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produced by its administration. I do not give it in the large doses recommended by Mackenzie, or even alone; but I generally administer it combined in solution with some other remedy, in doses never to exceed five grains every two or three hours, and I believe its constitutional action is such as to oppose the reproduction of cacoplastic exudations, thinning them when already formed. Salicylic acid is recommended by some, but, as it is converted into salicylate in the system, it ceases to be antiseptic.
After attending to the hygienic conditions, assuming that we have the advantages of a comfortable, well-ventilated room, and can control the temperature and humidity of the atmosphere (for often we have to treat our patients as we find them), as the thin patches of false membrane present themselves, with the other concomitant symptoms, I gently spray the throat with a weak solution of chlorine gas, made by the action of tincture of chloride of iron on the potassium chlorate, slowly adding water as the chlorine gas is given off. I also begin the treatment with from ten to fifteen drops of the tincture of chloride of iron internally, every three hours, in a little glycerin and water. If the disease be not checked on the second day, I apply, myself, a spray composed of potass. chlorat., j; carbolic acid, pure, gtts. iv; aquæ, 3 ij, M., three or four times a day; and twice daily I apply, myself, thoroughly, with absorbent cotton on an ordinary sponge-holder, a mixture composed of iodine, grs. iii; potass. iodid., grs. vi; aquæ, 3ij; glycerin, q. s. 3j. M. This I have found one of the best topical applications I have ever used; and with most cases this application, applied thoroughly but gently at least twice daily, will, by the fourth or fifth day, so loosen the exudation that it can be easily removed with a pair of forceps without tearing it off. I do not believe in tearing off the exudation. Occasionally a slight hæmorrhage will follow the removal, but so far I have had no trouble in controlling this with a little tincture of iron applied with soft brush. The efficacy of these remedies depends on the thoroughness of their application. It is not well to depend for their application upon the parents or attendants, for while parents will be afraid
of injuring their children, attendants will be apprehensive of the disease.
In connection with local applications, I administer freely iodine, in form of Lugol's solution, in doses of one drop with a half-drop of pure carbolic acid in a little glycerin and water, every two hours, and increase the intervals of the administration of iron to four or five hours. I also give brandy as a stimulant after the second day, to the amount of from four to six ounces in the twenty-four hours.
I fully agree with Dr. Jacobi that the internal and external use of ice, lime-water, and lactic acid has been greatly overestimated.
The treatment I have just laid down in brief has been my plan for the last year and a half; and I must say it has been followed with remarkable success. Of course it has failed me at times, particularly when the recuperative action of the system could not be brought about quickly enough to prevent the membrane from extending downward into the larynx and trachea, the patient dying from fibrinous tracheo-bronchitis in spite of tracheotomy. I believe, if life can be maintained for a certain number of days, nature herself will make a decided curative effort, even in the severest cases. Then is the time when our stimulating and supporting treatment comes in play.
At the present day, I doubt if there be a disease that has more thoroughly and severely taxed the ingenuity and the therapeutical resources of the physician than the one under consideration; and at times our earnest efforts will meet with failure, no matter how much we may study and devise, or how particular we may be in carrying out innumerable little details, hygienic, dietetic, and medicinal.
I do not believe in emetics; for, unless the exudative stage be ended, the ejection of the false membrane affords only a temporary respite, new layers forming speedily, to replace those which have been thrown off. Then, again, the prostration and emaciation in diphtheritic patients is so great that the liberal administration of alcohol seems to be imperatively demanded, instead of depletion such as would be produced by most emetics.
MODERN PROGRESS IN MATERIA MEDICA AND THERAPEUTICS.
By E. R. SQUIBB, M. D., of Kings County.
TWENTY-FIVE years' experience in supplying a small part of the medical profession with some of the established articles of the materia medica suggests a retrospect of what has appeared to be the progress made in the remedies used and the use of remedies in the treatment of disease.
The very large and important modern progress in the discovery and application of new remedies, and the improved views and processes of the books and journals, are not to be considered here; but only the elements of that slow and substantial progress made among that class of close observers, scattered all over the nation, who learn most and improve most on their own observations and experience, who read much, but rarely write, who are rarely seen in the medical societies, and whose progress, therefore, has to be inferred from the use of the materials they employ in the practice of their art. The number of those who are quite outside of the medical organizations, or who are simply enrolled without taking any active part, is very large indeed, and their value and influence in the profession are very great and generally conservative and good.
From a pretty close association with some of this class in all parts of the country, through their correspondence and a certain familiarity with their wants in the materia medica, when not prompted by the ubiquitous "drummer" and his wares, the following points of progress are either indicated by facts or are inferred from collateral circumstances; and the points are made
here, in the loose form of inference, not simply or principally as a retrospect of the past, but as being of much more importance in the progress of the future.
That is, modern progress is taken in the sense of learning from the advancement of the recent past what to work for and to look for in the near future.
First, the thoughtful physician seems more and more to realize the fact that his success as an individual, as well as the success of his profession, depends upon his real utility to the public. As the age grows more and more utilitarian, so the profession has answered and must answer to this progress. The demands of the public upon the medical profession are that disease be prevented as far as practicable, that it be successfully managed when it comes, and that its damages be skillfully repaired; and, in proportion as these demands are rationally and successfully met, will the standing of the individual and of the profession to which he belongs be elevated.
The public, though much interested in abstruse researches and ingenious speculations and theories of health and disease, is only entertained or amused by them; and the profession not only gets little substantial credit for them, but often has them turned against it in ridicule. All this is becoming better understood and realized; and the physician is looking more and more carefully, not only for knowledge, but for the means of applying it. He makes the accurate investigation of disease, but he does not rest there; he tries to control the abnormal conditions found. Much less is heard of expectancy, much less of "Young Physic," than formerly. Active agencies carefully studied and skillfully used are much more common now; and the search after such agencies is even becoming hurtfully keen, so that there is danger of an extreme opposite to the former expectancy.
Instances might easily be given of individuals of no uncommon attainments or opportunities, gifted with neither the polished manners nor liberal morals which so often contribute to one kind of success, but fairly equipped with the known means of controlling disease, who, often in frontier populations, within five or ten years, show to the communities in which they work
the utilitarian value of a doctor, and through him of his profession. Success, to his community, means success to him and to his profession at large. And the success which begins in the actual results of his skill and labor in his community endures and increases just in proportion to its utilitarian character. Thermometers, urinometers, litmus-paper, test-tubes, and a few reagents, are always found in the orders of such physicians, and plain microscopes and even sphygmographs, occasionally. Their materia medica proper is commonly simple, the articles not many, but effective, and rarely outside of the Pharmacopœia, and their orders for the newest and best advertised remedies are often conditional, always in very small quantities, and, as a general rule, they are not repeated.
Few will doubt the dependence of the profession for success upon its utility to the public; and very much of this utility must always depend upon therapeutics, and this, in turn, upon the materia medica. Hence, if there be a progress in materia medica and therapeutics, it is an improvement of the very foundation upon which the medical profession rests, and its importance in the future can hardly be overestimated.
Another important reformation that appears to have been slowly and steadily going on in the recent past is in the value of the word, cure. The old idea of specific or particular diseases and specific cures seems to have undergone considerable modification for the better, not only among the intelligent portion of the people, but in the medical profession. That diseases are all so many definite entities, for each of which there is a special cure or antidote, if it could only be discovered, and that incurable diseases are those only for which cures have not yet been discovered, but for which they may be discovered at any time, is a doctrine which common education in the sciences is steadily bringing into a newer and truer light. Many physicians successfully treat disease, if not diseases; but very few undertake cures. Neither do intelligent persons call physicians with the unalterable idea of being cured. They rather seek for skilled advice, and they submit themselves with more or less confidence to be so controlled that they may have the best chance of speedy