forcing of the medical-practice law in that State. The legal luminary cogitated for a while, and then delivered the opinion that the magnetic healers and the hypnotists and all other quacks except divine healers can be prosecuted, but adds that the divine healers claim their power to come from Jehovah, and that, as he understands it, the rights and privileges of Jehovah can in no way be regulated or restricted by the statutes of Kansas.-Medical Record.

ICHTHYOL RUbber PlasterS.-The following formulæ are attributed to Schneegans and Corneille (Journal de medecine de Paris, February 13, 1898 (New York Medical Journal):

THE COMMUNICATION OF Venereal DISEASE A CRIMINAL Offense. A measure is just being discussed before the German Reichstag, whose purpose is the prevention of the spread of venereal disease. Any one found guilty of having communicated a venereal disease to another shall be punishable by fine and imprisonment. Certain circumstances are considered to mitigate the offense, especially in the married, and when the disease has been innocently acquired. It is an attempt to solve a difficult social question from another point of view than that from which it is usually approached.-Philadelphia Medical Journal.

LEFT-HANDEDNESS CURED BY SUGGESTION.-Rothschild (Jahrbuchre fur Psychiatrie, xvi, 3; Wiener klinische Wochenschrift, March 10, 1898,) relates the case of a left-handed girl, four years old, well developed and of a healthy family, whom he cured by hypnotizing her and suggesting to her to use her right hand. She began at once to use the right hand oftener than the left, and at the time of the report, two years and a half later, she continued right-handed.-New York Medical Journal.

LOUISVILLE MEDICO-CHIRURGICAL SOCIETY.-At the regular annual meeting of the Louisville Medico-Chirurgical Society, May 20, 1898, the following officers were duly elected for the ensuing year:

President, Dr. Thomas Hunt Stucky; Vice-President, Dr. John Mason Williams; Secretary and Treasurer, Dr. Louis Frank.

Certainly it is excellent discipline for an author to feel that he must say all he has to say in the fewest possible words, or his reader is sure to skip them; and in the plainest possible words, or his reader will certainly misunderstand them. Generally, also, a downright fact may be told in a plain way; and we want downright facts at present more than any thing else.-RUSKIN.

Original Articles.

TREATMENT OF DIPHTHERIA.*

BY S. G. DABNEY, M. D.

Clinical Lecturer on Diseases of Eye, Ear, Nose, and Throat, Hospital College of Medicine, Louisville, Ky.

In the following paper on the treatment of diphtheria especial attention will be paid to serum therapy and to intubation, partly because these are our most important therapeutic resources and partly because the writer, confining his practice to an exclusive specialty, has been most frequently engaged in cases in which the measures were demanded. The subject may be divided into, first, Prophylaxis, second, Treatment of Nasal and Pharyngeal Diphtheria, third, Treatment of Laryngeal Diphtheria, including intubation.

First, Prophylaxis. Undoubledly many cases of diphtheria are caused by withdrawing quarantine from the convalescent while the germs of the disease are still in the throat. The most scientific way to determine this is by examination for the Klebs-Loeffler bacillus. It is well to have several examinations made, and of course to avoid using an antiseptic at this time. In a great number of cases, however, the aid of a skillful bacteriologist can not be obtained. In such the advice of Holt (1), to continue quarantine ten days in mild, and three weeks in severe cases, after the membrane has disappeared, is doubtless wise. The importance of a well-ventilated room and of sunlight, both as therapeutic measures and to prevent infection of the apartment, have long been recognized clinically; and Pittsfield (2) has

* Read at the meeting of the Kentucky State Medical Society, Maysville, Ky., May 12, 1898.

shown their value from the standpoint of the microscopist by observing that sunlight produces speedy death of the bacillus, while darkness and dampness increase its longevity. The unaffected children of the household, if they can not be removed to another home, should spend as much time as possible in the open air, and their noses and throats should be cleansed by antiseptic sprays and gargles. Caille (3) rccommends pouring a teaspoonful of a normal saline solution or of a weak antiseptic into each nostril of the child, lying on its back, and directing it to hawk it out through the mouth night and morning. Among prophylactic measures should also be mentioned the removal of enlarged tonsils and adenoid growths, since there can be no question that these conditions increase the liability of the disease and augment its dangers should it occur. It is scarcely necessary to say that such operations should not be done while the child is in the house with diphtheria or likely to be soon exposed to it.

Public funerals should be avoided, the children of the house kept from school, the discharges from the patient and the walls and contents of the room carefully disinfected. Finally the value of antitoxin for prophylactic purposes has in its behalf testimony almost if not quite as overwhelming as its use as a curative agent. Moreover, the vast number of cases in which it has thus been employed in healthy persons without any serious untoward result has demonstrated its harmlessness. In young infants and in pregnant and parturient women it has pro duced no bad effect on the kidney, as urinalysis showed. Of 15,986 persons, mostly young children, who had been exposed to diphtheria, and who were immunized with antitoxin, only seventy-nine, or five tenths of one per cent had the disease in the following thirty days (4). In many of these cases it is now admitted that the doses used were insufficient. As a prophylactic against diphtheria complicating other infectious diseases, the figures, while not so numerous, are almost equally convincing. Thus in the New York Foundling Hospital diphtheria had long been one of the most frequent and most dreaded complications of measles. In a recent epidemic, Northrup (5) reports that of seventyseven cases immunized with antitoxin none had diphtheria, while of nine not so immunized four had positive evidence of this disease. The period of immunity is about four weeks. The dose of antitoxin for this purpose is from 50 units in a young infant to 250 or 300 in a child. between five and ten years of age. In private practice its employment for prophylaxis is not imperative, but in public institutions where large

numbers of children are gathered together statistics establish its great value.

Second, Treatment of Nasal and Pharyngeal Diphtheria: It is well to emphasize here that every case which is fairly suspicious of being diphtheria should be treated as if this diagnosis were certain. delay of twenty-four hours is only permissible if the case is seen in the beginning, and the suspicion mild; otherwise antitoxin should be used at once. The importance of the prompt administration of the agent. can not be overestimated. All observers agree that the best results are obtained when used in the first twenty-four hours of the disease, and that after the third or fourth day comparatively little can be accomplished. This is to be expected, as by the latter time the toxin of diphtheria has already produced changes which its antidote can not overcome. In laryngeal cases, however, even if they appear late in a mild or overlooked case, in which the serum has not been used, its action will still be most efficatious. Here the fatal result comes either from obstruction of the larynx, or downward extension of the membrane. Intubation relieves the former, and if used while the disease. is confined to the larynx antitoxin almost surely prevents the latter.

It would seem needless at this day to urge the claims of this serum therapy, yet in a great number of cases it is still neglected. Here, as elsewhere, conservatism is too often a failure to keep well abreast with medical progress, and incredulity and timidity are the results of ignorance and prejudice. "Any practitioner who studies the collective investigation reports for 1896 and 1897, on antitoxin for diphtheria and croup, in private practice, issued by the American Pediatric Society, and fails to use antitoxin because 'he does not believe in it,' should not be intrusted with the management of a case of diphtheria; and the practitioner who thinks a case is mild, and waits for severe symptoms before using antitoxin, utterly fails to grasp the situation, and will frequently be disappointed." These are the words of Dr. Caille, above quoted. They are put in italics by the Therapeutic Gazette in reviewing his article, and they deserve the indorsement of every student of this subject.

Passing over the disputed question of how antitoxin acts, I will consider, first, its efficacy; second, its dose and mode of administration, and, third, the alleged bad results from its use.

First, as to its efficacy, the best way to be convinced is to use it. The most skeptical will thus be converted.

Statistics in its favor are now so universal the world over, and so overwhelming that it would appear needless to quote any. But a

few will be mentioned. These statistics, which are from large hospitals, show a greater mortality, both previous to and with the antitoxin than the average of private practice. This may be due to more of the hospital cases being first seen when in extremis and to their lessened power of resistance from the bad hygiene common to the poorer classes of great cities. Thus, McCullom, of 844 cases treated in Boston City Hospital with antitoxin, found mortality 11 per cent; without it the mortality had been 40 per cent.

Reports from private practice to the Committee of the American Pediatric Society for 1896, showed that in 4,120 cases the mortality was 7.3 per cent, including those moribund when the remedy was used. Of 1,112 cases injected by the Chicago Health Officers the first three days of the disease the mortality, was but 2.5 per cent. It may be argued, however, that the diagnosis was often mistaken in these cases, and that under certain lines of treatment some practitioners had previously claimed results almost as good. Realizing the plausibility at least of these statements, the American Pediatric Society appointed a committee for 1897 to collect statistics on the use of antitoxin in laryngeal diphtheria. These are absolutely irrefutable, for here the diagnosis is very rarely in doubt, and the great mortality universally admitted. 1,704 cases of diphtheria of the larynx were reported (6); 1,036 were not operated on; the mortality of these was 17 per cent against 90 per cent formerly accepted as the mortality without operation before antitoxin. Of 668 cases of intubation, mortality was 27 per cent with antitoxin, while without it it had been 70 per cent. Far more impressive, however, to the surgeon who has performed intubation before and since the days of antitoxin, than these dry statistics must be his own personal experience. Formerly we expected these cases to die; now we expect them to recover; the chances are at least three to one in our favor, and my own experience and that of my colleagues in Louisville has been far mor favorable than this. Antitoxin is certainly of special value in laryngeal cases. Dillon Brown believes this due to the fact that such cases are more free from streptococcus infection, and this is probably the correct explanation.

Second, Dose and Mode of Administration: It is important that the serum should be as concentrated as possible, as the slight disturbances which have occasionally followed its use, seem to result from the