phate of iron, carbolic acid, and glycerine; third, chlorate of potash and muriated tincture of iron; fourth, muriated tincture of iron and chlorate of potash as a gargle every half hour; fifth, muriated tincture of iron; sixth, "solution of pepsin will dissolve the membrane; try it;" seventh, sulphur, sulphuric acid, and tincture of chloride of iron; eighth, rennet wine, lime spray, and saturated solution of chlorate of potash in form of spray; ninth, "chlorate of potash;" tenth, "steam;" eleventh, nitrate of silver followed by chlorate of potash, myrrh, carbolic acid, and muriated tincture of iron mixed together; twelfth, persulphate of iron 3ii to four ounces of water. One correspondent has faith in large doses of salicylic acid given internally, as in rheumatism.

The question regarding the more successful treatment of diphtheria is just now being urged persistently from many parts of this country and Europe. The Crown Prince and Princess of Germany were at Wiesbaden last April, whither they had repaired after the death of the late Prince Waldemar, their third and youngest son, who died of diphtheria, the same disease which had previously committed such deadly havoc in the family of the Grand Duke of Hesse. As a meeting of Germany's leading physicians was, at the time, in session at Berlin, the Empress of Germany, with her practical good sense, embraced the opportunity to offer an international prize for the best treatise tending to facilitate the cure of diphtheria. A hope has been expressed that American physicians will take part in the competition.

Yours very truly,

WILLIAM A. LOCKWOOD, M. D.,

Reporter.

DIPHTHERIA.

N. E. WORDEN, M.D., BRIDGEPORT.

The printed circular of questions concerning diphtheria, sent out by the Committee on Matters of Professional Interest in the State, was received only yesterday. Before beginning my reply direct, I wish to say a few words which the circular suggests. If they are worth considering, I hope they may reach the committee who would be directly concerned with them. Probably no more important subject than diphtheria could claim the attention of the medical men of our State: a disease so fatal, so little amenable to any kind of treatment, so common, and whose manifold causes lurk concealed in the houses of both rich and

poor. It is a disease which is increasing among us. It is one which every physician would like to know more about, and would willingly investigate.

It is therefore very unfortunate that the committee should have chosen such a time for issuing their circular of inquiry. Had it been given to us at the beginning of the year, instead of at its close, every case could have been intelligently investigated, with direct reference to questions four, five, nine, and ten. As it is, there is nothing to depend upon but memory and the record-book. The former is not always a safe guide where so much, and in such detail, is to be recorded. Besides, what physician with fifty cases of diphtheria would have both time and practice to look over the names in his ledger, and review every case? As to the record-book, what proportion of the physicians record every case of diphtheria that they attend? What proportion keep any record-book at all? If the committee want intelligent, accurate reports, it seems to me they ought to change the time for sending out their circular. Mine was received on the 21st inst. I must send my reply on or before April 1st. That leaves me eight days in which to prepare a reply. Some will be abundantly able to do it; for others I know that the hours will be too few.

Question 1. Has diphtheria increased in your vicinity during the past five years?

From the record of deaths in the Town Clerk's office, which I have just examined with care, I am much surprised to find that this fearful disease scarcely existed among us previous to 1873. Of course the only means I have of finding the presence or the comparative prevalence of the disease is from its record of death.

Statisticians who have compiled reports carefully will know how many cases of diphtheria, on an average, every death represents. I have no such tables from which to compute.

1876, deaths, 1875, deaths,

Last year, 1878, there are recorded 399 deaths, of which 78 were from diphtheria, or one-fifth the whole number, and this is about the proportion for the last five years. Going beyond that time, we shall see a very sudden change, the causes of which are well worth study. In 1877, the deaths were 450, of which diphtheria took 75-one in six. 409; from diphtheria, 75, a proportion of one to 5.4533. 339; from diphtheria, 50, a proportion of one to 6.78. 1874, deaths, 391, from diphtheria, 72; or one in 5.43. 1873, deaths, 387; diphtheria 26, proportion one to 4.884. Of the 333 deaths in 1872, only two are ascribed to diphtheria, and of the 265 in 1871, only one. We see, then, that this disease has suddenly and enormously swelled the death rate in our city, and that this increase has been within the past five years, the list in 1874 being the highest; and that it was almost unknown in our midst, as a fatal disease at least, previous to the year 1873. There is a very interesting subject of study for our new Board of Health yet to be appointed, and it is to be regretted that the city government have so

made the ordinance that a politician is likely to be selected for the position of health officer.

2. I cannot say that the type has altered markedly. We have, as we have had, the catarrhal and the fibrinous forms, although I do not think the disease is so virulent, that it is so quickly fatal, as some years ago.

3. I do not think remedies reach it any more surely now than before. If it is not so fatal it is owing to the character of the disease, rather than to the effect of medication. I do not know of any remedy yet found which will in the least prevent the formation or spread of fibrous diphtheria.

4. I am sorry that I have kept no record of cases and of deaths, for in such a way only can this question be answered properly. I regret to say that I cannot answer this question. I do not know in my own experience what the ratio of deaths have been.

5. In none, but I am convinced that many cases arise from that cause. In a manufacturing city, it is difficult to single out any one cause absolutely.

On page 109 of the first Annual Report of the Connecticut State Board of Health, is a map of Bridgeport, with the fatal cases of diphtheria for the last two years located on it. As locating the spots was entrusted to me, I can say that during the years 1877-8 diphtheria was found throughout nearly every part of our city, in houses old, dirty, without water or sewer connections, and also in houses just built, clean and well plumbed. It is found on the very edge of tide water, and on the highest elevation of Golden Hill, seventy feet above the river.*

A few facts, however, in regard to the sewers may be worth noticing. Of the cases on the map referred to, thirty-nine were in E. Bridgeport. Previous to 1878, the city clerk informs me that the only sewer on that side of the river was a private one in the northern part, put in simply to drain the land through which it ran. Within the last year, five sewers, some of them large ones, have been put in, and these drain most of the entire eastern district. Granting that the mortality from this disease from 1873 to 1878 was from want of sewerage, and in 1878, that it was caused by digging up the ground for laying the sewers, there is still left to be explained the small mortality of 1871 and 1872, amounting to almost nothing. For the growth of the city within the past seven years has not been fast enough to make the difference.

Again, of the seventy-five cases noted in the principal or western part of the city, forty-seven of them are in the northern part. Of the four sewers there, three have been put in within the past year, and one added to. This latter has been made to discharge into the Pequonnock river, above the four bridges that cross the stream. Near this spot is a tract of level ground east of the Housatonic Railroad, on which are tenement houses for the poorer class. Here has been a home and plenty of food

* The map is here inserted.

for this fearful disease. A large proportion of the people living in the region now referred to, the northern part of the city, are of the laboring class.

I do not think the circular would justify me in elaborating further, as it simply asks for answers to questions.

6. It begins, in my opinion, as a constitutional disease. In answering thus, I forget all theories, and speak from observation alone.

7. Regarding the disease as constitutional, I rely mainly on constitutional medication, not knowing any local remedy which will cure or

prevent the disease. I hope sometimes to keep up strength and life by constitutional remedies, until convalescence may occur.

9. It may, but not, it seems to me, so that such a rule can be laid down. I have seen presumable transmissions less malignant than the contrary, and I think that by far the greater number of cases observed have been less rather than more malignant.

10. I can not say; I do not know. I never have observed any such.

DIPHTHERIA.

F. POWERS, WESTPORT.

According to my experience, this much dreaded disease has decreased in this vicinity during the past three years. It has also become somewhat less malignant, consequently treatment is now followed by better results than formerly. Of all my cases of genuine diphtheria during the past five years, about ten per cent. were fatal. A very great majority, perhaps seven-eighths, of the fatal cases were children of poor people living under bad hygienic influences. About two-thirds of the whole number of cases occurred in marshy districts without drainage, or where from other causes there was accumulated filth.

In opposition to the views of Oertel, I believe diphtheria is a constitutional disease from the beginning, as much so as scarlet fever or measles. The headache, pains in the limbs, slight chills, etc., are symptoms common to the invasion of this and other acute diseases. The febrile movement of diphtheria begins quite early, often hours before the appearance of pseudo-membrane, the temperature sometimes reaching 103° Fah. while the local manifestations are yet exceedingly slight. As a rule, soon after the throat symptoms acquire prominence the fever begins to subside.

In the present state of therapeutical science we have no specific for diphtheria. Indeed it is extremely doubtful that the seemingly brilliant results reported by some physicians were due in any great measure to the particular things employed. However, I do not hold the extreme views of some very eminent men in the profession who say, ""Tis utterly useless to treat diphtheria." Local and constitutional measures are about equal in importance. The former for the purpose of moderating the inflammation, cleansing the parts most involved, and preventing the absorption of septic material; the latter supportive. On theoretical grounds rennet wine (introduced by Dr. Thomas) ought to be the best topical application, as it not only very rapidly dissolves the diphtheritic membrane, but also possesses antiseptic properties. I have had no experience with it. I think favorably of the free use of lime water. It should be employed in the form of a spray five minutes in every hour