There is no evidence that the virus of diphtheria becomes more malignant by transmission through one human organism. There is nothing in the experience of our county that enables us to give an opinion, and it is not in accordance with any hypothesis. I can state very positively, as the opinion of the profession of this county, that the successive transmissions of non-specific sore throat do not develop diphtheria. There is but one opinion given that favors that thing; and as an interchange of views is desirable, I give the quotation from Dr. Cassidy: "I believe that a neglected non-specific sore throat may develop diphtheria; but I think it is as liable to appear in an idiopathic case as that which is transmitted."

In conclusion, we can sum up the whole matter in few words. Diphtheria has increased in some portions of New London County during the past five years. Its type has not changed; it is more amenable to treatment because better understood. That the disease may arise from bad sewerage, but it arises frequently where no exciting cause is known to exist. It is a constitutional disease with local manifestations; and that the treatment is both local and constitutional; the latter most relied on. That topical applications are made to the throat, for the purpose of dissolving, destroying, or neutralizing the poison as locally manifested. That the disease does not become more malignant by successive transmissions; and that a non-specific sore throat cannot develop into that of a specific character.

L. S. PADDOCK, M.D., Reporter for New London County.

NORWICH, April 1879.

ANSWERS TO QUESTIONS.

W. P. BARBER, M.D., LEBANON.

Your first question relative to the increase of diphtheria must be answered without hesitation affirmatively. I did not see diphtheria in this town until 1877. A few cases of pharyngitis were the nearest approach to the malady of anything we had previous to that time. I have seen only two cases since then in this part of the town (Lebanon Center).

I saw in the years 1877, 1878, in the village of Bozrahville-a part of it only in this town-twenty cases or more. Previous to that, there had been several epidemics of the disease which did not come under my observation, but I think I may safely say they were not as extensive as those of 1877 and 1878.

There has been under my observation two cases of fatal termination. Here I would ask the profession their experience of this disease during pregnancy. One of the fatal cases was my own wife. I have diligently sought information from books, and personal inquiry concerning it in this connection, but have failed to find any one who had seen a case in connection with pregnancy.

I hope I may hear from some one who has had a more extensive experience, and not as sad a one. I may answer your fifth question by repeating in substance what I said last year. I have not been able to trace its exciting cause directly or indirectly to bad sewcrage.

That possibly is an exciting cause, but why does it sometimes produce diphtheria, and other times dysentery and typhoid fever? In my opinion it begins a local disease. The fact that very early there is little constitutional disturbance is my argument for its local origin. It is after the absorption of septic substances that the constitutional symptoms are prominent. It seems to me there is a discrepancy in the way Trousseau regards it, being a strong advocate of its constitutional origin, and the treatment he relies so much on, which is essentially local.

Although believing it local in the start, I must answer your seventh by saying I rely more on constitutional medication from the first, suitable nourishment and stimulants, with tr. ferri mur. and quinine, than all things else. I consider chlorate of potass. the best topical application, although I always use other things as alternates. My little girl, two years and seven months of age, when in perfect health was seized with sore throat last December. After two days I observed slight swelling of the submaxillary region. Examination of the throat revealed pharynx and tonsils bright red, tonsils were enlarged, and on the right one there was a grayish, rather thick false membrane. I came to the conclusion that diphtheria had invaded my own household. I treated her with nourishing diet, quinine and iron-about 1 gr. of the former, 10 drops of the latter (tr. ferri mur.), and 2 grs. of potass. ch. once in four hours. She being rather an intractable child I did not attempt local applications. The ease progressed favorably to the seventh day, the membrane disappearing. The child felt so much better it was with the greatest difficulty we kept her in the nursery. On the eighth day the first symptoms of diphtheritic croup were announced by a small dry cough. The disease increased in severity, and I had a well-marked case of laryngeal diphtheria. I determined to try the slake-lime vapor-bath, and was strengthened in this by the approbation of Dr. Chase of Colchester, called as counsel.

The child was placed on a mattress, the bed divested of everything excepting a light covering. We were fortunate in having a small room, about 10×12, with one window only. We then commenced the bath by slackening lime in pails; we kept the room saturated with this vapor. It was warmed by heating stones and throwing them in the slackening lime. I maintained a temperature of 90° Fht. The relief this treatment gave to the laryngeal symptoms encouraged me to continue it, and for eight days I persevered in it. It was frequently, it seemed to me, a hopeless struggle, but I had become satisfied it was the only chance of relief offered. On auscultating, the murmur of the vesicular expansion was completely destroyed, and I have every reason to think the menibrane extended to the bronchial tubes. I continued the quin., iron, and chlorate potass., and added milk punch. After about the eighth day from the time the laryngeal symptoms first appeared, and the fifteenth or sixteenth of the attack, I ventured to gradually stop the vapor. From that time there was a slow convalescence. Albuminuria was, however, present for several weeks.

Two weeks after, or early in January of this year, I saw a child, five months old with diphtheritic croup, and pursued the same course—bath, etc. I was fortunate enough to witness a favorable termination in that case also. Dr. Cassidy, of your city, saw the first case here reported; the treatment was approved by him. These are interesting cases to me, and I shall think, until I am convinced by more experience, that the vapor bath is the best and only local treatment we can rely on in diphtheritic or membraneous laryngitis, remembering of course tracheotomy.

I regret very much, my dear Doctor, my neglect to send this report until this late day, but if you should find anything in it worth while, I hope you will give it a place in your annual volume. I claim no originality in the treatment of these cases of croup; I have reported them, hoping it may encourage others to try this remedy more frequently.

CASE OF CHARLES JEWETT, M.D., OF NORWICH TOWN.

REPORTED BY A. PECK, M.D., OF NORWICH TOWN, CONN.

Dr. Jewett, aged 71-American-lecturer-family history good. Has always been a healthy man until six years ago, at which time he was lecturing in Vermont; he then had a sudden attack of some kind (?) of heart trouble, since which time his heart has caused him more or less uneasiness. The directions of Dr. Bowditch to live a quiet life were unheeded.

During the attack, six years ago, he got into a cold bed, which seemed to chill the surface, driving the blood to the center and causing embarrassment to the heart; pain of the heart was such that he was unable to

call for help; he has had three attacks since; from that time to the present the heart has been irregular in action.

Present illness began eight weeks ago, with severe angina, which lasted eight hours. At first, the pain, which was intense, was diffused over the whole chest; soon it centered over the praccordium, and became an indescribable agony. During first four hours of attack, rapidity of pulse was such that he was unable to count it, but rapidity gradually became less; improvement soon began, and progressed so that in four days he started for home, 250 miles distant, and reached there in safety. His physician had advised him to use digitalis.

When I first saw him he was comfortable, but weak; he had a spasmodic cough, for which I could not account, but for which I gave him pot. bromid, without benefit. Examination of heart showed it to be greatly enlarged, apex being to left of nipple. The valvular sounds were weak; no murmurs heard. Patient was put upon digitalis, M. x. t. i. d.; after taking this for a few days he showed alarming cerebral symptoms, when the digitalis was discontinued. With the abatement of cerebral symptoms digitalis was re-administered, M. v. t. i. d.; the pulse was not changed by this treatment in the least; it had been at about 100 per minute since beginning of illness. Cough gradually grew worse, and about ten days ago he began to raise bloody sputa; at times the sputa were dark and hard; at other times, bright, florid, and frothy. At no time has there been any fever, and nothing has been found in lungs but a few rales at base of left lung, with slight dullness. During last four or five weeks there has been some œdema of legs; none of face. Urine acid, 1022; natural color; no albumen; no casts. For last three weeks has been unable to lie down for a moment (and so he continued till the moment of death). Considering these facts: the spasmodic cough (at first there were no sputa), the inability to lie down, and the fact that the loudest valvular sounds were heard at right edge of sternum, about fourth intercostal space, it was thought that there might be an aortic aneurism.

Dr. Smith of Springfield saw patient on February 3d; he expressed the opinion that fatty degeneration of the heart would account for the symptoms; he advised a continued free use of stimulants, and infusion of digitalis, 3 ss. q. 4. t. ; this course was pursued, and the next day the pulse had dropped from 120 to 110.

Feb. 7, A. M. Digitalis continued until to-day. This morning muscles of body and arms twitched; there was vomiting of mucus and bile; everything before the eyes appeared like "masses of jelly, all in a tremble." Pulse 94, irregular as to rhythm and force, and occasionally intermittent. Ord. digitalis stopped and stimulants continued. 8 P. M.; pulse 110, weak, irregular; ord. whiskey, 3i. q. 1. t.

Feb. 8. Slept fairly; pulse 73 and better in character; ord. stimulants continued.

Feb. 9. Pulse 100, regular. Indistinctness of objects remains.

Feb. 10. Some vomiting of mucus and bile.

with anodynes at night.

Stimulants continued,

Feb. 14. Passed poor night; was quite delirious; had an attack of angina; gave three or four drops of nitrite of amyl to inhale, which gave almost perfect relief in about one minute; all symptoms of digitalis poisoning vanished; ord. to diminish anodynes so far as possible, and to give 3i. infusion digitalis, q. 4. t.; pulse 108.

Feb. 15. Another poor night, with the worst attack of angina he had experienced thus far; his son gave him amyl nitrite, which relieved .him as before.

Feb. 19. Not much change since last note. Amyl relieves the angina, and if given with the premonitory symptoms prevents the attacks. As glimmering before the eyes returned the digitalis was ordered, q. 6. t. instead of q. 4. t.

Appetite and bowels good, as they have been during the whole course of the disease. Expectoration continues; sometimes it is bloody and in hard masses; at other times soft, frothy, and nearly free from blood; says it seems to him as if the sputa came from the base of the lungs. No sleep without opiates.

March 3. Patient very restless; distress not relieved by amyl nitrite. Ord. whiskey, 3 ss. q. 3. t. (During the whole course of the disease stimulants agreed with the patient, and sometimes gave almost as marked relief as did the amyl at first; but he had an unconquerable antipathy to liquors, which always led him to cut down the amount ordered.)

March 11. Exceedingly restless and irritable. Stomach also irritable; vomits food and medicines; pulse 120; neither stimulants or amyl give any relief; distress greater than ever before. Complains greatly of wind in the stomach.

April 1. Since last note patient has failed constantly. Pulse 120, feeble and irregular. His respiration when asleep is peculiar; he will breathe 25 or 30 times, each breath being rapid and deep; then all respiration ceases for from 30 to 60 seconds;* so he continues until he awakes. Mouth is very dry; can swallow nothing but a little water. His whole body is jaundiced.

For last ten days there has been considerable œdema of the limbs. Is delirious most of the time.

April 3d. Patient died this morning; has not been able to swallow for last two days, nor to recognize any one for more than an instant. Was unable to lie down to the very last.

AUTOPSY.

Autopsy eight hours after death. Body emaciated, and jaundiced : marked œdema of legs.

Lungs.-On opening the chest, some pleuritic adhesions were found;

Cheyne-Stokes-respiration.