DIPHTHERIA. 239 



he is suffering from any particular disease. In the slighter cases of diphtheria 



umlaut ;it Jill is wanted; whereas in the more severe forms, where the 



< > .strength is utterly worn out, nothing but the free administration of 



ln-an.lv will enahle him to weather the storm. Do not be in too great a hurry 



to give wine or brandy, or you may find when it is too late that you have 



thrown away your best card. Remember, too, that the mere fact of your getting 



down so much brandy does not prove that it is taken into the system, for it 



m.iv remain in tho stomach unabsorbed, and might just as well, for all the good 



it does, be outside the body. Feel the pulse, and if you find your stimulant 



Athens it you may hope that it is doing good. In severe cases, attended 



with great prostration, as much as four or five ounces of good brandy may be 



,n\en in the twenty-four hours, even to a child. 



In the majority of cases of diphtheria it is not necessary to use gargles, but 

 should the breath become very offensive they may have to be resorted to. One 

 of the most useful is made by adding half an ounce of the solution of chlorinated 

 soda to half a pint of water. 



We must now consider the treatment to be adopted for the different forms 

 of diphtheritic paralysis. When the paralysis is limited to one part, as the eye 

 or palate, no very active measures are required, for the symptoms usually disappear 

 of themselves in a few weeks. If, however, the patient is still a little out of 

 health, and feels pulled down by his late illness, he will derive benefit from a 

 course of tonics, and especially from iron (Prs. 2, 3, and 4) and quinine (Pr. 9). 

 hould have a good nourishing diet, and should pass most of his time in the 

 open air. 



When, however, the paralysis involves several distinct parts it assumes a 

 more serious aspect. As in the former case, we give the patient plenty of 

 nourishment and some iron and quinine, but we do not let him take much exercise, 

 preferring to keep him quiet and free from excitement. When the paralysis is 

 no longer progressing, we cautiously apply electricity to the parts, using either 

 what is called an induced or a constant current. In some cases doses of from one 

 to five drops of tincture of gelseminum, given hourly in a little water, have been 

 found materially to assist the restoration to power. This drug is especially 

 indicated when the eye is affected and there is double vision. 



When the palate is involved to such an extent that the patient loses either 

 entirely or in a great measure the power of swallowing, we may find it neces- 

 sary to feed him for days and days together either by injections into the bowel, 

 or by means of the stomach pump. We do this for two reasons firstly, because 

 when an attempt is made to take food in the ordinary manner the smaller 

 particles are apt to go the wrong way and pass into the lungs, and set up in- 

 flammation of those organs ; and secondly, because such a small amount of 

 nourishment is taken that the patient is in danger of dying of starvation. 



Of late years, hypodermic injections of strychnia have been frequently used 

 in the paralysis following diphtheria, and very favourable results have been 

 obtained. The quantity injected is six drops of the British Pharmacopeia solu- 

 tion of -strychnia, which is equivalent to one-twentieth of a grain. The injection 



