedly, and can be applied with perfect efficiency in the form of a spray from one of Siegel's spray producers. Lime-water, alone or with carbolic acid (twenty drops to the ounce of lime-water), liq. potass (twenty drops to the ounce of water), boracic acid (a scruple to the ounce), lactic acid (twenty-six grains to the ounce), benzoate of soda (one scruple to one drachm to the ounce), all these are of service, and the addition of glycerine (half a drachm to the ounce) increases the efficacy of the solu tions. Lotions of chlorate of potash (ten grains to the ounce) and of
salicylic acid (three or four grains to the ounce) are praised by some, as well as dry insuffiations of flour of sulphur, of alum, and of tannin. These latter have, however, the disadvantage that they cannot be employed with out distressing the patient. If thought more desirable, any of the above liquid preparations may be used with a brush, but this method of em ployment is distressing, and except perhaps in the case of infants, presents no special advantage.
The third indication, viz., to destroy the poisonous products of putre faction so as to prevent absorption and blood contamination, is partly affected by the use of many of the preceding agents. But besides these, special disinfectants may be sprayed into the throat, such as the solution of chlorinated soda or lime diluted with water (half a drachm to the ounce), permanganate of potash (five grains to the ounce), sulphurous acid, pure or diluted with an equal quantity of water, etc. The comfort of the patient is also promoted by the use of the steam kettle, as already recommended, and by warm applications externally to the throat. If the child be old enough,, he may be allowed to suck lumps of ice.
In nasal diphtheria, where septiccemia is especially to be dreaded, the thorough cleansing of the nasal passages with a mild disinfecting solution should never be omitted. The importance of this measure is insisted upon by Dr. Jacobi, who recommends that the process should be carried out by the fountain syringe wherever practicable. Failing that, an ordinary ear syringe can be made use of. He directs that the injection should be re peated as often as every hour, and that if the obstructed nostrils resist the passage of fluid, the coarser matters must be removed by a probe or forceps. Dr. Jacobi states that these injections, efficiently employed, give great relief to the patient and rapidly reduce the size of the swollen glands. He advises a warm solution of carbolic acid (two to four grains to the ounce), or, if there is no fcotor, of lime-water.