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cases of a somewhat similar character. There is no for about three months had been under treatment for question as to the accuracy of these observations. I do syphilis. For a short time the vaccine vesicles ran not admit, however, that such cases necessarily prove their ordinary course ; they finally dried, but pus any antagonism between the streptococci of erysipelas formed beneath them, and ulceration progressed until and the germ of syphilis or its products. Erysipelas a perfectly typical syphilitic ecthymatous ulcer recures a simple ulcer, and the hard, callous ulcers of

sulted,

This extended to the size of a half dollar and the leg, quite as readily as the syphilitic processes did not yield until I substituted the mixed treatment described by the authors mentioned. Not that I de for the mercury that the patient was then taking. ny the possible antagonism of germs of various kinds, Aside from his syphilis this patient was healthy, and but I believe that in our microbic enthusiasm we are as he was taking mercury in small doses, there is no forgetting the relations of such processes as erysipe- question in my mind as to the relation of the syphilis las and syphilis to tissue nutrition.

to the ulceration. In this connection the question As is well known, it is not the poison of syphilis per arises whether such instances do not explain many se that prevents healing of syphilitic ulcers, but it is cases in which the accusation of having used impure the local choking up of tissues with the syphilized cells. virus is made against the physician. In children Erysipelas is for the time being attended by greatly with hereditary syphilis, such a case might lead to exaggerated activity of the nutritive processes and a results very embarrassing to the physician. I have in rapid breaking down and removal of the syphilitic mind the case of a practitioner that narrowly escaped neoplasm. Inasmuch as the syphilis has probably no a malpractice suit at the hands of the parents of a directly corrosive action upon the tissues, and no ef child that, it was claimed, lost its eyesight as a refect at the sight of the neoplasm other than that inci sult of a syphilitic keratitis following vaccination with dental to a heaping up of rapidly proliferated mate impure virus. Knowing the gentleman who had vacrial, the erysipelas runs essentially the same course as cinated the child; and being assured by him that he under ordinary circumstances. I am of the opinion

I am of the opinion had used bovine virus obtained from a reliable firm, that the cessation of active anti-syphilitic treatment and furthermore, being rather skeptical as to the posand the substitution of the tonic and stimulant regi- sibility of the existence of the syphilized heifer, I took men so essential in erysipelas, has much to do with some pains to inquire into the case. I found that the the beneficial effects of erysipelas in such cases as vaccinia had run its usual course for about two weeks, those described by Horwitz and Neumann. It is to when transformation into an ulcer occurred, and it be remembered that malignant syphilis is probably so was less than two weeks after this that the trouble not because of a high degree of toxicity of infection, with the eyes developed. This alone was enough to but because of a high degree of constitutional sus exculpate the physician, and if it were not, the caceptibility and lack of tissue resistance. The effects chectic aspect of the child, the peculiar appearance of of a germ of any variety depend on the condition of its teeth, and the absence of axillary bubo certainly the soil in which it is implanted. To say that erysip- proved his innocence. It required very little arguelas is beneficial to the local process in patients suf ment upon my part to convince the father of the child fering from syphilitic ulceration because the strepto that it was best not to take his case into court. coccus of the one antagonizes the bacillus of the Chancroids occurring upon syphilitic subjects are other-admitting for the sake of argument that syph. likely to become phagadenic, and gangrene is likely ilis has a bacillus--is the argument of post hoc propter to occur in patients broken down in the period of hoc with a vengeance! If, however, we admit the sequelæ from overtreatment and the disease in comclinical facts, and explain them by a modification bination. I am inclined to think that overactive of the soil, we are at least within the bounds of treatment has more to do with the constitutional conlogic.

dition and tissue depravity than the syphilis. As to this point, although irrelevant to the imme I have had a rather limited experience in fractures diate question in hand, it is worthy of note that in occurring in syphilitic subjects, but I have not noticed spite of all that has been said regarding the relation any difference between the rapidity and thoroughof the bacillus tuberculosis to consumption, and the ness in repair of otherwise healthy subjects with action of the latest scientific phantasm, tuberculin, secondary syphilis and the rapidity and thoroughness upon the disease, we are still brought face to face of repair in absolutely healthy patients. I have in with the discouraging fact that we have no method of several instances observed bad results in cachectic treatment to offer that is more reliable than that of and intemperate syphilitic subjects. Such our medical forefathers, who achieved their best re seem to be especially prone to necrosis and nonsults from measures that modified the soil in which the union. bacillus flourishes. There are few clinicians that, I have seen one case of necrosis of the humerus, however enthusiastic they may be regarding the following a fracture in a syphilitic subject, in a man lymph treatment, would not give more for measures who absolutely disregarded my advice and kept himof hypernutrition and superoxygenation than for all self comfortably intoxicated for some weeks following the lymph ever manufactured. I would not pose as the injury. This case finally went out of my hands, an iconoclast, but I think that we had better realize and I know nothing of its subsequent history. that there is much in the heritage of philosophy that other instance I observed nonunion of a Pott's fracthe fathers in medicine have left us. Our hero-wor ture in an intemperate syphilitic subject, but in both ship and our dalliance with strange gods are fast lead of these cases I attributed the unfavorable result to ing us away from the philosophical relations of medi constitutional depravity induced by dissipation rather cine into the realms of medical sensationalism and than to the syphilis per se.

In the period of sequela fadism.

or the so-called tertiary stage of syphilis, operation Vaccination of subjects recently syphilitic is apt to wounds and surgical lesions are liable to pursue an be followed by unpleasant results. In this connection unfavorable course as a consequence of one or all of I recall a case in which I vaccinated a gentleman who three conditions:

cases

1. Profound syphilitic cachexia, due to the pro- likely to occur until the patient had had a thorough longed and secondary severe stage.

course of mercury and iodide of potash. The patient 2. The abuse of mercury.

has not yet made up his mind upon the question of 3. The condition that often prevails-alcoholism. operation, but most practical surgeons will bear me

Operations about the mouth, naso-pharynx, and out in the assertion that an operation will be the fauces during the active period of syphilis have, in surest method of treatment for the patient's general my experience, been attended with some disagreeable condition. results. Clean incised wounds are rarely made in A case in point is one in which I operated for cenoperating in these localities, and it is well nigh im tral syphilitic necrosis of the tibia involving the entire possible to keep wounds of these parts in a perfectly shaft of the bone for about four inches. The question aseptic condition, or free from irritation. Rest is also arose in council as to the propriety of operation until difficult to secure. In the case of the mouth and after vigorous antisyphilitic treatment for a few pharynx, the contact of the food and the movements weeks. I advised immediate operation, which was of chewing and swallowing are sufficient not only to finally consented to. After removal of the necrotic aggravate mucous patches and ulcers, but even in bone I applied a fenestrated plaster bandage, put the perfectly healthy individuals often serve to develop patient upon cod-liver oil, and allowed him to go out ulceration in wounds of these parts. In syphilitic pa on crutches. Repair was quite rapid, and at the end of tients, typically specific ulceration is apt to follow three months the patient was able to get about withsurgical lesions. Excision of the tonsils in syphilitic out artificial support and had gained about twenty subjects has, in my experience, several times resulted pounds in weight. in obstinate ulceration. An illustration of this has recently come under my observation. A gentleman who had been under my care for syphilis for nearly

Infant Feeding. * two years, but in whom no lesions had been observed

By S. C. STREMMEL, M. D., MACOMB, ILL. for eighteen months, came to see me in regard to several ulcers on the inner surface of the lower lip. These

Owing to a variety of circumstances and many inhad the appearance of typical gummatous ulcers, one

dividual idiosyncrasies infant feeding is a most diffiof them being quite deep and ugly looking: On in

cult problem. quiry I found that these ulcers followed a blow upon

The clinical experience of different writers has the mouth that caused laceration of the mucous mem

given rise to a wide diversity of opinions, well suited brane by the teeth at the site of the ulcers.

to keep one tossing upon the wide sea of unsettled I have seen several cases in which laceration of the knowledge. gums by the dental forceps, in the careless extraction Every practitioner has seen infants thrive heartily of a tooth during the active period of syphilis, had

under miserable hygienic conditions, and by the use caused ulceration of a typical specific character. In

of foods that would, in the average case prove fatal one instance I noted extensive ulceration of the pal

within a fortnight. These cases are the exception, ate, apparently precipitated by laceration of the gums

and should not influence us in the management of inin the removal of tartar. Crushing injuries are apt in

fants as a class. syphilitics to be followed by ulceration of a typical

The chief barrier to our success in infant feeding is character. I have seen several cases of onychia syph

our comparative ignorance of the physiology of inilitica, with loss of the nail resulting from crushing of fancy and a sufficiently thorough knowledge of the the end of the finger.

minute chemistry of foods. The efforts of the past reOperations upon the cartilaginous and bony struc

mind us of the alchemist of the dark ages who filled tures of the nose in syphilitic subjects are apt to be fol- his crucible with mysterious compounds and sat by lowed by slow healing, and perhaps ulceration of the patiently waiting for the evolution of some grand disoperation wounds. Lack of rest and the contact of covery only to meet with dire disappointment. irritating secretions in all such cases afford sufficient

We however know that the digestive apparatus of explanation. Bruising of the periosteum and bone is the newly born infant is in a state of incomplete delikely to be the determining factor in the production velopment. The secretions of the salivary, peptic of a node. Ulceration and caries or necrosis are, of

and intestinal glands are scanty, and the diastatic accourse, thus more likely to result than in syphilitic tion of the ferments is scarcely perceptible. The bile nodes and osseous inflammations occurring indepen- is deficient in inorganic salts, cholesterin, lecithine dently of traumatism.

and bile acids ; but emulcine is present in sufficient In broken down syphilitic cases suffering from quantity to dispose of a fair amount of fat. operation wounds and injuries, my experience has led For the nutrition of this delicate organism nature me to exercise great caution in the exhibition of anti

has provided a food which is simple in composition syphilitic remedies, and I have come to regard the

and universally acknowledged as the food par excelgeneral condition of the patient, independently of his lence for infants. Nevertheless we frequently see the syphilis, as much more importance than the old con

nursing infant suffering from every form of indigestion stitutional affection; in other words, I find much bet and showing unmistakable signs of malnutrition. ter results from treating the patient than from treat

These disturbances are caused by temporary or pering his syphilis.

manent changes in the composition of the mother's The question of the influence of the syphilitic milk or to irregularity in nursing. I will not discuss dyscrasia upon the repair of operation wounds was here the many conditions which influence these brought to my mind not long ago by the protest of a

changes further than to say that an improper diet or physician against my operating upon a case of syphi- anything which interferes with the general health and litic necrosis of the tibia. The physician thought peace of mind of the mother may cause them. that an operation was unwarrantable, and that repair

* Read before the Military Tract Medical Association at of the bone and of the operation wound would not be Peoria, I11., Oct. 20 and 21, 1891.

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Unfortunately many of these little sufferers are According to analyses made by Dr. Charles Harrecklessly weaned to take their chances as bottle fed rington, of Harvard, the composition of human milk babies, when by proper attention to the mother or is as follows: perhaps by taking it from the breast for a few days or

Reaction.. .slightly alkaline. weeks as the case may be it would go on to natural

Water.... .87 to 88 per cent. improvement.

Total solids.. 13 « 12 I wish to state here emphatically that the nursing

Fat.....

.3 4 infant should never be weaned under age unless it is

Albuminoids.. 1 - 2 absolutely necessary, and that it is seldom necessary

Sugar..

.7 except in the presence of serious and wasting dis

Ash.. eases. Sometimes the mother does not have sufficient nourishment for her infant. In that case it should by This, of course, is subject to variation. In the alno means be weaned but should be fed and nursed buminoids are included casein and an albumin rather alternately. The popular and fallacious belief in the obscure in its composition. Cow's milk, though not incompatibility of nursing and feeding disappears be the nearest approach to human milk, is accessible to fore the brilliant results of experience. My own ex every one in the civilized world, and when properly perience coincides with that of others and has been prepared is the best food to use. This, however, premost satisfactory.

sents differences which seem slight but are sufficient Irregular and too frequent nursing is often respon to cause failure frequently when used as a substitute sible for a fretful and despeptic baby, and sometimes for the natural food of infants. The following analyseems even to afford a pretext for weaning. I recall sis shows us the composition of cow's milk: to mind now a little patient whose mother, a hearty ro

Reaction..

..slightly acid. bust woman, gave me the following history: “Six weeks

Water..

.87.80 per cent. ago when the baby was three weeks old it began to

Solids.

13.20 be restless, vomited frequently and wanted to nurse

Fat....

4.00 every few minutes. The doctor told me that my milk

Albuminoids

4.00 was poison to it and that I must wean it. I did so

Sugar..

4.50 and fed it boiled milk, but that didn't help it. It

Ash

.70 vomited more, cried nearly all the time and four weeks ago began to have a diarrhæa. The medicine would We see that it is acid in reaction, contains more check the bowels for a day or two then they would be fat, much more of the albuminoids, a large percentas bad as ever again. It was getting worse all the time age of which is casein, and less sugar. To give a and losing flesh rapidly." I told her to put the baby baby this food in its original state as it was intended back to the breast. She said she hadn't nursed it for by nature for the calf, whose digestive power is susix weeks and didn't see how she could. I encour- perior and whose organism and growth differ in many aged her and advised her to use the breast pump, then respects, is unscientific and a grave injustice to the in two hours nurse it, then in two hours use the breast human infant. We can, however, modify cow's milk pump again and to continue alternating in this way. in such a way as to make it resemble fairly well huShe did so and in two weeks succeeded in restoring man milk, by first adding lime water to change the the normal secretion of milk, and her baby made a reaction, then add water sufficient to bring the alburapid recovery.

minoids down to one or two per cent. By so doing The unnatural habit of putting the infant to the we diminish the fat and sugar too much. We must breast whenever it cries as though nursing was a now add cream and sugar of milk enough to bring panacea for all its ills and wants as well as to appease them up to four and seven per cent.

I know of no its hunger should be strictly discouraged. Under six better formula than that suggested by Dr. T. M. months of age it should not be allowed to nurse more Rotch, of Boston. It has been more satisfactory in than once in two hours, and above that age not more my hands than any other food I have ever used. It than once in three hours. If the mother cannot nurse is as follows: Take of milk two ounces, cream her infant the next best thing is to get a wet nurse. three ounces, water ten ounces, sugar of milk six and In the country this is very difficult and sometimes im three-quarter drams, and lime water one ounce. The possible.

milk, cream, water and sugar of milk are mixed and When from any cause whatever it becomes nec steamed in sterilizer for one hour, then add lime essary to resort to artificial feeding our skill and water. Of course this as it is will not suit every case, genius are taxed to the utmost. The tendency of the I diminish or increase the solids as each individual age is to herald every new theory with enthusiasm to case requires. I make little or no variation in the the exclusion of everything else. For some time the

For some time the quality of a food for the different periods of infancy. quality of food alone engaged the attention of the There are few if any changes in the mother's milk. It medical profession. Then sterilization was declared is important, however, to increase the quantity from the secret of success. We know now that these are time to time. but factors in the solution of the problem, and not Having selected the above food the next step is to until all the different elements of the subject are sterilize it. By so doing we again imitate nature. If known and appreciated can we hope for a fair state human or cow's milk is put into a carefully sterilized of perfection.

test tube without exposure to the air and sealed, it I have tried to emphasize the importance of moth will remain sterile for months, while if exposed to the ers nursing their infants, because it is eminently the air as cow's milk is during the process of milking, most successful method of bringing them up. If this straining, etc., it will swarm with bacteria and germs be true it behooves us to imitate nature by the selec in the course of twenty-four hours. We thus see that tion of a food whose physical and chemical character the nursing infant gets sterile milk, and we know istics resemble as nearly as possible the natural food. that the greater bulk of adult food is sterilized by

we

cooking. By what mode of reasoning then can very offensive. Then came a system of treatment impose upon the helpless infant a food which we which is more conspicuous for its common employknow contains a variety of bacteria, ptomaine poisons ment than for a judicious and scientific medication. and often diseased germs.

Bismuth, opiates and astringents were used freely. The modern researches in bacteriology demon The acid cow's milk rich in casein bacteria and strate beyond a doubt the transmissibility of various ptomaines was continued. It was like dashing a cup disease germs through milk. The most virulent and of water into a fire to extinguish the flames then perdeadly of which are the bacilli tuberculosis. These sistently applying the torch. Of course it went from bacilli have been found in the milk of cows whose bad to worse. The food instead of digesting fergeneral condition was such as not to lead to a sus mented and decomposed. This soon brought about picion of tuberculosis. As a safeguard to these germs pathological changes of a serious nature. First there alone, if for no other cause, milk should be strictly was a general catarrhal condition of the bowels then sterilized. I cannot lay too much stress upon the there was hyperplasia of the lymph nodules followed importance of sterilizing milk. It is scientific and by follicular ulceration. The characteristic remisright.

sions of pain and restlessness raised the suspicion of I have used a number of Siebert's sterilizers, which malaria then quinine and Fowler's solution were are cheap and good. I prefer Arnold's steam steri added to its woes. lizer and think it is the best apparatus I have seen. The little patient was now extremely emaciated. If a sterilizer can't be gotten, use ordinary four, six Its little body and limbs were little more than skin or eight-ounce bottles, as the case may be, put them and bone. The skin was flabby, the eyes sunken and in a kettle of water or common steamer and boil for the sickly pale features were bathed in a cold, clammy one hour, then close the bottles with a plug of perspiration. The respiration was shallow and the absorbent cotton and it will keep for weeks.

feeble pulse beat one hundred and eighty times per My experience with patent foods has been such minute. I was the third physician called and told that I cannot recommend them. We need but notice the mother that it had but a short time to live. In a their composition to see that they are very different few days it was driven to the cemetery another vicfrom human milk. Nestle's food contains three per tim to bad feeding. cent starch, very little fat and but three and one-half per cent of sugar. Melin's food and the Imperial granum are acid and contain starch, little sugar and

Diphtheria.* fat. Carnrick's food, when ready for use, consists of

By W. S. McCLANAHAN. M. D., WOODHULL, ILL. 97.22 per cent of water, 2 per cent dextrin and only .78 per cent other ingredients. The formula which I It is not the purpose of this paper to enter the have given is a much nearer approach to human milk

realms of science to discuss the bacterian theory and and the clinical experience with it is far superior.

its relation to diphtheria, whether the disease be priIt seems strange to me that so many general prac

marily in the pseudo, membranous formation and titioners pay little or no attention to infant feeding, followed by constitutional affects. Nor whether the yet more human lives may be saved by the judicious ad- active poison be first in the blood and tissues as a ministration of foods than in any other department of

cause and favoring the development of the diphtherimedicine. I do not exaggerate when I say that

tic membrane; nor will any attempt be made to thousands of infants die every year who could be change the minds of any one regarding the endemic, saved by proper feeding. This is a frightful state

epidemic, infectuous and contagous character of mament, but it is true.

lignant diphtheria, but will simply relate a few facts Frequently, when giving directions for feeding, the gathered during an epidemic of this disease which ocmother will say, and sometimes the physician too,

curred prior to and during the month of May this that they have seen a number of cases get along all year in the town of Nekoma and vicinity. To make right without any such mode of procedure. Such this history more complete it will be necessary for me statements are as sensible as to say that a number of

to record several cases that were not in my own pracour soldiers came from the late war without a scratch,

tice. The latter part of December, 1890, two childtherefore there is no danger in facing a storm of shot

ren of Mr. H-, living in N, died of malignant diphand shell. They fail to appreciate the cause of the

theria in the course of three or four days from date of symptoms of bad feeding and are ever ready to attrib

attack in each case. In both cases the membrane exute them to teething and worms. These cases often tended to larynx, also to schneiderian membrane. In present every symptom of indigestion, mycotic diar

a few days the mother developed the same disease, rhoea and enterocolitis, and unless treated by proper

but as the membrane was confined to tonsils and pilfeeding, as a rule prove fatal.

lars of fauces she recovered in the course of ten days The following patient which I saw some time ago

or two weeks. In May, 1891, a four year old son of in the last stage of entrocolitis illustrates this unfor another Mr. H. died of diphtheria and measles comtunate class of cases. The mother and nurse gave

bined, was sick but a few days, membrane extended me the following history: When the baby was six to larynx. I saw none of these cases but it was in months old the mother had a suppurating mastitis.

this same house that I afterward treated five cases By the advice of her physician she weaned it and fed

and lost one. it cows milk. She used a common nursing bottle

May 5th, was called in consultation with Dr. W. to with long rubber tubing; the most pernicious appara

see the first case of malignant diphtheria I had ever tus ever made for infants. It did very well for a few

Mack L., aged fourteen, had been sick about weeks when it began to have colic, was restless at one week. Tonsils, uvula, and pharynx had been night and the passages from its bowels contained covered with pseudo membrane and partially cleared thick curds. In a few days a diarrhea developed,

*Read before The Military Tract Medical Association, Peoria, the discharges of which were green, egg colored and Ill., Oct. 20 and 21, 1891.

seen.

was

off, but at this time the membrane was extending over vom. and electricity these have all disappeared and
the same territory again. Membrane had also in now five months after he is walking one and one-half
vaded the larynx. We had tubular breathing and a miles to school every school day.
barking, whistling cough. Temperature, 102°; pulse, Ethel's nose and throat were clear in five days and
80. Patient restless. It might be well to add that from that time on made a rapid recovery. The fourth
this patient had been exposed to measles shortly be- day of her sickness her sister aged twelve, and broth-
fore he was taken sick and at this time the character ers aged ten and fourteen all had characteristic patch-
istic measle eruption showed on face, neck and chest. es on their tonsils. Membrane spread rapidly in all.
An unfavorable prognosis was given. The unfavor With the fever, prostration, and other symptoms of a
able symptom being the croupous character of the severe disease. The ten year old boy grew rapidly
diphtheria.

worse without one favorable symptom and died the The treatment had been a spray of dilute solution morning of the fourth day. In this case the whole of hydrogen peroxide used occasionally for the throat throat, tonsil fauces, pharynx and uvula and as far and gelsemiun and bryonia. (I don't know what dilu forward in the mouth as the first molar tooth were all tion) to allay fever. I ordered in addition 20 gr. hy covered with membrane. The nose was also full of drarg. bichloride every two hours

The case

membrane, which in this case was fully one-fourth of seen again that evening, with no change in the symp an inch in depth or thickness. The night before he died toms. Patient could get out of bed without help. I attempted to remove some of it by grasping the anThe same treatment kept up till he died, which terior edge on the roof of the mouth with a pair of event took place about two o'clock the next morning. dressing forceps. It bled so freely and was attached Dr. W. remained with him during the night, and said so firmly to the mucous membrane that all efforts in about two the patient remarked that he must use the that line were abandoned. The disease in the other chamber, which he did, getting out of bed and back two ran a similar course to the first two cases deagain without help, and in less than ten minutes was scribed and fully recovered. The worst symptom not dead. The cause supposed to be heart failure. lasting more than eight days in either case. Two

May 8th, was called to see Ethel H- and Guy B weeks after Guy B. was taken sick, his sister aged saw them both at the commencement of the throat sixteen came down with the disease. I saw her about trouble. As these two cases were the first cases I three o'clock in the morning. Was well the evening treated, being the same age, nine years, and seen the before. On examination throat was very red, tonsils same day and in many respects running a similar swollen, and on the right one could be seen two little course, I will describe them together. At first visit chamois colored spots not larger than twice the size found them vomiting, temperature 10234, pulse 120 of a pin's head. I tried to wipe them off but failed. and 135 respectfully. Glands of neck slightly en Still I informed the parents that owing to her age and larged. On examining throat, the tonsils were en strong constitution she would likely not have the dislarged and red. Small patches of membrane on both ease very hard, which I admit now was a great misbut more on the left than right in each case, but in take on my part, for when she was seen about thirty less than the twenty-four hours from date of first visit hours after, somebody was actually frightened, for in the tonsils, fauces, uvula and schneiderian mem looking into that throat nothing could be seen but brane were all covered with a thick chamois skin that terrible mernbrane that I for one was getting membrane, completely obstructing the nostrils and tired of seeing. Her throat was so similar to the ten causing a constant discharge from the nose. The year old boy's that died, that I felt sure this case respiration was guttural. This symptom was more would end in the same way, but we worked faithfully prominent during sleep. The fauces were swollen for four days and nights when the membrane began to and of a deep red hue as seen around the edge of the loosen around the edge on the roof of her mouth. pseudo membrane. When any of the membrane was The fifth day I removed one piece from the roof of removed by the action of remedies it rapidly re the mouth and one from each buccal surface. The formed. The worst symptoms lasted three days with three pieces together measuring two and one-half Ethel and five with Guy, during which time both inches square and one fourth inch thick and each were threatened with heart failure, which at times succeeding day for several days great pieces of memwould become extremely weak and irregular. Ethel brane would be removed from some part of her throat, had slight bleeding from the nose the third day, and leaving usually a bleeding surface. It would reappear from the third to fifth day Guy had several violent but not so thick as at first. In two weeks time all attacks of epistaxis, so much so at one time that the was gone, yet it was two months before she could be tampon was resorted to in order to arrest the bleed understood when talking and several weeks before she ing; this was done by saturating some cotton with tr. could take any but liquid nourishment and that only ferri chlor. and placing it in the anterior nares, this by holding her nose and throwing her head back to stopped the external outlet.

allow the liquid to run down her throat. She could The posterior one was already closed with mem neither talk, swallow, cough nor (spit). She is now brane. It was ten days before all traces of the mem perfectly well. The family of Mr. L. had lost a four brane left Guy's throat, his tonsils were still swollen year old girl after a six days sickness and the father and evidences of the violent disease we had been was now down and very sick with diphtheria, both fighting could still be seen. The uvula was at least under the care of another physician, but I was called one-half destroyed. There were ragged edged fissures

to attend the only remaining child, a little twenty-one and holes in the tonsils that looked like they had been months old girl. The disease in this case assumed torn and at least one-fourth of an inch in depth, but the usual type. The membrane was confined to tonfrom this time on he gradually improved for nearly sils, fauces and schneiderian membrane ; her throat one month when paralysis began to show itself, prin was free from diphtheritic membrane by the sixth cipally in the lower limbs; he also had double vision day, but being so young none of it was expelled but for about three weeks, but with the aid of tinct. nux passed into the stomach, she gradually became

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