three times a day, which would cause portions of the membrane to be detached and curl up. A highly stimulating diet of beef tea, egg-nog, iced champagne, was given after all heat and fever had disappeared, while fresh fruit was allowed, as grapes, strawberries, etc. The swollen gland was painted outside with tincture of iodine. When the membrane passed up the nose and eustachian tube to the middle ear, steam sprays from the atomizer, with sprays of hot water charged with boracic acid, were again passed up the nose back of the pharynx with great relief to the patient; and as it began to disappear, the parts which were red and inflamed were painted a second time with an alcoholic solution of tolu (not etherized), as we have found the alcohol destructive to low forms of organisms, and not so disagreeable as the other. The solution of the chloride of zinc, I feel satisfied, possessed disinfecting antiseptic and germicidal powers to a greater degree than any other agent which I have employed. All the discharges and secretions were carefully disinfected, and the vessels, spittoons, etc. were washed with Platt's chlorides, while it was fully employed about the rooms, sink, and watercloset, and renewed each day. This system was extremely satisfactory in its results, removing all odor as well as decomposing the injurious gases from the traps, etc. During convalescence, which began the last of March, the patient was carefully watched, and her system treated by iron wine and koumyss as a drink. A mixture containing brandy, quinine and nux vomica, alternating with a syrup of hypophosphites, with strychnia owing to the paralysis. The paralysis of the pharynx was also much improved but not removed; towards the latter portion resort was had to the primary electric current of six cells, passed through the nose by an insulated conductor, and into the eustachian tube by means of an elastic catheter with a wire of platinum on which was a small copper ball. This was continued with the general treatment until the voice returned and the muscles raised the pharynx. The patient was then sent to the seashore (Atlantic City) for its bracing effect, and later made a trip to the south. On her return in May she had two slight attacks, owing, I think, to the fact of not dismantling her rooms; she stated that the servants had kept up the free use of the disinfecting solution. REPORT OF DR. LONGSTRETH ON THE MEMBRANE REMOVED FROM THE ABOVE CASE. THE specimens sent for examination yield the following results: To the naked eye, the masses are seen to be composed in general of two layers: the outer is brownish-grey in color, friable in flakes, and in places stained red or black. This layer encloses another (the enclosure is apparently produced by the greater contraction of the inner layer by alcohol) which is greyish-white in color, and also in places stained red (with blood). The inner layer is finely friable. Sections of tensings of the masses show the outer layer to be composed of epithelial cells in which are seen a few fibres. The inner layer is almost wholly composed of fibres. So that the whole masses seem to be composed of fibrillæ and pavement epithelium, which are very easily recognized and are very little altered in appearance; scattered through them are very numerous small granular and fatty cells. The fibres treated with acetic acid, or even with glycerine, become almost transparent, and nearly disappear. The epithelia by similar treatment come out very clearly, have irregular outlines and a more voluminous nucleus than normal, and some of them appear nucleolated. The red blood corpuscles and granular cells in places appear quite abundant, and have insinuated themselves between these cells, showing that hemorrhage has occurred in parts; the pavement epitheliums are arranged laminated, quite like those seen in sections of the mucous membrane; in others they are Their normal imbrication is quite confused and disturbed. The coloration with carmine affects often very apparent. everything except the fibrilla and the red corpuscles. The epithelia nuclei and the granular cells tak this coloration very freely, and it even extends itself into the bodies of the cells. This condition is the characteristic of diphtheritic inflammation of the post-pharyngeal, pharyngeal and nasal mucous membrane, and in fact differentiates it thoroughly from every other catarrhal condition which can exist in these parts, as well as from the morbid growths. Finally, as confirmatory evidence of its character, if any were wanted, I found, without any particular search, one or two specimens of vegetable mycelium so common in the membrane, but none of the tilletia diphtheritica which is supposed to have the power to transmit the diphtheritic inflammation. |