232 



DIPHTHERIA. 



DISASTERS IN 1892. 



has been claimed that by fair doses the false 

 membrane may be detached. The great danger 

 is the prostration that always follows a dose of 

 any size. Sulphuret of potassium, chlorate of 

 potassium, the sodic compounds, bromine com- 

 pounds, cubebs, copaiba, carbolic acid, the 

 mercurials, iron, and quinine have been succes- 

 sively employed, but mercury, iron, and quinine 

 are most to be relied upon. The mercurial treat- 

 ment of diphtheria is old, and, on account of the 

 excessive doses given in the past, had fallen into 

 disfavor, but now that we recognize the germ 

 element in the poison of the disease and admin- 

 ister mercury with a better understanding of its 

 power and action, it has risen to favor, and is 

 beyond question a valuable agent. In the early 

 treatment of diphtheria, calomel, in doses of 1 

 to 8 grains every two to four hours, until the 

 stools are frequent and green, has received much 

 praise. It is also a most excellent practice to 

 blow it dry into the throat. Bichloride of 

 mercury is the best preparation to use in treat- 

 ing diphtheria, and its advocates rank among 

 the highest authorities in the profession. With- 

 in the past three years most gratifying testi- 

 mony has been added to its credit. Out of 2,000 

 cases treated in England during the past three 

 years, the mortality was reduced, under this 

 treatment, to 16 per cent. In the writer's hands 

 most favorable results have followed from this 

 agent. It should be administered in doses of 

 Tstr to ^j of a grain, given every two to three 

 hours, according to age. The remedy must be 

 pushed, and. as in the case of alcohol, diphtheria 

 seems to form a tolerance for mercury. In a 

 severe case it can be given every hour. Such 

 authorities as Dillon Brown, Huber, and O'Dyer 

 approve the administration of even such quanti- 

 ties as one quarter to one half grain of bichloride 

 of mercury within twenty-four hours. The 

 biniodide of mercury has not proved so satisfac- 

 tory in its results, and the use of the cyanide is 

 attended with considerable risk of digestive dis- 

 turbances. Inunction of the mercurial ointment 

 or of the oleate has also been recommended, 

 but both these preparations have many disad- 

 vantages. The hypodermic injection of bi- 

 chloride of mercury is so painful, and so liable 

 to be followed by an abscess, that it had best not 

 be used. Within the past year bicyanide of 

 mercury, in combination with cocaine, has been 

 recommended for hypodermic use. Iron is a 

 valuable agent and possesses the advantage of 

 lessening the heart complications. It is of value 

 both locally and internally. It must, be pushed 

 in large doses, well diluted and frequently ad- 

 ministered. The best preparation is the tincture 

 of the chloride of iron. After recovery this 

 should be continued for some time. Quinine 

 has proved of much value in the treatment of 

 diphtheria, especially in combination with iron. 

 In the early stages 'of the disease it should be 

 given in large doses, afterward in tonic doses. 



During convalescence a patient should be care- 

 fully watched. Iron, quinine, and cod-liver oil 

 will be of great value. Change of air, especially 

 the seashore, is of much benefit. If, as so often 

 happens, weak and disturbed digestion follows, 

 tonics, cold baths, and strict attention to diet 

 must be prescribed. 



The question of operation as a last resort in 



diphtheria is an open one. Much has been 

 claimed for it, but experience has been most 

 unsatisfactory. The mode of procedure has been 

 improved, but a corresponding improvement in 

 results is lacking. A patient suffering from 

 diphtheria is a bad subject for an operation of 

 any kind at best, so little can be expected from 

 it. Some recoveries after very desperate cases 

 have been reported ; hence, as a last resort, op- 

 erative procedures might be attempted. But the 

 writer believes that almost all the cases where a 

 recovery has followed an operation have been 

 croup, and not true diphtheria. 



DISASTERS IN 1892. The list of acci- 

 dents presents no peculiar features. There is 

 rarely a year that lacks terrible calamities, 

 whether caused by earthquakes, storms, or other 

 natural phenomena, and the past year is no ex- 

 ception in this respect. Losses of life and prop- 

 erty by fire have been perhaps exceptionally 

 frequent, and it will be noticed that the flames 

 have spared neither churches nor charities nor 

 business houses, but have consumed all alike, 

 with seeming impartiality. The summaries of 

 train accidents are from the tables prepared by 

 the " Railroad Gazette," and apply to the United 

 States alone. 



January 2. Fire : warehouses burned, Nashville, 

 Tenn., 3 killed, several hurt, loss, about $450,000. 

 Panic in a hall, several persons badly hurt at Oella, 

 Aid., cause, an overturned lamp. 



3. Shipwreck : British bark Chidwell sunk in col- 

 lision, 15 drowned. Fires : grain-lifts, Brooklyn, 

 N. Y., loss, about $100,000 ; stables and other build- 

 ings, Ballston, N. Y. 



5. Trains wrecked in Illinois, 6 killed, several huft; 

 and near Asheville, N. C., 4 killed. 



6. Trains wrecked near Smyrna, N. Y., 3 killed ; 

 and Fairmount, W. Va., 12 hurt. Fire : Wapello, 

 Iowa, loss, $30,000. Tornado : Florida and Georgia, 

 buildings destroyed and many people hurt. 



7. Explosions : steam boilers Durst at Boiling, Ala., 

 4 killed, 4 hurt ; and Kankin Station, Pa., 1 killed, 12 

 hurt. 



8. Colliery explosion, McAllister, Indian Territory, 

 100 killed, 115 hurt. Steam boiler bursts in Chicago, 

 111., 4 killed. Fires : at Jeanette, Pa., and Syracuse, 

 N. Y., total loss, $75,000. 



9. Fires: at Jersey City, N. J. ; Milwaukee, Wis. ; 

 Pittsburg, Pa. ; Decatur, Ala., and Charlestown, W. 

 Va., aggregate loss, about $375,000. 



11. Trains wrecked near Nicolson Crossing, Ind., 2 

 killed, 29 hurt. Boiler bursts at Bridgeport, Pa., 2 

 killed, several hurt. 



12. Fire : Worcester, Mass., mills of Pratt Manufac- 

 turing Company. 



13. Fires : Cleveland, Ohio, and Topeka, Kan., losses 

 about $210,000. Shipwreck : steamer Namchow in 

 the China Sea, 414 lives lost. 



14. Chicago, tramear wrecked, 2 killed, 13 hurt. 

 Fires : Waterbury, Conn., brass works, loss, $260,000 ; 

 Jackson, Miss., business houses burned. 



15. Train wrecked near Brainerd, Minn., 2 killed, 

 23 hurt. Floods in New York and New England. 



16. Fires: New York, damage, $200,000, 1 life lost; 

 Wausau, Wis., opera house, loss, $200,000 ; Charleston, 

 S. C., brewery, loss, $100,000 ; Au Sable, Mich., loss, 

 $75,000 ; unknown ship burned at sea, all hands prob- 

 ably lost, reported by steamer Imperial Prince. 



18. Central City, W. Va., explosion of powder mill, 

 6 killed. Fires : Kansas City, loss, $150,000 ; Orleans, 

 Neb., loss, $40,000. 



19. Fires: Chicago, 111. ; Toledo, Ohio ; Tarkio, Mo., 

 and Shamokin, Pa., 2 lives lost at Chicago, damage, 

 about $250,000. A bridge falls at Tiflis, many lives 

 lost. 



20. Train accident at grade crossing, St. Louis, Mo., 



