the peculiar nasal voice, as well as by the regurgitation of fluid nourishment through the nose. There occurs also in some cases an inability to swallow, because the epiglottis is insensible to the stimulus of the food and the muscles of deglutition are quiescent. The food may enter the larynx and cause violent respiratory efforts. Again, the phrenic or intercostal nerves may become affected, in some cases giving rise to deficient respiratory movements, and we have dyspnea present as a result. Hoarseness may occur and the voice may be reduced to a whisper. Breathing becomes irregular and deficient; your patient looks up to you imploringly as if to say, "Cannot you help me to get my breath?" Cyanosis comes on, the face assuming a bluish tint, the patient may experience pain in the stomach, and when asked to place his hand on the locality of the pain invariably places it over the abdomen. Sometimes there is vomiting. The pulse in most. cases is rapid, weak and compressible. Some cases develop extreme restlessness, cold hands and feet, with great pallor, death finally closing the scene.

TREATMENT.

Cyanosis

Prior to the introduction of antitoxine five or six years ago the treatment of diphtheria was practically nil. Since the advent of this new remedy, however, the medical profession has had at its disposal a remedy for diphtheria which performs its work quite as surely and efficaciously as quinine does in malarial intoxication, provided always it is administered in the early stages of the disease. This latter factor is of extreme importance, for too much stress cannot be laid upon the necessity of using the serum with the greatest promptness possible. In former years statistics show that the mortality in diphtheria was 60 to 70 per cent; it now has been reduced to 12 to 15 per cent. Excluding those cases in which the injections were made late and those already moribund, the mortality is still further reduced to 6 to 8 per cent. In the face of such extraordinary and incontrovertible results it is difficult to comprehend the exact reasons why some practitioners (although their number seems to be rapidly decreasing) refuse to give this agent at

least a trial. The results attained and reported by thousands of painstaking and reliable investigators surely constitute evidence sufficiently trustworthy to warrant those physicians who have not already done so making investigations on their own account. their own account. The experience of the writer with antitoxine, covering a period of three years, gained in the service of the Health Department in the city of Baltimore and in private practice, has afforded him exceptional opportunities in making observations along this line. During the period referred to about 110 diphtheria cases have been seen, antitoxine in every instance being used. In only one instance in the writer's experience with these cases has a death resulted. The hearer at this point may raise his eyebrows and say "faulty diagnosis." Every case, however, was subjected to a careful bacteriological examination and the presence of the bacilli was clearly revealed.

The serum cannot be given by any other route than under the skin, and for this purpose a syringe holding five c.c. (seventy-five minims) is best adapted. The one we use (Mulford's) is compact, easily sterilized, and, being made with rubber packing, avoids shredding or drying, so frequently experienced in hypodermatic syringes which have leather or cotton packing. Before using, syringe and needles can be placed in cold water in a suitable vessel and placed on the stove and allowed to boil for ten minutes. While this is going on the site of injection should be thoroughly cleansed with a five-minim solution of carbolic acid or a saturated solution of boracic acid and finally washed with a dilute solution of alcohol or brandy. The site of injection. can be either the cellular tissue of the infra-scapular region, the thighs or the abdomen. We prefer the thigh, because it does not inconvenience the patient while in bed. The site having been made surgically clean, the skin is held between the thumb and index finger and the needle inserted deep into the cellular tissue. We say deep advisedly, for on several occasions, having neglected this precaution, the patient could hardly be controlled on account of the pain induced by

the pressure of the serum upon the surrounding nerves. After injection is made the finger should be held over the needle puncture for a few moments, or, better, a piece of sterilized gauze.

DOSAGE.

As yet there seems to be no absolute fixed rule as to the exact quantity of serum which should be administered. The dose must be regulated according to the severity of the case, although the tendency lately seems to be in the direction of increased dosage, and we are positive that when the serum is administered more freely the mortality will be still further reduced. In a recent case we gave to a child sixteen months old an initial dose of 1500 units, and repeated this quantity without the slightest inconvenience to the patient. Holt declares that the initial dose for a child two years old should be 1500 to 2000 units, and that it may be repeated, if necessary, in eight or twelve hours if no improvement is observable.

Illustrating the great value, in fact the necessity, of immunization by the use of antitoxine, the following account is most significant and interesting: Several months ago in an orphan asylum in East Baltimore a case of diphtheria appeared; others soon followed, until finally eight were under care, while others were developing the early symptoms, and it looked very much as though an epidemic among the 125 inmates was to follow. Antitoxine (P., D. & Co.'s) was administered to the eight cases in heroic doses and the balance of the inmates were immunized. Although several of the children under treatment were severely sick, not a single death occurred, and no further cases developed, the epidemic having been successfully checked. Experience has shown the necessity of using the serum early, without waiting for a bacteriological test. Where the clinical evidence leads one to suspect diphtheria it is proper to immediately inject 1500 or 2000 units of the serum. Meanwhile the bacteriological examination, in confirmation of diagnosis, may be made.

In our experience good results have come from antitoxine of various makes. but we have given preference to that of

Parke, Davis & Co., as being concentrated and hermetically sealed.

"What is a unit of antitoxine?" The standard adopted by reliable manufacturers conforms to the principles laid down by Behring, which may be stated as follows: A unit is ten times the quantity of serum which will neutralize ten times the smallest fatal dose of diphtheria toxine in a half-grown guinea pig. Properly-made serums are standardized so that each unit will be of the strength specified above.

Although the evidence in favor of the anti-diphtheritic serum treatment is overwhelming, it may not be amiss to quote from Holt's valuable text-book on the diseases of infancy and childhood, in which he states: "Certainly there is no remedy for any disease that has more testimony in its favor than has now antitoxine in diphtheria." Were we to stop to quote other reliable authorities on this subject our task would be an endless one. In short, the facts are so well established and so indisputable that any practitioner who fails to avail himself of this wonderful aid in combatting so dreadful a discase is committing the greatest injustice. to himself in jeopardizing his reputation and to the patient in needlessly risking his life.

It is, of course, to be understood that the general treatment should not be neglected. There should be plenty of fresh air, good, nourishing food, and the patient should be kept quiet and not be permitted to stir about the room, although the attack may be mild or apparently cured. As before stated, it is during convalescence that cardiac failure chiefly occurs. Where the patient is unable to swallow recourse may be had to gavage. To guard against the depressing influence of the toxine, stimulants must be employed, namely, alcohol, strychnia or morphia. The alcohol should be pushed, and strychnia or morphia should be immediately employed if there are the slightest indications of heart failure. As to local treatment we have nothing to say in its favor, since it irritates the child. causes the parts to bleed and produces discomfort. generally. Suffice it to say that ordinary cleanliness is sufficient; the secretions should be wiped from the nos

trils gently, not failing to immediately destroy the cloths by burning. Kidney complications, should they occur, are best treated by benzoate of sodium, tincture of chloride of iron and the liberal use of water to flush the kidneys.

P. S. Since the above paper was read a great many additional cases have been seen, and the results attained from the serum treatment only tend to confirm and emphasize the statements made in the foregoing.

Medical Progress.

HYGIENE AT HEALTH RESORTS.-ACcording to the British Medical Journal, a young lady from Berlin was attacked by diphtheria whilst on a visit to one of the seaside resorts on the Baltic. The proprietor of the hotel where the lady was staying was not unwilling to allow her to stay on, but the other guests objected. The unfortunate patient had, therefore, to be removed to a house which happened at that time to be empty, and there after a short time she died. The inconveniences to which families are sometimes subjected at health resorts when one of their party happens to be attacked by an infectious disease may be most trying, and it would certainly be satisfactory if in all largely-visited health resorts fixed rules could be agreed on as to what is to be done in such circumstances. All much-frequented health resorts should have hospitals or isolation-houses, with adequate accommodation, where visitors suspected to be suffering from infectious. diseases can be at once received and where they can be sure of obtaining proper treatment and attention. In fact, on sanitary grounds, all spas and health resorts may be divided into two classes --first, those where the drainage arrangements and the water supply are good, where there are hospitals or isolation cottages ready for use in case of the outbreak of any infectious disease during the crowded season, and where in addition to the special climatic and balneotherapeutic advantages of the place there are likewise facilities for simple, but often most important dietetic treatment; sec

ondly, the numerous class of health resorts which, though often possessing great climatic and balneotherapeutic attractions, yet in sanitary arrangements are altogether deficient, or, at least, not above the standard of the numberless little holiday and summer resorts with which most countries abound. The second class of health resorts are unworthy of receiving the immense number of invalids and visitors which may suddenly flock to them during the season. It would be well if the managing bodies were in all cases to consider the matter carefully, and, if they have not done so already, settle the question to which class. they wish their own health resorts to get the reputation of belonging.

THE PHYSIOLOGICAL EFFECTS OF OVARIAN JUICE.-Ferré and Bestion make a report in the Therapeutic Gazette of the effect of a glycerine and water extract of ovary, and find it to possess distinct physiological influence in males and females, and they find that males cannot stand the doses well borne by females. If a large dose be given to a male he becomes intoxicated and dies, and a female requires double this dose to produce death. The symptoms shown by the male consist in progressive hypothermia, the production of sloughs at the point of injection, excitement of the genital apparatus, with erections and ejaculation of semen, and finally tremors and paralysis. Hematuria may develop. They found tubular nephritis, and in the paralyzed animals congestion of the spinal cords, particularly in the area of the spinal center in the lower dorsal and lumbar region. There was also well advanced lesions in the anterior cornua of the spinal cord. Ferré and Bestion conclude that the juice has a distinct effect. and that the partial immunity of females to this effect is due to the fact that they are accustomed to the ovarian juice in that doses similar to those which caused death in the male will do so in females below puberty who are not accustomed to ovarian activity. They believe that ovarian gland should be cautiously given to women who have passed the climacteric for these reasons.

THE CARROT CURE.-The following anecdote, which is going the rounds, appeared in an English weekly: A Birmingham physician has had an amusing experience. The other day a somewhat distracted mother brought her daughter to see him. The girl was suffering from what is known among people as "general lowness." There was nothing much the matter with her, but she was pale and listless, and did not care about eating or doing anything. The doctor after due consultation prescribed for her a glass of claret three times a day with her meals. The mother was somewhat deaf, but apparently heard all he said, and bore off her daughter, determined to carry out the prescription to the very letter. In ten days' time they were back again, and the girl looked quite a different creature. She was rosy-cheeked, smiling and the picture of health. The doctor congratulated himself upon the keen insight he had displayed in his diagnosis of the case. "I am glad to see that your daughter is so much better," he said. "Yes," exclaimed the excited and grateful mother; "thanks to you, doctor! She has eaten carrots three times a day since we

TREATMENT OF GONORRHEA. — Dr. Behrend reports in the American Journal of the Medical Science that of twelve instances of this disease in males (first attack) after one or two days the gonococci disappeared under the use of 1⁄2 to 1 per cent. solutions of protargol. Upon the clinical. symptoms this remedy had no influence; Better results the discharge continued. were obtained by the use of other astringents, as the alum injection, although the latter does not destroy the gonococci. He treats the disease, while the followers of Neisser treat only the gonococci. The disadvantage of protargol lies in the fact that it acts only on the gonococci which it can reach; those which it cannot it leaves in peace, for it does not penetrate into the tissues.

This provoked a vigorous reply from Frank and Meissner, the former basing his argument upon five months' use of the remedy (133 patients), and quoting Fenger (110 patients), who had lauded the new remedy.

PSORIASIS. Dr. J. V. Shoemaker of Philadelphia describes in the Philadelphia Polyclinic a case of extensive psoriasis

once or twice uncooked-and now look at her!"

SEROGUAIACOL IN THE TREATMENT OF TUBERCULOSIS.-Berlioz makes to the British Medical Journal a communication in which he stated that in order to combat the impairment of the constitution, as well as the microbic infection, he had attempted to combine with serum, which has a stimulating action on the nutrition, a remedy of well-known efficacy in tuberculosis, namely, phosphite of guaiacol. which contains 95 per cent. of guaiacol and soluble phosphorus. A still more active product is obtained by adding glycerinated extract of testicle, liver, brain, spleen, or lung, in the proportion of 3 per cent. This mixture is administered in enemata of thirty grains. Two such enemata may be given daily. Berlioz said that by this treatment he had obtained considerable improvement in tuberculous patients.

pointed out that the cutaneous disorder would not disappear until the constitutional state was corrected. Treatment was directed toward building the system up, improving the condition of the mucous membranes, elevating the nutrition with the aid of such remedies as nux vomica, prickly-ash bark, coptis trifolia and hypodermic injections of pilocarpin hydrochlorate.

*

FOR INTRACTABLE ECZEMA.-It is recommended in the Medical News, in cases in which the application of any medicinal substance whatever seems only to increase the irritation of the skin, to cover the affected area thickly with starch powder. After forty-eight hours the crusts are removed by means of compresses dipped in sterilized water and the powder is reapplied. Excellent results are said to be obtained by this method in very severe cases which had resisted all previous

treatment.

After careful observations on several occasions of the guileful persistency of the house

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The Bacillus and the Fly.

THERE are some medical themes that never lose their vitality. You can subject them to the hottest discussions, or desiccate them for years-generations-in the dryest of statistical compilations, and when the proper season comes round again they stir and come to life again chipper as ever. So is it with the problem of the spread of enteric fever. Now, we have positive proof that it is air-borne; again, that the drinking water conveys it; again, the milkman is laid under suspicion of manslaughter. It certainly seems strange that pure water-supplies are so difficult to be obtained in country regions. There is a deep mystery about it all somewhere.

A factor in the conveyance of the disease— there are different modes, doubtless, in different cases-that has come to the front in the army epidemic which is now crowding the hospitals is the obtrusive house-fly. It seems that certain of the camp privies were only some twenty or thirty feet from the camp kitchens, and the flies-by the million-carried the typhoid poison from the vault to the table, and so infected the food.

would infer that the simplest mode of prevention of such infection of food would be to render all privies fly-proof, or else to cover the surface of fecal deposits with some liquid substance distasteful to flies. The domiciling and breeding of mosquitoes--another possible agent-in city cesspools is said to be prevented by pouring a layer of coal oil on the surface of the water.

The house-fly should not be maligned. He is essentially cleanly, as anyone can see who has watched his efforts to scrub his back with his hind legs. A Swift might demonstrate that he is no worse than the human animal, which latter never sees a sparkling stream of water but he has an impulse to pollute it.

Children

at

THE opening of the public schools and the discussions as to the length and time of the sessions make it evident that not only should school boards be School. composed of men capable of doing their work, but that the latest results of scientific research as. to the ability of young children to apply themselves should be made use of.

For instance, it is known that the power of application to any subject varies not only with the sex and temperament, but also with the stage of cerebral development. Other things being equal, it has been found that a child of ten years can give continued attention, without weariness or distraction, to any one subject much longer than can a child of eight. Also, when the conditions are not the same, as is usually the case, children possess varying powers of application to study. And yet how few school boards, even in the most advanced cities, contain members able to appreciate these facts.

The public school system in most large cities is far from perfect, and from what is known through the daily papers and through other more reliable sources the public school system of Baltimore needs a thorough overhauling to bring it nearer perfection.

When politicians and men bent on self-advancement have to do with the education of the young little can be expected. It is time that good citizens were taking more active interest in the city government.