foreign, it is, therefore, the most efficient and | The patients were cachectic, bearers of squa harmless disinfectant or prophylactic that can be used in all forms of purulent inflammation. In the 25-per-cent. solution (aside from its use in pyorrhoea) I find it the 'acme' of protection in restoring discolored teeth. To be able .to enliven its energy by heat is its truly remarkable power, as upon heat we depend very greatly. I might add that in all the several applications of pyrozone heat will only render its power more effective." H. C. Raymond, D.D.S., says: "I take pleasure in saying, as a bleaching agent, I have had some excellent results with the 25-percent. solution, and it promises to be exceedingly useful in the treatment of pyorrhoea alveolaris. The 5-per-cent. solution I use largely in setting crowns and bridges, its styptic qualities rendering it extremely valuable in arresting any bleeding, and in effectually stopping up the pores through which moisture will find its way. Operators in crown and bridge work who have not used pyrozone for this purpose have no idea what an aid it is in keeping the parts perfectly dry. I prescribe 3-per-cent. pyrozone for my patients, to be used as a mouth-wash just before retiring, and specially urge its use to those wearing plates and crowns, or bridges, for its prophylactic qualities are, in my opinion, inestimable." NEURASTHENIA. Lépine recommends:. B Gallobromol, mous, ulcerating, and osseous lesions where the mercurials and iodides had been adminis tered in vain. The dry extract of the thyroid glands of sheep was given, in the form of tablets, 25 to 50 centigrammes per diem, while all specific medication was suspended. In all these cases he obtained a more or less considerable amelioration of the local as well as of the general condition. The cutaneous and osseous lesions healed, at least partly, and the pigmentations following the skin lesions disappeared as well. Another English physician, Dr. N. YorkeDavies, of London, has discovered these same tablets to be a precious addition to the treatment of obesity. Thus, in patients placed under both an appropriate diet and treated with thyroidin, the decrease in weight was from two to three times greater by dieting alone.-Medical and Surgical Reporter. CONSTIPATION. In a paper in the Brooklyn Medical Journal on the constipation of tea poisoning, Dr. James Wood, of Brooklyn, gives the following for mula: B Inspissated ox-bile, pure Sulphate of quinine, 2 scruples. I scruple. I grain. I scruple. Extract of cascara sagrada, Extract of euonymus, Extract of gentian, Dissolve in Distilled water, Syrup of currents, B Iodoformi, . M. Ess. bergamotte, Ol. theobrom., gr. xv. gr. viij. mx. 3iiss. Sig. To make 12 suppositories; I to be introduced into the vagina when necessary.— Prescription. The Journal des Praticiens contains a review of a work by M. F. Aury, in which the writer remarks that the author of this original thesis aims, with praiseworthy intentions, to restore to these two drinks the recognition of their prophylactic merits and curative action, which seem to him to have been too nearly lost. As an alimentary drink, he advises weak cider, which is free from pathogenic microbes, well tolerated by the stomach, and a prophylactic of the uric-acid diathesis. It is the most eligible drink, he says, in intermittent fever, in vomiting, in the uric-acid diathesis, and in arthritis. Pure, it is a tonic, and is useful in chlorosis, in anæmia, and for convalescents. It is also, he adds, a topical antiseptic in varicose ulcers and recent wounds. Medicinal ciders may be prepared by the maceration or solution of certain drugs in cider, such as calumba, gentian, cinchona, and vari--Universal Medical Journal. METHYLENE BLUE IN LEUCOCYTHÆMIA. Gram tried chloride of methylene blue, in doses of 0.10 gramme (11⁄2 grains), three times a day, in four cases of leucocythæmia. During the administration of the drug the number of leucocytes diminished and the patients seemed to improve; but three of the cases ended fatally and the fourth was finally discharged from the hospital unimproved. In some instances the drug seemed also to cause a diminution in the number of red corpuscles. THE Medical Bulletin. JOHN V. SHOEMAKER, A.M., M.D., Editor. Philadelphia, Jan., 1893. STATISTICS in Regard TO THE DIPHTHERIA. DIPH IPHTHERIA, so commonly prevalent in crowded cities, so often epidemic in country towns and retired hamlets, is such a terrible scourge that we all stand ready to welcome any improved plan of treatment. Notwithstanding the numerous remedies, local and general, which have hitherto been employed, we must confess that the mortality rate has been very large. To the dangers dependent upon specific infection are often added those produced by mechanical obstruction of the upper air-passages. When the larynx is invaded we may avert immediate death by a resort to tracheotomy or intubation. The operation does not, however, prevent the extension of the disease. Tracheotomy, in particular, is followed by disadvantages of its own. It facilitates the development of bronchitis or pneumonia, and the wound is very liable to become diphtheritic. Given a serious toxæmia with mechanical obstruction to respiration, with a tendency to the occurrence of secondary inflammations of the air-passages and acute renal trouble, the conditions are indeed formidable to meet with any therapeu tic measures formerly at our command. Despite our most strenuous efforts, the mortality of this disease has been extremely high. Doubtless diphtheria, like other acute infectious disorders, differs considerably in severity in different epidemics. Some are comparatively mild, while others run a deadly course. It is, therefore, only by the average of many years and many epidemics that we can approximate the actual rate of prevalence and fatality of diphtheria. Statistics can teach us much, can assure us concerning the ratio of cases to the population and the average probability of death or recovery. We do not question that the diligent collection and intelligent study of statistics. have an important part in enlarging the fields of knowledge. As made use of by one like Quetelet, the "laws of large numbers" become, at any rate, of tremendous suggestive import. The field of statistics is, on the other hand, limited by numerous fallacies. As regards medical statistics, the capital consideration, the sine qua non, is that they should a foundation of unimpeachable rest upon The treatment of diphtheria by means of antitoxin offers us a decidedly promising method. The theory upon which it is founded is in strict accord with the tendency of scientific research and speculation. It seems to suggest the means by which, in the future, we may be able to control the progress of specific infections. The manner in which Nature effects a cure of a contagious, infectious, selflimited disease and the mode in which immunity to such diseases is conferred are deep. problems. We may not assert that those problems have yet been solved, but a flood of light has, in the past few years, been thrown upon the question. The study of bacteriology, in its broadest sense, has given us the clue to the solution. It is far from sufficient to be able to recognize the forms of pathogenetic microbes when these have been prepared and placed under the microscope. We need to know the chemical poisons elaborated by the microorganisms and their influence upon the animal system in health and disease. We wish to understand how different bacterial products may possess counteracting effects. As these points are discovered our conceptions of infection enlarge. It is in connection with such questions as these that the antitoxin treatment has had its origin. Its mode of genesis is, accordingly, in some degree a guaranty, if not of its efficacy, at least of its probable worth. Its efficacy can only be determined by the test of actual clinical experiment. Clinical experiment must, however, be governed by the same laws which regulate evidence goes to show could have been of no investigations in other branches of physical such character. science. It is true that, in studying disease in the human subject, the conditions upon which wise judgment must be formed are much more complex than in other branches of Nature. In order to estimate the comparative value of different therapeutical methods in diphtheria, the physician must first assure himself that he is indeed dealing with a case of diphtheria. Here, again, we are pointed back to the study of bacteriology. In case of doubt the question can be indubitably settled by the recognition of the Klebs-Loeffler bacillus. In fact, as a strictly scientific investigation, the presence of the bacillus should be demonstrated in every case recorded as an instance of the reme dial or immunizing power of the diphtheria antitoxin. This may not, perhaps, be possible in every-day practice, but it can only be from such examinations that absolutely reliable statistical tables can be formed. We admit, however, that cases are not infrequently met with in which an absolute and prompt diagnosis is a matter of difficulty. Acute follicular tonsillitis may bear a close resemblance to diphtheria. Points of exudation derived from neighboring crypts may coalesce into a continuous sheet of deposit which has a very doubtful appearance. We have observed a marked instance of this kind within the last few months. To add to the confusion which may arise follicular tonsillitis occasions fever, enlargement of cervical glands, and prostration of strength. Furthermore, this and other forms of sore throat afford an excellent field for the development of the Klebs-Loeffler bacillus; so that what began as a common inflammation may be transformed into a diphtheritic process. During the last few weeks we have noticed in the journals reports of many cases of diphtheria successfully treated by means of antitoxin. The cases were so numerous as to excite the thought that they were in excess, and that a proportion were instances of other affections. It is highly desirable, both in the interest of science and humanity, that the new method should be thoroughly and impartially And yet, to meet the demands of daily duty, should there often be a inistake in the diagnosis of diphtheria? We lay aside the oft-disputed question as to the unity or duality of laryngeal diphtheria and membranous croup. The fact that such a doubtful question does exist, how ever, is a further argument in favor of confirming by bacteriological examination the diag—that is, scientifically-examined. The prenosis of every case which is admitted into tables intended to show the value of the new method of treatment. Ordinarily, it would seem that one could scarcely make a mistake. Do we not all retain a vivid recollection of the first case with which we were, as young practitioners, brought into contact? Having seen it once, can we ever fail to recognize its typical feature? Nevertheless, the typical feature may be disguised. Classical cases occur nowhere except in text-books. Our diagnostic schemes are beautifully clear on paper. It is at the bedside that the picture is apt to be obscured. It sumption is that the specific antitoxin of diphtheria can be a beneficial remedy in that disease alone, and that if mistakenly applied to others it will fail to have the desired effect, and may even prove directly injurious. It is, consequently, simple justice to a therapeutical procedure which may prove of the highest value in a destructive malady that the cases submitted to its influence should be properly chosen. Otherwise the agent may be undeservedly discredited. SCARLATINIFORM RASHES. would almost seem, moreover, as if the picture THE study of erythematous eruptions, of diphtheria were far from clear in the minds of all physicians. We will lay no stress upon matters of popular hearsay, though it is of common occurrence to hear of cases being pronounced diphtheria which every point of especially in children and when accompanied by fever, is not only interesting in itself, but it is also charged with much importance in relation to a physician's reputation and success. As a rule, one must quickly prove himself the master of the situation. Failure and certain products of indigestion. Among of identification is fraught with mortification the drugs which excite an exanthem is merand reproach. The mother, bending anxiously cury, and in a paper by Dr. L. Galliard, over her child, inquires," Is it scarlet fever?" on "Scarlatiniform Erythema,' some interIt is that disease so justly dreaded by parents, esting examples are adduced of the influence which every erythematous eruption suggests. of this drug upon the skin. In different inIt is not in every instance that the physician stances the effect is produced either by the exis able, from the appearance of the rash ternal or internal administration of mercury. alone, to pronounce decidedly concerning its Alley and Bazin have described three forms of nature and origin. It will be frequently neces- hydrargyrism as it affects the skin,-viz., besary for him to inquire into the history, to nign, febrile, and malignant,-in the last of compare local with general conditions, and to which serious constitutional symptoms also debate cautiously with himself in regard to the bear witness to the toxic influence, and which meaning of a suspicious throat. Some ery has in rare instances a fatal termination. Halthemas closely resemble the rash of scarlet lopeau has published the history of a syphilitic fever. On the contrary, the eruption of un- so peculiarly susceptible that a single applicadoubted scarlatina is not always as distinctive tion, or a single dose internally administered, as could be desired, and, in order to frame a caused the appearance of a scarlatiniform rash diagnosis, we must take other manifestations of which was followed, at the end of about two the case into consideration. The eruption may weeks, by a much more abundant desquamafirst come out upon the forearms or legs in- tion than usually occurs in simple scarlatina. stead of the face. The febrile movement may A rash of similar character may follow the innot be very active. The sore throat may not gestion of belladonna and other members of be very well marked. Yet the case may be the solanaceous family, opium, benzoic or saligenuine scarlatina and may possibly, after a cylic acid, ether, chloral hydrate, antipyrin, favorable progress through the early stages, and sulphate of quinine. That due to bellaprove fatal from nephritis. We recall a case, donna is accompanied by but little fever or mild as to fever and throat, in which the pruritus, and is not followed by desquamation. earliest objective manifestations were a rose- The peculiar dryness of the throat and the colored erythema developing first upon the dilatation of the pupil should lead us to susforearms and face, together with a puffy con- pect the influence of belladonna or an allied dition of the face. The color of the rash was drug. very different from the usual "boiled-lobster " hue, and the swollen face suggested the presence of acute Bright's disease. In other cases the throat trouble is so marked during the first twenty-four or thirty-six hours that one might be misled into overlooking the constitutional aspects. In fact, the occurrence of sore throat in young children should cause us to think of scarlet fever just as pain in the right flank in young adults suggests a thought of typhoid fever. The causes of an erythematous rash, apart from scarlet fever, are various. Some are caused by drugs, some by gastro-intestinal disorders, others are produced by infections distinct from scarlet fever, while in a fourth class the mode of origin cannot be ascertained. A toxic influence is common to certain drugs Shell-fish and other articles of food, when they affect the skin, generally cause urticaria; but that food may give rise to a rash simulating that of scarlatina is demonstrated, among others, by some cases observed and reported by the late Dr. Jubel Renoy and caused by eating pork. As is well known, but perhaps not generally enough recognized, the development of the specific eruption of small-pox is sometimes preceded by a rash which resembles that of scarlatina, and which may be the cause of embarrassment if one do not habitually bear in mind the possibility of its occurrence. Diphtheria, also, is sometimes accompanied by an erythema irregular as to time of development and mode of distribution. * La Médecine Moderne, November 14, 1894. |