of soda with tincture of nux vomica was employed, and lastly salicylate of potassa in the following formula:

M. S.-A teaspoonful in a wineglass of water three times a day, half an hour before meals, until appetite improves, then to be taken immediately after eating, to stimulate the action of the digestive organs; for it is at this time its best effects are seen, as alkalies are more readily absorbed during the process of digestion. When objection is made to the bitterness, a little syrup may be added.

This combination, excellent as I know it to be, fills only one indication in the treatment of dyspepsia; the other necessary adjuvant is a remedy for the constipation which usually accompanies this disease, arising from torpor of liver and other digestive organs. To cure this troublesome symptom, it is necessary to stimulate the natural digestive secretions by the following pill.

M. S.-One or two every night, grading the dose so as to effect one evacuation at a regular hour each day, to be aided by the will of the patient in forming regularity of habit.

With an experience of over two hundred cases of dyspepsia cured by the salicylate of potassa, I can unhesitatingly recommend it as superior to any of the bitter tonics; it will be found the most successful treatment for nine out of ten cases; the tenth one requiring mineral acids, owing to the bilious condition of the patient, to effect a cure.

I am convinced that every indication for the cure of acid dyspepsia is met by this remedy; the acidity of the stomach is corrected, the flatulence arising from fermentation of food, or perhaps the presence of bacteria, is relieved; and, lastly, the nerves of the stomach are aroused to action by the tincture of nux vomica, a very important element in the cure of dyspepsia

DIPHTHERIA, WITH PARALYSIS OF THE

PALATE AND EXTENSION INTO THE
NASAL CAVITY AND EUSTACHIAN
TUBES.

BY LAURENCE TURNBULL, M.D.,

PENNSYLVANIA.

Was called to see Mrs. C. J. C., aged 30 years, suffering with all the symptoms of diphtheria. Feb. 24, 1882. At this time a number of cases of this disease were scattered over the southwestern part of the city (Philadelphia), and it was subsequently found that she had kissed a friend, who soon after suffered from a severe attack; but my own impression is that it was owing to defective arrangements of the water-closet, and although a great deal of money had been spent in an attempt to improve the drainage, yet the sewer-gas entered the house. Prior to the attack, the lady's maid had catarrhal pneumonia, and another inmate of the house who nursed our patient had diphtheria, with a deposit of false membrane on the third day, and was kept in bed for a week with local and general treatment, and for three or four weeks she was feeble, suffering from a cough, with consolidation of her lung. The lady's husband also had a milder form of diphtheria, but was protected by a former attack.

The lady had at times pharyngeal catarrh, and in treating her, change of climate to the seashore was necessary before this was overcome. This form of catarrh is stated to increase the predisposition to diphtheria, and we know that diphtheria is contagious, probably from minute particles of matter which are found floating in the air of the room if not very completely disinfected, by an abundance of pure air circulating and displacing the foul.

I am fully of the opinion that the membrane contains low forms of organism. (See the microscopic examination by

Dr. Longstreth appended to this paper.) Dr. Maclagan has clearly shown that "the germ theory explains all the phenomena of this disease.**

They talk of its spontaneous origin, and give the following instance in proof; but we think the case can be as well understood and explained, on the theory of contagion, for in all this class of disease the contact takes place before the outbreak in the individual and communicates it to another individual; the case is stated by Dr. Simon,† at a small health resort called “Bad Fusch,” in the Tyrol, of only two houses; it is situated at an elevation of from three thousand to four thousand feet above the sea, and is celebrated for its fresh air and pure water. In one of these houses a little girl, five years of age, who had left Vienna five weeks previously, was suddenly attacked with diphtheria, which was subsequently followed by paralysis. The visitors consisted of tourists ascending the high mountains in the neighborhood. Although other children had been playing with the little girl up to the day on which she was attacked, no other case of this kind occurred." She may have contracted the disease from the children of a passing visitor‡.

In the winter or spring months we have found this disease most prevalent. In this and other cases which I have seen, the contagion, when set free from a severely affected individual, undergoes further development, and even attaches itself to the apartment or even to the clothes and hangings of the rooms. The poison enters the system by means of the water we drink, and sewer-gas.

We know that several valuable lives have been lost by physicians receiving the false membrane into the mouth. M. See | reported a case in which a woman suckled a child with diphtheria. In consequence her own child which she was nursing at the same time contracted labial diphtheria, and communicated it to the mother, who frequently kissed her infant. The ordinary period of incubation is from two to three days; yet cases are on record in which this has been extended to weeks, * The Germ Theory, etc., London, 1876. See also The Bacillus of Diphtheria of Wood and Formad.

Simon Sixth Report on Public Health (M. Mackenzie on Diphtheria).

A very similar case occurred in the practice of a friend at Sky Top, White Mountain, in this country.

Valleix and Henri Blache.

|| Bull. de la Soc. Med. des Hop., I. p. 378; quoted by Mackenzie, p 96.

where the germs have remained dormant.

MacKenzie states

that he has known of one instance in which the disease occurred fifteen days after exposure to contagion (opt. cit., p. 95).

Our patient had an attack on returning to her house after being away for several weeks. The mortality of females from diphtheria is rather higher than that of males, and we are satisfied that there is a family susceptibility. Sir William Jenner quotes an instance in which five members of one family took the disease. In our own practice we have had two, three, and four members of one family affected, and in two patients has there been more than one attack. In the Florentine epidemic, in four cases, diphtheria proved fatal to three members, and in twenty-two cases to two members, of the same family. In a syphilitic family under my care, of three children affected, two cases proved fatal by laryngeal diphtheria; and in another family in which I was called in consultation, two out of three died from the enormous gangrenous swelling of the lymphatic glands, and poisoning of the blood. As we have before stated, social rank or wealthy surroundings do not prevent imperfect drainage or blocked sewers; and the convenient water-closet, merely being shut off from the bed-room by a constantly open door or a curtain, sewer-gas, charged with germs of the disease, has opportunities. of causing infection to those who are much in the room during damp weather, or at night. In the case of typical diphtheria the symptoms in our patient were as follows: First stage, rapid rise in the temperature and pulse, the former 102 and 103, preceded by chilliness, malaise and depression. Then followed pain in the loins, and headache, with the throat hot and dry, pain in swallowing, while the neck felt stiff. On examination of the pharynx and tonsils there was found that it contained points; the mucous membrane was infiltrated by a superficial layer of yellow substance soon passing from yellow into gray, assuming a leathery consistence, which was with difficulty removed; underneath this deposit was found the mucous membrane of a bright red color with more or less bloody points.

The heat of skin and temperature at this stage became less, but the patient complained of pain in the larynx, and difficulty in breathing, also pain in the nostrils and eustachian tubes; the exudation filled up the posterior nares, and was removed with difficulty, the patient assisting, and removing it during VOL. XXXIII.—11

the hours the physician was not in attendance. A mass of this material was removed and placed in alcohol, and was then submitted to Dr. Morris Longstreth, pathologist to Jefferson College Hospital. (See his report.)

After repeated removals of the membrane, and painting with a solution of tolu in alcohol to protect the irritable mucous membrane, the lymph-like material ceased, without being reproduced.

The sequelæ in our patient's case were, on the 20th of March, partial paralysis of the muscles of the soft palate and pharynx, with general impairment of muscular and cutaneous sensibility. The soft palate and uvula hung loosely, and could not be elevated. This impeded expectoration, and the secretions accumulated in the throat.

The diphtheritic paralysis, preceded by inflammation, extended into the eustachian tubes, followed by pain in the ear and subsequent impairment of hearing. In this case, there must have been an interference with the function of the otie ganglion. A similar case has been reported* of a medical man; the affection was not sufficient to impair his hearing for ordinary purposes, but " enough to render music unintelligible."

In children, at or about the termination of an attack of diphtheria, there is inflammation which attacks both the external meatus, or, by means of the throat and eustachian tubes, passes into the mastoid region, and is sometimes fatal, especially the gangrenous variety in delicate and scrofulous children. Again, diphtheria leaves the throat and naso-pharyngeal membrane and eustachian tubes so changed that many persons in after years are found more or less deaf from this cause; and it is one of the causes of deafness in school children.

Treatment. The patient was placed in bed in a moderatesized room, ventilated from an adjoining room by opening the windows, the fever and heat of the skin were reduced by tineture of aconite and belladonna in a mixture containing the tincture of the perchloride of iron with chlorate of potash, and by the free use of ice. After the fever and heat had subsided, quinine and iron were continued. This treatment did not diminish the false membrane, which was thick and abundant. This was painted with a solution of zinc, 30 grains to an ounce of water,

* Dr. Hughlings Jackson, British Medical Journal, May 12, 1877, p. 518.