354 ACUTE GLANDERS IN THE HUMAN SUBJECT. 
medicines, more especially in acute diseases. But this argu- 
ment undoubtedly applies with greatest force to the treatment 
of a disease running a rapid and destructive course, and de- 
pendent in its origin on the presence of a septic poison, 
introduced into the system from without. 
In such conditions, and especially in cases of equinia, the 
indication I apprehend to be, — to sustain the vital force in 
its conflict with the destructive chemical processes going on 
in certain tissues. And this can only be done by a stimulant, 
powerful in its nature, rapidly diffusible, and administered in 
such a manner as to keep up its full effect on the constitution. 
Ammonia, given in large doses, in a concentrated form, and 
at very short intervals, appears the agent best calculated to 
fulfil these requirements. Dr. Mackenzie, in his own cases, 
gave it every hour; in my own case, it was not judged neces- 
sary to give it more frequently than at intervals of two hours. 
Of course, this point must be left to the discretion of the prac- 
titioner in each particular case. 
Dr. Mackenzie says : “ This remedy and mode of exhibit- 
ing it, were suggested by the good effects which I had seen 
it produce when so given in malignant scarlet fever.” And 
he quotes at length from Mr. Wilkinson’s, work on the disease 
in question, in allusion to the employment of the remedy by 
Dr. Peart, by whom it w as originally recommended ; and also 
his (Mr. Wilkinson’s) experience of its good effects; also 
from Mr. Ricardo, of Bow t , who used the remedy largely in 
the treatment of scarlatina maligna, and with the greatest 
success. So far as my limited experience goes, it decidedly 
confirms the view 7 s and statements of these writers. During 
the last three years, I have been in the habit of treating almost 
all cases of putrid sore-throat, scarlatina, and gangrenous 
erysipelas, accompanied w 7 ith severe constitutional irritation, 
with ammonia in a concentrated form : and since so doing 
have lost but one patient, and that one could not be got to 
sw allow 7 the medicine. In fact, my confidence in the remedy 
is such, that I never despair of the recovery of any case of 
this kind, provided the swelling of the glands under the jaw 
has not proceeded to such an extent as to preclude the pos- 
sibility of sw 7 allow 7 ing at all, but address myself to the 
treatment with confidence instead of despair. 
Much stress has been laid by writers in general on the 
value of antiseptics in treating this class of maladies; of 
course their local application is rational and sanctioned by 
experience, but will by no means suffice for the cure. In the 
case of my own patient, for instance, powerful gargles of 
chloride of soda appeared to be of little service ; but I have 
no faith whatever in the internal administration of remedial 
