DIPHTHERIA. 669 



peat this operation more than once or twice daily, and not to continue 

 't too long. Besides this, as long as the mucous membrane is still 

 very red and swollen, I let the patient swallow small pieces of ice 

 slowly, and prescribe a solution of chlorate of potash ( 3 i to vi), 

 with directions to take a tablespoonful in the mouth every two hours, 

 and to keep it in contact with the pharyngeal tissues for some time 

 before swallowing it. I have no personal experience about the local 

 application of chlorine-water, or the solutions of sulphite of soda 

 ( 3 i to the | j), or of permanganate of potash, which are said not 

 only to remove the fetid odor, but also to arrest the putrefaction. On 

 account of the threatening collapse, we must avoid all debilitating 

 treatment, especially abstraction of blood ; on the contrary, we should, 

 from the first, attend to keeping up the strength of the patient by 

 tonics, quinine, and iron, and by wine and nutritious diet. If collapse 

 occur, we should give analeptics, camphor, musk, and particularly 

 plenty of strong wine. Croupous laryngitis coming on during the 

 disease requires about the same treatment that we advised in the first 

 volume for idiopathic croupous laryngitis ; only I do not employ ab- 

 straction of blood or calomel even in recent cases. Tracheotomy 

 should not be deferred too long, if we hope to have it succeed, which 

 it rarely does. 



Short, cold ablutions, cold douches, and sea-bathing, have obtained 

 the most confidence in diphtheritic paralysis. The induced and con- 

 stant currents have also been advised. I have subjected many cases 

 to long-continued treatment by electricity without benefit. In one 

 case, where the patient was paralyzed in all her extremities, and was 

 treated at my clinic by electricity, without benefit, for four weeks, she 

 completely recovered, without any treatment, a short time after be- 

 ing dismissed from the hospital. 4 



[Diphtheria so often occurs without our being able to detect the 

 source of contagion, that we may very strongly suspect its occa- 

 sional spontaneous origin. 



Some authors regard general blood-infection as the first step, 

 and say the throat-affection is only a local expression of this, as 

 the bronchitis is of measles or pharyngitis of scarlatina ; while 

 others say the affection is at first local, and may remain so or may 

 become a general disease. Numerous vegetable organisms (micro- 

 cocci) have been found in the diphtheritic membranes and even in 

 the blood of the patients. The transmissibility of diphtheria to 

 the lower animals by inoculating in the muscles, trachea, cornea, 

 etc., has been proved, and the excessive multiplication of bacteria 

 at these points has indicated them as the bearers of the contagion. 

 In favor of the first view is the fact that at the commencement of 



