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gave the first teaspoonful to my patient. This dose was repeated every two hours.
The remainder of the day passed over without anything particular occurring. Towards evening, however, the patient fell into a quiet sleep, which had not been the case for several days, and he was but little disturbed during the night. Whilst it lasted I could only notice a change in the sound of the less frequent cough. It sounded more scraping than barking; the respiration, too, was more regular and noiseless. In the morning the patient awoke refreshed and wanted food. He got some beef tea and immediately fell asleep again. On inspecting the throat we found the contours of the soft palate distinctly visible. Some small remains of pseudo-membrane were to be seen. The mucous membrane exhibited no great degree of swelling or redness. The coating on the tongue was transparent, the temperature of the skin normal, the pulse strong, and nearly normal in frequency.
The remainder of the convalescence was completed in an astonishingly short time, the meHicine being continued at longer intervals. Sleep, appetite, normal alvine evacuations and copious urinary secretion returned, and strength and plumpness were soon restored. In three days more the child bore no traces of his serious malady.
As this case was unique, we could not be sure whether it was one of spontaneous cure or due to the remedy employed. But we did not remain long in doubt. A week afterwards I met with a similar case in the family of a poor man who had just lost a child from diphtheria, where no medical treatment had been employed. When a second child, an ill-nourished, three-year-old boy, sickened in the same way, the parents sought my aid. I undertook the treatment under the most unfavourable hygienic conditions. My new patient was in close proximity to the corpse of the diphtheric child, which was only removed twenty-four hours later. He lay on a dirty bed on the floor, covered with dirty rags. When I arrived the mother had just been scrubbing the floor; the walls of the room were damp, a thick coating of ice encrusted the window. The diphtheria was fully developed. The disease had been ushered in by prostration and headache. After a restless night there was pain on swallowing, no appetite, no motion of the bowels, diminished secretion of urine. I found the tonsils and velum palati covered with a yellowish-white pseudo-membrane, the tongue was coated with a thick yellow fur. The submaxillary glands were swollen and tender to the touch, the cutaneous temperature was irregularly distributed, the pulse small and scarcely to be felt, the prostration great; the voice was hoarse, no cough.
Taught by the experience of my child's case, I immediately prescribed the Cyanuret of Mercury in the abovenamed form and dose. After three doses at two hours' intervals, sleep came on and lasted all night. On awaking the patient wanted food. Inspection showed only a few remains of the pseudo-membranous exudation, which all disappeared in the next twenty-four hours. There was scarcely any stage of convalescence. In three days he was perfectly well.*
In view of the above-described bad hygienic conditions and the short duration of the disease, I could not doubt the fact of a cure by art. I had ample opportunity of confirming this impression during the enormous prevalence of the diphtheric epidemic in Petersburg in the following weeks and months. The cases that came under my care were very numerous, and I treated them all without exception with the Cyanuret of Mercury, with equal success, whilst all around, under the constant employment of Nitrate of Silver locally, and the frequent recourse to laryngotomy, the mortality was enormous. The plague
• Although my treatment might be considered as ended, I continued to visit the patient. On visiting the wretched house one afternoon, I found the patient sitting on the window seat, his back towards the window, which was covered with ice. I had him immediately removed to a more appropriate seat and reproached the mother for her carelessness. I was unable to repeat my visit until after the lapse of forty-eight hours, when I found him suffering from severe laryngitis with violent fever, which under Phosphorus was cured in two days, so that the child could be pronounced quite well. The observation of two serious diseases cured in this ill-nourished child, without leaving a trace behind them, convinced me of the power of art to cure diphtheria.
lasted through the winter and spring with undiminished violence; every week I had two or three cases, and up to the month of July of that year I had had to treat sporadic cases which occurred in the summer residences outside the town. Then the epidemic extension of the diphtheria declined, but there were frequent recrudescences of the epidemic in the following year, though limited in extent; even yet it is not quite extinguished. It became endemic as it did in other thickly populated places.
I may spare myself and my readers the further record of cured cases of diphtheria, as I have given my first two cases in such ample detail that the reader may understand my position. The course of the cure was the same in all cases, even those complicated with scarlatina proved no exception. After the first doses sleep came on, which in most cases was tranquil, seldom disturbed and then only for a short time. The only exception to this was in the case of hypochondriacal men and hysterical women, but this did not interfere with the other favourable progress. On awaking the patients wanted food (which was supplied in moderation), the act of swallowing became less painful, in some cases all pain ceased, the patches of exudation were mostly, in some cases completely, gone, the colour and size of the affected mucous membrane and glands were nearly normal, the pulse was increased in strength and diminished in frequency; normal faecal evacuations soon occurred, the quantity of urine was increased. The doctor at his second visit was received by the patient with a smiling countenance. Perfect health was speedily restored after the disappearance of the last traces of the disease; there was no stage of convalescence worth mentioning, indeed, not unfrequently in children after the rapid cure of the diphtheria, there was observed a remarkable development of the whole organism. I never saw any after-affections. I never met with an extension of the diphtheric process on the mucous membrane of the respiratory organs, except in those cases where it was already present before treatment was commenced.
Such was the course of the cure of diphtheria by small doses of Cyanuret of Mercury as witnessed by myself and others during nearly two decenniums in an immense number of cases. There were but few deviations from this course, and these were owing to accidental external influences or complications. I may relate a case which occurred to me in the third year of my acquaintance with diphtheria:
In the month of March I was called to see a man, aged forty, who was suffering from phthisis pulmonum consummata. The patient told me he did not expect any good result from my treatment, as he had long given up all hope of recovery. He only wanted to ask me if I thought he could return home alive after making a journey of several months' duration which he ought to undertake. If he were able to do this, and to make the required report to his employers, then should he die his widow would receive a considerable pension for her life; whereas were he unable to do this she would be left in necessitous circumstances, and be thereby prevented from giving the children a sufficient education. I saw at once that if I decided against his journey that would do him harm, so I advised him to carry out his intention, and I gave him some dietetic and medical advice as to his treatment when ou the journey. When I saw him on his return from his travels, I found that the journey had had a favourable influence on his health.
The decision he had made, and the consciousness of having fulfilled his duty, had proved an excellent remedy. As he went to reside in the country a good way from town I lost sight of him for some time, but in the middle of September I was urgently requested to visit him. Four or five days previously his debility had suddenly increased to a remarkable degree. He h,ad febrile symptoms and complete anorexia. Believing as he did that his inevitable death was near, the patient would not at first consent to my being sent for. But he yielded to the persuasion of his friends, and put himself under the care of two local doctors, who, in order to combat the fever, prescribed Quinine in large doses. No importance was attached to the patient's complaint of difficulty in swallowing, as this had been a constant symptom in the past. But an extremely disgusting foetor of the breath which I noticed on coming into the room directed my attention to the mouth, in which I found on inspection a contourless cavity, covered with a large greyish-green exudation. Even the mucous membrane of the cheeks was coated with this horrible false membrane. The other symptoms of the patient pointed to a highly-developed diphtheric process. As I then always carried about me a small phial filled with globules moistened with the sixth dilution of Cyanuret of Mercury, without delay I could administer a teaspoonful of the solution, which I prepared with ten globules to the same number of tablespoonfuls of water. Expecting to hear next day that my patient was dead, I departed with the request that I might have a report sent to my house. As none came by the following evening, I concluded that my prognosis infausta had been verified. A week later I received a very effusive letter from his wife thanking me for having saved her husband's life. The night following my visit was passed in sleep so far as the cough permitted. Two days after the first dose the mouth and fauces commenced to clean, the appetite returned, and a considerable amouut of streugth was gained, which in the course of a week allowed the patient to pass a portion of the day out of bed. The phthisis pulmonum pursued its inevitable course. Three months after this episode the patient died calmly and easily.
If we consider the uselessness of the previous treatment with Quinine, and the far advanced period of the diphtheric process, together with the complication with the other incurable disease, which must have diminished the resisting power of the patient, this cure of the diphtheria in this case must testify in favour of the remedial power of Cyanuret of Mercury more than that of a case of simple diphtheria.
I remained five years after my first acquaintance with diphtheria in the same sphere of practice. The number of cases treated by me exclusively with the Cyanuret of Mercury amounted to 200, without a single death.
My excellent colleague, Dr. A. Beck, to whom alone belongs the credit of having suggested this excellent remedy,