PATHOLOGY AND TREATMENT 
. % nt 
Diphtheria. 
BY . 
WM. C. DAKE, M.D., 
NASHVILLE. TEW. 
H. C. G. LUYTIES. 
No. jo6 North Fifth Street, ST. I.OUfS, 
NASHVILLE: 
WHEELER BROTHERS. 
1877. DIPHTHERIA: 
ITS PATHOLOGY AND TREATMENT. 
A REPORT OF ONE HUNDRED AND SEVENTY-SIX CASES, 
TREATED, DURING A PERIOD OF ELEVEN MONTHS, 
by wm. D 
NASHVILLE, TENN^rTQ^ 
Enlarged from a Paper read at the Third Annual Meeting of the Homoeo- 
pathic Medical Society of Tennessee, at Memphis, Sept, i,y, 1S77. 
NASHVILLE: 
WHEELER BROTHERS. 
1877. PREFACE. 
AFTER preparing a report of my cases of Diphtheria, 
treated during a period of eleven months preceding the 
meeting of our State Society, I was urged by several members 
to enlarge my paper, so as to make a pamphlet presenting to 
the profession a more particular statement of the characteristics 
and treatment of a disease with which I had become familiar 
by an extended and careful clinical experience. 
It is my purpose to supplement, in a measure, the valuable 
works of Neidhard, Oehme and others, presenting the latest 
views as to the pathology and treatment of a much-dreaded 
and quite prevalent disease. 
If I shall be able to enlighten one single member of the 
profession, so that he may save a single life in jeopardy with 
Diphtheria, I shall be amply rewarded for the time and .labor 
devoted to the preparation of this little monograph. 
Regarding my cases, embraced in this report, I may mention 
that every one had the undoubted characteristics of Diphtheria. DIPHTHERIA. 
HISTORY. 
DIPHTHERIA was but little known in this 
country until a quarter of a century ago, 
though it is one of the oldest epidemic diseases 
which preys upon the human race, having pre- 
vailed in Egypt about the beginning of the second 
century. 
In the sixteenth century the disease appeared 
epidemically in Holland, shortly afterward in Spain ; 
and from that time to the present most of the coun- 
tries of Europe and America have, at one time or 
another, suffered from its inroads. 
The first reported appearance of diphtheria, in an 
epidemic form, in the United States, was in Califor- 
nia, in 1856; and wherever the disease has pre- 
vailed it has generally been attended with remarka- 
ble fatality. 6 
DIPHTHERIA. 
We find mention by Dr. Lea J. Williamson' of a 
severe epidemic of the disease occurring at Sardis, 
Mississippi, in August, 1859. And portions of 
Georgia, Alabama and Tennessee have suffered 
from its ravages since that period. 
Whole families have been swept away by it. 
Trousseau'1 mentions a household of eighteen per- 
sons in which only two escaped death. 
Dr. Brown? of Haverford West, treated two 
hundred cases, of which forty terminated fatally. 
Mr. Oza?ian gives a summary of thirty-nine epi- 
demics of diphtheria, from 1657 to 1805, showing a 
mortality of eighty per cent. 
The Academie de Medecine4 publishes tables of 
epidemics from 1805 to 1830, giving a mortality of 
twenty-five per cent. 
On an average, in later years,5 the death rate has 
been about twenty per cent, under ordinary treat- 
ment. 
Under Homoeopathic treatment the mortality has 
been much less. Dr. Neidhard, one of the most 
successful physicians of the new school, reports but 
1 American Journal of Medical Sciences, p. ioo, 1859. 
2 Trousseau’s Clinical Lectures, Vol. I, p. 350. 
3 British Journal of Homoeopathy, Vol. XVI, p. 637. 
4—s Neidhard on Diphtheria, n. 100. ITS PA THO LOG Y AND TREA TMENT. 
two deaths out of three hundred cases treated in 
Philadelphia during a period of five years.1 
Dr. J. P. Dake,2 during an epidemic of four 
months, at Pittsburgh, in 1861, treated one hundred 
and ninety-three cases, losing but seven of the 
number. 
In a period of two months, in the fall of 1875, I 
lost two out of twenty-six cases treated, most of 
them being of a most malignant type. 
In September, 1876, the disease re-appeared in 
our city, as a severe epidemic. 
From that time to the present there have been 
cases constantly occurring, scarcely a week passing 
without fresh ones coming under treatment. 
The disease has prevailed in a malignant form, 
and the deaths from it have been many. 
In some families, under the common modes of 
treatment, three and sometimes four deaths have 
taken place, within a few days’ time; so that the 
disease has been looked upon with much dread. 
In regard to rates of mortality, it must be remem- 
bered that the malignancy of the disease varies in 
different seasons, different localities, and different 
persons. 
1 Neidhard on Diphtheria, p. 165. 
2 North American Journal of Homoeopathy, Vol. X, p. 424. 8 
DIPHTHERIA 
PATHOLOGY AND ETIOLOGY. 
Numerous theories have been, and are at the 
present day, held regarding the nature of this dis- 
ease. 
Bretonneau,* at first, taught that Diphtheria must 
be considered as a local disease ; but at a later date 
conceded that blood poisoning was one of its essen- 
tial characteristics. 
Virchoiv called attention to an exudation into the 
substance of the mucous membrane in diphtheritic 
inflammation, followed by gangrene of this mem- 
brane from deficient nourishment, and distinguished 
this type of inflammation from the croupous by the 
exudation in the latter being upon the surface of the 
mucous membrane. 
Wag7ier2 has endeavored to prove that diphthe- 
ria and croup are one and the same disease, the 
only difference being, that one is confined to the 
throat while the other affects the air passages ; and 
that the false membrane is owing to a peculiar met- 
1 Ziemssen’s Cyclopedia, Vol. I, p. 57^- 
2 Ziemssen’s Cyclopedia, Vol. I, p. 577* See a^s0 Wagners General 
Pathology, American Translation of 6th German edition, p. 264 et seq. ITS PA THOLOG Y AND TREA TMENT 
9 
amorphosis of the epithelium—a fibrinous degener- 
ation of its cells—not dependent upon a fibrinous 
exudation upon the surface. 
B7thl believes that, diphtheria is a general infec- 
tious disease and entirely independent of any pre- 
viously-existing local affection. 
Also, that the principal characteristic of it consists 
in a nuclear or cytoid growth of the submucous con- 
nective tissue, a process which leads to the death of 
the tissues through compression of the blood-ves- 
sels. 
According to this author’s view the disease in 
the throat and air passages is not an originally 
localized affection, but an indication of a general 
infection, manifesting itself by preference upon the 
tonsils, in the larynx, etc., as scarlatina upon the 
skin—mumps in the parotids, etc. 
Prof. Hallier, of Jena, announced the discovery 
of one of the higher forms of yeast (ferment) fungi 
in diphtheritic membranes. 
Dr. Granvogl1 holds that the membranes consist, 
chiefly, of cells of ferment and microscopic fungi,— 
(diplosporium fuscum,)—which grow between the 
cells. 
i Raue’s Pathology and Diagnostics, p. 121. 10 
DIPHTHERIA, 
That they live and grow at first upon the decom- 
posed particles of food, of which more or less always 
remains in the fauces, soon rooting deeper, growing 
into the mucous membrane, compressing its vessels 
and causing mortification of this structure. 
Both Prof. Hallier and Dr. Grauvogl1 contend 
that the fungi are microscopic and take root in the 
mucous membrane, causing inflammation and intro- 
ducing the poison into the system before the deposit 
becomes visible to the naked eye. 
Raue2 says that the white, or gray, or yellowish- 
white mass, which we observe in diphtheria, appears 
before, or at least simultaneously with, the signs of 
.inflammation ; and, therefore, can not be a product 
of this inflammation ; but, on the contrary, that this 
so-called diphtheritic exudate, which is a compact 
mass from its very first appearance, is the ca?ise of 
the inflamed state of the mucous membrane, and its 
subsequent mortification. 
The discovery was made by Heuter'i and Oertel 
simultaneously, as far back as 1868, that the diph- 
theritic membrane, the subjacent diseased parts and 
the blood contained, in large numbers, vegetable 
1 New England Medical Gazette, Vol. XII, No. 5, p. 223. 
2 Raue’s Pathology and Diagnostics, p. 121. 
3 Ziemssen’s Cyclopaedia, Vol. I, p. 577 et seq. ITS PATHOLOGY AMD TREATMENT. 
11 
organisms, or bacteria, to which the latter gave the 
name micrococci. 
Oertel, by a series of experiments, has endedvored 
to prove that the disease begins as a local affection 
and afterward develops into a general one, and that 
the latter is kept up by the former. 
That the disease begins at one point, the focus ol 
infection, and thence radiates through the body until 
by general blood poisoning it renders the organism 
incapable of life. 
He considers croup a simple form of inflamma- 
tion, in which a fibrinous exudation occurs upon the 
mucous membrane, and which never can pass be- 
yond the bounds of a local process. 
The presence of bacteria in the membrane and 
in the different organs and tissues has been demon- 
strated by Von Recklinghausen, Mass Hoff, Waldeyer, 
Klebs, Eberth, Heiberg and others. 
The question whether the fungus is the cause or 
an effect of the constitutional disturbance is unset- 
tled in the minds of some writers ; but in the light 
of the latest investigations, by able pathologists, 
there should be no doubt as to its being the specific 
cause. 
As to the pathology of the disease, then, follow- 
ing the divisions and modifications as presented by DIPHTHERIA. 
the Chair of Practice, in the Hahnemann Medical 
College, Philadelphia, last winter,1 we find— 
« 
i st. A hyperaemic state of the mucous membrane, 
beginning in the epithelium. 
2d. Cellular infiltration, thickening and whitening 
of epithelium by exudation, variously called fib- 
rinous—albuminous—-fatty or purulent. 
3d. The entrance and presence of fungus—globu- 
lar bacteria—in the exudation or membrane— 
these micrococci constituting the specific cause of 
genuine or constitutional diphtheritis. 
In tracing the course of a case we generally no- 
tice— 
1 st. A predisposition to croup or throat affections, 
and then— 
2d. A sudden chilling, followed by hyperaemia, in- 
flammation and exudation resulting in a false 
membrane. 
I11 ordinary circumstances the membrane is loos- 
ened or disintegrated and thrown out, and so relief 
is gained; or it becomes a mechanical obstruction, 
resulting in suffocation and death. 
If the atmosphere is damp, favorable to the pres- 
1 Lectures of Prof. T. P. Dake, M. D ITS PA THOL OGY AND TREA TMEN7 
13 
ence of fungi, or if the room or house has mildewed 
walls or decaying vegetables in the cellar, the diph- 
theritic fungi, or bacteria, may be present and may 
become lodged in the raised, softened and broken 
epithelium or skin, in such a warm moist bed, grow- 
ing and multiplying and extending, even into and 
through the mucous membrane and other tissues, 
and so, of course, into the blood. 
No sooner in the blood than they are carried to 
all parts of the system, finding an early lodgement 
in the lymphatic glands, occasioning swelling and 
sometimes suppuration. 
The diphtheritic membrane has been found in 
almost all parts of the body, on the tonsils, palate, 
fauces and walls of the pharynx ; in the Eustachian 
tubes, nares, larynx, trachea, bronchi, oesophagus, 
stomach, intestines, vulva, vagina, and in wounds 
upon the surface. 
As an illustration of the infectious character of 
the disease, especially of the readiness of the fungus 
to seize upon broken patches of skin, I may men- 
tion that about three years ago a messenger, com- 
ing from a house in which we had a bad case of 
diphtheria, was thrown from his horse, tearing a 
piece of skin, nearly an inch square, from his knee. 
After the injury and before the wound had been DITHTHERIA. 
dressed the gentleman visited the sick room, re- 
maining in it for an hour or more. 
Though not within two miles of the place again, 
for weeks, in a few days the broken patch was cov- 
ered with a thick white membrane, accompanied 
with much swelling of the leg, and signs of phle- 
bitis from the groin down to the foot. 
The membrane formed there again after being 
once removed. Shortly afterward a child of the 
injured man had diphtheria in nose and throat; then 
a lady in the house had it severely in the throat, 
while another had it in her ears. 
The residence of the injured man was fully two 
miles from the home of the patient for whom he 
came to us at the time of his accident. 
Though all the family recovered, it was months 
before the leg was fit for use. 
Up to the appearance and penetration of the 
fungus, croup and diphtheria are not essentially 
different. 
Oertel vaccinated animals1 with diphtheritic mem- 
brane and produced a general infection, while vac- 
cinations with the croup membrane merely produced 
a local irritation, sometimes with croupy exudation. 
1 Raue’s Record Homoeopathic Literature, 1874, p. hi. ITS PA THOLOGY AND TREA TMENT. 
15 
In croup there is no blood poisoning—no gland- 
ular swellings—no tissue destruction. 
Death comes from lack of oxygen and excess of 
carbonic acid, or simple mechanical strangulation. 
The fungus has been found, in all or nearly all 
cases of severe diphtheria, where the membrane has 
been examined well with the microscope. 
A few months ago we had a case, in which 
the result was death, where a piece of thick, 
white membrane was thrown off from one of the 
tonsils. With our microscope, of moderate power, 
we failed to discover any of the peculiar fungus, 
and so likewise did Dr. W. H. Winslow, of Phil- 
adelphia, to whom we sent a piece for examin- 
ation. 
I should mention that the fragment examined by 
Dr. Winslow had been in strong alcohol several 
weeks before he saw it. 
Though not discovered, we can but believe that 
the peculiar fungus was present when the mem- 
brane came from the tonsil. 
Fungus flourishes most in a warm damp atmos- 
phere and upon decaying organic matter. 
It has been observed, everywhere, worse in the 
damp weather of fall and spring, and in a warm 
wet winter or wet cool summer. 16 
DIPHTHERIA. 
It has been worse in warm wet countries than in 
cold and dry. 
I hough the fungus, found in diphtheria, is con- 
sidered much the same as that seen upon mouldy 
bread and decaying vegetables and wet wall paper, 
it must, in some respects, be essentially different; 
otherwise in every house and locality where such 
mould appears, every case of tonsillitis and every 
abrasion of skin must result in a case of diphtheria. 
The fungus of diphtheria must, therefore, be of a 
specific character, occurring only in certain places 
and under peculiar circumstances. 
As to persons, doubtless a scrofulous diathesis so 
affects the character of the tissues involved as to 
make them a more attractive field for the ready 
planting and rapid growth of the fungus ; and hence 
such persons will have more of the peculiar blood 
poisoning and gland irritation. 
All observers agree that persons subject to 
laryngitis, tonsillitis, otitis, or to erysipelas, gland- 
ular swellings or aphthous ulcerations, have the 
disease worse than others. Among such the mor- 
tality is surely greater. 
According to Oertel,* the process caused by 
inoculation is entirely a specific one, and can not 
1 Raue’s Record Homoeopathic Literature, 1874, p. hi. ITS PA THOLOGY AND TREA TMENT. 
be produced either by chemical, septic, decaying 
or fermenting substances. 
The infection spreads from the spot of inocula- 
tion in centrifugal directions, by means of the 
blood and lymph-vessels through the tissues, with- 
out choosing any particular plan for localization. 
Healthy and unabraded skin and mucous mem- 
brane is little apt to take the infection, while an 
injured surface or catarrhal state greatly increases 
the liability to its infection and propagation. 
Before passing on I should mention that, in the 
epidemic visitations of diphtheria observed by my 
father, years ago, at Pittsburg, and in those observed 
by us both in this city and vicinity, there is a marked 
difference in the obvious characteristics of the mem- 
brane in different cases. 
Sometimes it is seen on the tonsils or palate or 
back wall of the pharynx, at first as a light, rough, 
cheesy deposit, more than an epithelial exudate. 
This may be removed, in some cases, or partially 
broken up by mechanical means and remedies to be 
mentioned hereafter. 
Again it resists mechanical and other means and, 
in one day, may thicken and harden and extend so 
as to prove its malignant character beyond all ques- 
tion. 18 
DIPHTHERIA. 
In other cases the membrane, at the outset, pre- 
sents a smooth, hard, pearly and almost shining 
appearance, as immovable as the mucous membrane 
itself. When this is the case there must be earnest 
work to save the patient. 
The difference in the first white patches, which 
appear, as I have mentioned, may be owing to the 
absence of the peculiar fungus in one case and its 
presence in another ; or to a greater or less amount 
of it present; or again, to some constitutional pe- 
culiarity independent of the fungus. 
When the patches, in all cases or nearly all, are 
of the rough, cheesy character, it need not be sur- 
prising if all or nearly all patients recover; nor 
should it be surprising that, a high rate of mortality 
appears when the patches are of the smooth, white, 
tenacious character, especially when accompanied 
with much glandular swelling and a putrid breath. 
In regard to the germs of the disease there is 
little to be gained by an inquiry as to their 
origin. 
As mentioned, at the outset, it belongs to a re- 
mote antiquity. 
Whether, from the first historical period of diph- 
theria, its germs have been in active existence 
among men, in one part of the earth or another, or ITS PATHOLOGY AND TREATMENT. 
19 
whether, those germs occur, from time to time, by 
some process of evolution, as a product of some other 
disease, animal or vegetable ; or under what circum- 
stances, or from what causes those germs are imported 
or generated, and how they may be avoided, are 
questions that may be pursued with some profit. 
I confess that, to this hour, the accumulation of 
facts and their generalization, will not warrant us in 
many satisfactory conclusions regarding the aetiology 
of diphtheria. 
Many theories have been put forward and much 
has been written about sewer gas, impurities of 
drinking water, etc., as the causes of the disease; 
but not one of them is sustained by sufficient facts. 
Localities where no sewers exist, where the great- 
est cleanliness is exercised, and where the water is 
as pure as nature furnishes, the disease has been as 
prevalent and fatal as in the most crowded cities 
where sewer gases and filth are supposed to abound. 
It has been in country places as well as crowded 
cities, in localities high and dry as well as low and 
damp, and in palaces as well as hovels. 
But, in speaking of the prevention and treatment 
of the disease in another place I shall present some 
of the fruits of observation and inquiry regarding 
its causes and character. 20 
DIPHTHERIA. 
TREATMENT. 
I shall here present the course of treatment as 
followed in our home practice, and taught by my 
father in his Philadelphia lectures.1 
In looking for remedies, we must be governed 
by the symptoms presented, and also the history 
and circumstances of the case. 
For convenience, we may divide the course of 
diphtheria into different stages, the first presenting 
in two forms, that of hyperaemia from chill, and 
hyperaemia from disordered stomach. 
FIRST STAGE. 
The fungus, which gives type to the disease, 
does not attack persons in health. 1 here must be 
as already mentioned, an hyperaemic mucous mem- 
brane, an inflamed and roughened epithelium, 
or a broken skin, upon which the fungus may 
locate and make attachment. 
The hyperaemic or inflamed condition usually 
comes from cold, a chill; but may also arise from 
a disordered condition of the stomach. 
i Winter of 1876-77, in Hahnemann Medical College ITS PATHOLOGY AND TREATMENT. 
21 
It must then be apparent that the attendant 
symptoms are not the same in both cases; and 
further, that we must look for two different classes 
of remedies early in the treatment. 
Then if called while there is yet chilliness and 
a feeling of prostration, 
Camphor is the remedy. Two drops of the first deci- 
mal attenuation, on sugar, every twenty minutes 
until reaction is established. 
If called after reaction is established, and there 
is fever, hot skin, accelerated pulse, thirst, with 
only slight soreness in the throat, as yet, 
Aconite is the remedy; a dose every hour until the 
fever is reduced, or other remedy called for. 
Generally, medical aid is not summoned until 
the periods for camphor and aconite are past, and 
the tonsils and palate are inflamed and quite sore, 
then other remedies are indicated, namely: 
Capsicum: for sensation of heat in the throat, pain in 
swallowing as from soreness, and pain when not 
swallowing, of a drawing, pinching character; 
heat and throbbing in the head, flushed face, 
epistaxis, fever and chilliness, thirst, nausea, con- 
gested and inflamed appearance of the palate and 
tonsils. DIPHTHERIA. 
Belladonna: for similar symptoms, with a greater de- 
gree of soreness and inflammation, involving the 
sub-mucous and glandular tissues, as indicated 
by swelling and more difficult deglutition; great 
restlessness, extreme dryness in the mouth with 
no great thirst; very red tongue with elevated 
papillae, deep redness, almost purple color, of pal- 
ate, tonsils and fauces. 
Capsicum is called for more when the inflamma- 
tion involves the mucous membrane chiefly and Bel- 
ladonna when the inflammation is deeper and there 
is more profound erethism and nervous excitement. 
Beside these remedies there are others which may 
be indicated, such as Apis—Bryonia—Lachesis and 
Phytolacca, but they are not called for so often, nor 
are they generally as efficient as the two which I 
have presented for inflamed throat. 
Gargles. In all cases of inflamed throat a hot water 
gargle is useful, but when diphtheria is prevalent 
a better gargle is alcohol and hot water, equal 
parts. 
Mercurius Iodatus: is indicated when, beside the in- 
flammation, which I have described, there is con- 
siderable swelling of the tonsils, submaxillary or 
parotid glands ; nasal obstruction or fluent coryza ITS PATHOLOGY AND TP £ A TALENT. 
with general soreness and stiffness of the neck, 
and offensive breath. 
We have given it, one or two doses in twenty-four 
hours, with capsicum or belladonna between times, 
as indicated, every two or three hours. 
I should say, in regard to Mercurial preparations 
generally, that in our practice they have shown very 
little efficacy. I am skeptical as to their good influ- 
ence in diphtheria, in any form or dose; and am 
very sure of their bad influence, in the form of calo- 
mel and blue pill, as I have known them used in 
the common practice. 
I stated that the sore throat might arise from dis- 
ordered stomach, acidity, pyrosis, etc., as well as 
from cold. 
When the stomach is thus the seat of trouble, 
there will be sore throat of a less acute and painful 
character, little or no swelling at first, but a white 
deposit on the tonsils or walls of pharynx, cheesy, 
rough, but not very prominent or persistent—more 
of the oidium albicans or of the aphthae. 
In this form of sore throat the best remedy is 
Nitric Acid: which we use most successfully in the 
first decimal attenuation. 24 
DIPHTHERIA. 
The special indications for it are the following— 
Burning of the tongue, mouth or pharynx—redness 
and soreness of the mucous membrane, ptyalism, 
white and ulcerated spots in the mouth and throat, 
obstructed nares and fluent coryza, epistaxis, pu- 
trid smelling breath, urging to urinate frequently, 
red or whitish deposit in urine; or hoarseness, 
dry barking cough, worse at night; earache, pains 
in various parts like rheumatism, swelling and in- 
flammation of face, like erysipelas ; loss of appe- 
tite and aversion to food ; nausea, pain in stom- 
ach ; paleness, debility, perspiration; miliary 
eruption with itching ; sloughing and gangrene 
in throat. 
We have thus, in the effects of this acid, a picture 
of diphtheria in some of its worst forms, not alone 
in its first stages, but its last as well. 
In its administration we put about twenty drops, 
of the attenuation already mentioned, in six table- 
spoonfuls of water, giving to a patient over ten 
years of age two teaspoonfuls every one, two, or 
three hours, as the case may require, and to a pa- 
tient under ten years, one teaspoonful. We employ 
the Capsicum or Belladonna, if called for, as inter- 
current, increasing the interval between doses of the 
acid, while doing so. ITS PATHOLOGY AND TREATMENT. 
25 
Arsenicum is indicated when there is nausea and 
vomiting, diarrhoea, thirst—great prostration and 
palor. We usually employ the second or third 
decimal trituration. We have employed Dono- 
van’s Solution very successfully in some such 
cases, especially where the patient had been sub- 
ject to glandular or catarrhal affections. 
Another remedy, strongly endorsed by Dr. Neid- 
hard, in cases such as I have just described, is the 
Chloride of Lime—Liquor Calcis Chlorinatae—the spe- 
cial indications for which are given in his valua- 
ble work on diphtheria. 
The Formula for the preparation of this remedy 
is not found in some editions of the U. S. Dispen- 
satory, but is given in the Hahnemannian Monthly, 
Volume X, p. 329, viz.:—“ Take of chlorinated lime 
one pound (avoirdupois), distilled water one gallon 
(imperial measure), mix well the water and chloride 
of lime by trituration in a mortar, and having trans- 
ferred the mixture to a stoppered bottle, let it be 
well shaken several times for the space of three 
hours ; pour out now the contents of the bottle on 
a calico filter ; let the solution which passes through 
be preserved in a stoppered bottle. Sp. grav. 1.035, 
Br.” 26 
DIPHTHERIA. 
I should here mention that, in the use of the chlo- 
rinated lime we have found it producing a great de- 
gree of dryness of the mucous membranes, in nasal 
ducts, mouth and throat, a seeming suppression of 
mucus, which we do not consider desirable. This 
has been the case when small doses were used as 
well as when large doses, such as recommended by 
Dr. Neidhard. 
Preparations of Potash such as the chlorate, bro- 
mide and bichromate are also held in much esteem 
by some practitioners. 
In a few cases we have used a gargle of Perman- 
ganate of Potash, but without satisfactory results. 
On account of the nature of diphtheria Cai'bolic 
acid has been highly recommended, but has not, in 
our hands, been successful, though we have used it 
both as a gargle and as an internal remedy. In this 
form of the first stage as well as in the other, the 
alcohol gargle should be used when diphtheria is 
about. 
I must mention that, some of the remedies which 
I have presented are employed in later stages and 
other forms of the disease; but I shall not, on that 
account, deem it necessary to repeat the indications 
for their use which I have already given. ITS PA THOLOGY AND TREA TMENT. 
27 
SECOND STAGE. 
But let us see about the fungus, the entrance of 
which characterizes the real disease, or diphtheria 
in its second stage. When its presence is indicated 
by the peculiar membrane and its attendant symp- 
toms, some other measures are required beside those 
already mentioned. 
Alcohol is indicated by the symptoms- and also the 
pathology, so far as we can understand it, and has 
been well endorsed by clinical experience. 
It quickens the circulation in the parts affected, 
hastens the detachment of the false membrane and 
is death to fungus. 
Dr. Wallace McGeorge condemns the use of Mer- 
curious Iodatus rubrum, on account of the sloughing 
and indolent ulcers which follow in cases where the 
membrane has been removed by its use and says,1— 
“ Alcohol as an adjuvant in the form of a gargle (half water 
and half alcohol) has worked admirably and superceded the red 
iodide as a mechanical means of removing the membrane. The 
gargle should be used every one, two, or three hours, according 
to the violence of the symptoms and the amount of surface cov- 
ered, until the membrane is entirely detached. This agent and 
x Hahnemannian Monthly, Vol. VIII, p. 17. 28 
DIPHTHERIA. 
Spirits of Camphor entirely kill the membrane : while Nitrate of 
Silver, Caustic Potash, Corrosive Sublimate, etc., only deaden 
it for the time being. Hence the necessity of dispensing with 
these crude and hurtful appliances. 
“Remember then, that Alcohol kills the membrane and 
leaves no ulcer nor wound to be cured afterward.” 
As to the facts Dr. McGeorge is undoubtedly 
right, but his philosophy is not so satisfactory. To 
us alcohol acts as a medicine, not an adjuvant 
merely. 
Dr. Ockford says1— 
“ Among the remedies I have found most useful is Alcohol, 
used as a gargle, and I would advance as a reason for using it, 
that it destroys the fungous growth and at the same time admits 
of the use of the indicated remedy and a strictly homoeopathic 
treatment.” 
I would add that alcohol on the patient acts 
homoeopathically and on the fungus destructively. 
Dr. Grauvogl* recommends the use of French 
Brandy and water, equal parts, or of rectified alco- 
hol and water, as a gargle every hour, and also as 
an inhalation. 
In regard to the efficiency of this remedy Dr. 
Grauvogl remarks that, by it the parasite can effect- 
ually be destroyed. 
1 Cincinnati Medical Advance, May, 1877, p. 30. 
2 Raue’s Pathology and Diagnostics, p. 122. ITS PA THOLOGY AND TREA TMENT. 
29 
Dr. Oehme1 records the successful use of alcohol 
in a number of cases of diphtheria. 
I am aware that one of our writers2 has con- 
demned the employment of alcohol, in this disease, 
on the ground that it does not cure, that in cases 
where a gargle of it is used the patient is more 
liable to a return of the trouble, or to subsequent 
attacks; but such has not been our experience. 
Diphtheria is not one of the diseases the suscep- 
tibility to which can be exhausted by one attack; 
and, no matter what the treatment, it is possible for 
a patient to have it any number of times, longer or 
shorter periods intervening, according to his expos- 
ure to the specific germs and his susceptibility to 
their influence. 
We feel warranted in speaking quite positively in 
regard to the use of alcohol in this affection, satis- 
fied that no practitioners have had a more extensive 
and more carefully noted experience in its use 
than we during the past five years. 
We have observed its effects closely—not alone 
the immediate but likewise the remote—and have 
never seen anything unfavorable. After its use 
1 Therapeutics of Diphtheritis, pp. 6, 7 and 8. 
2 United States Medical Investigator, Vol. V, No. 2, p. 76 30 
DIPHTHERIA. 
paralysis is not so apt to follow diphtheria as in 
cases treated without it. 
For patients, old enough to use a gargle, we pre- 
scribe it in the form of gargle, pure, or diluted half 
with hot water. 
For young children and infants we prescribe it in 
the form of Brandy or Whisky toddy, strong as they 
will take. 
In some cases we have used with success and 
satisfaction a gargle of apple vinegar, pure or di- 
lute. 
Another agent has come into use lately— 
Salicylic Acid. 
Taken upon the tongue it is pungent, slightly 
sour, irritating the throat, causing heat and some- 
times coughing and sneezing. 
We have used it, the past two years, in place of 
the nitric acid, in some cases ; and in others in place 
of the alcohol. 
It acts homceopathically as to the diseased tissues 
and kills the fungus. We consider the distinction 
of its influence from that of carbolic acid, mentioned 
by Dr. Hale as very proper.1 
We have usually given it, morning and night, a 
i American Homoeopathist, Vol. I, No. 3, p. 94. ITS PATHOLOGY AND TREATMENT 
31 
powder, say one grain of the first decimal tritura- 
tion. 
It is especially useful in the second form of what 
I have called the first stage of the disease. 
Salicylic acid should be used with care, not given 
in too large or frequent doses, as we have known 
severe hemorrhage to follow its excessive use. 
In purchasing this article it is important to procure 
the very best, as there are different qualities on 
the market. 
We have used Flowers of Sulphur, pure and in 
the form of triturations, applying it directly to the 
affected part, by means of a camel’s hair pencil, but 
it has not given satisfactory results. 
In cases where there were, in addition to the in- 
dications for nitric acid, cough, catarrhal irritation 
of throat and especially of the nasal ducts, with a 
tough stringy discharge from the nose—especially 
where croup seems threatening—we have given with 
good results Kali bichromicum and Nitric Acid in 
alternation. 
My friend, Dr. Enloe, of Edgefield, has also 
used these remedies in alternation with gratifying 
success. 32 
DIPHTHERIA. 
THE CROUPOID FORM. 
When the larynx or trachea is the seat of trouble, 
the ordinary symptoms of croup are presented, ex- 
cept that there is more disturbance of the general 
health, more mucous irritation and more glandular 
engorgement and swelling. 
In diphtheritic croup the windpipe is seldom first 
invaded, but is occupied by an extension of the 
membrane from the pharynx, passing below the 
epiglottis. 
In several cases, where the membrane had entirely 
disappeared from the pharynx and tonsils, I have 
known a slight exposure to cold to so irritate the 
larynx as to occasion its rapid development there. 
When the croupoid form exists we have found the 
following remedies most useful:— 
Spongia: for paleness of the face and anxious feat- 
ures : stitches in the throat, great dryness of the 
larynx, with short barking cough ; difficult breath- 
ing, as from constriction of the larynx and trachea ; 
pain in larynx when pressing upon it; hoarseness ; 
dry cough, worse in the evening and toward 
morning from a tickling in the windpipe. 
The croupoid form of diphtheria is generally con- ITS PA THOL OGY AND TP DA TMENT. 
sidered incurable, and the common prognosis is 
death in ninety-nine cases out of a hundred. 
But with proper homoeopathic treatment such 
prognosis is not necessary. 
We can cure a good part of such cases, with 
Spongia and Kali Bichromicum. 
The special indications for this last remedy are, 
briefly these— 
Kali Bichromicum: Croupy cough, with general ca- 
tarrhal irritation, in throat and nasal ducts; dis- 
charge from nose is tough and stringy; pain in 
ears ; ulcers in fauces ; white patches ; swelling 
of parotid glands ; red raw tongue ; an eruption 
like measles. 
During the last few months we have had four 
cases of this croupoid form, where patches were 
visible in the fauces and pharynx, saved we are 
satisfied, by Spongia, Kali Bichromicum and Hepar 
Sulphur. 
In three of the cases referred to we were called 
after the chilling and the fever and hyperaemia of the 
throat were past; and before us were presented,— 
patients struggling for breath, pale, anxious, with 
the peculiar crowing cough of croup, swollen tonsils 34 
DIPHTHERIA. 
and submaxillary glands, white and yellowish, ele- 
vated patches on the tonsils and uvula. 
The fourth patient had an attack of diphtheria of 
considerable severity and was making a good recov- 
ery, when, on the tenth day, cold was taken, while 
there were yet patches of membrane on the tonsils, 
and the disease went on with renewed vigor, invad- 
ing the larynx and trachea. 
We prescribed Spongia, first decimal attenuation, 
a dose every hour, and, with advancing relief, the 
intervals were increased. 
We left Kali Bichromicum, second decimal tritu- 
ration, to be substituted for the regular remedy, in 
case of increased trouble, during the night, espe- 
cially directing it to be used in place of the Spongia, 
should there be some discharge, thick and tough, 
from the nasal ducts. 
I have already mentioned that we use this prepa- 
ration of potash also in cases where there is no 
croup. When there is a discharge of thick, tough, 
stringy mucus from the month or nose we have used 
it with the most decided benefit. 
Hepar Sulphur was given when there were glandular 
swellings, dryness of nasal membranes, dryness 
and scraping in throat, with a dry barking cough. 33 
ITS PATHOLOGY AND TREATMENT. 
We sometimes gave Belladonna, as an intercur- 
rent, with the Spongia, or Kali, or Hepar Sulphur, 
according to indications. 
Bromine has been employed in the croupoid form 
and is highly commended by some able practition- 
ers. Generally we have not had satisfactory re- 
sults from its use. It has done good in cases 
following Spongia—when that remedy, seemingly 
indicated, had been given without relief. 
As I have said, on a preceding page, in cases, 
when, in addition to croupy symptoms, there were 
distinct patches on the tonsils and Nitric Acid was 
indicated we have given the Acid and Kali in alter 
nation—sometimes, also, the Acid and Spongia— 
with marked relief. 
In this form of diphtheria, or when the nasal mem- 
branes are involved the inhalation of the vapor of 
alcohol is often followed by good results. 
I should here remark that, I believe in the use of 
the single remedy whenever the indications are suffi- 
ciently clear and our knowledge of the range and 
measure of the remedy so well defined as to warrant 
us in depending solely upon it; but I must say, once 
for all, that the knowledge of drug capabilities, as 
displayed in works on Materia Medica, is yet too 36 
DIPHTHERIA. 
imperfect to enable us, in all cases, to avoid the 
alternation of remedies. For my part I shall not 
risk the life of any patient, confiding in my skill, in 
order to maintain a principle, which contemplates a 
perfection of pathogenesy which does not exist and, 
I fear, will not exist for many a year to come. 
INJURIOUS TREATMENT. 
Tracheotomy. The operation of Tracheotomy has 
been resorted to in cases of the croupoid form but 
with very little success. In ordinary membranous 
croup, when death is threatening from simple me- 
chanical strangulation, it may be advisable; but 
when the tissues and blood are invaded by the in- 
visible germs of diphtheria, the same being also in 
the air, and a wound is made, it would only be to 
give a fresh field for infection and membranous 
display. It must therefore be evident, that such an 
operation can not improve the chances for life while 
causing much needless pain. 
Trousseau/ long ago said— 
“I can not, therefore, too often repeat to you; take care 
1 Clinical Medicine, Vol. I, p. 372. ITS FATHOLOGY AND TREATMENT. 
that you do not, for any reason whatever, apply blisters; beware 
of wounds, beware of th£ very smallest solutions of continuity, 
and of leech-bites in persons attacked with diphtheria.” 
External Applications. In the ordinary form of 
diphtheria external applications, such as poultices 
and packs, are of little if any use, and, we believe, 
may often prove positively injurious. They keep up 
too great a degree of heat in the parts affected which 
must favor the propagation of the fungus and de- 
struction of tissues. 
In the croupoid form a slice of old, fat, salty 
bacon, bound over the windpipe, has been of some 
benefit. 
Cathartics. In cases of diphtheria, when the bow- 
els are constipated, anxious mothers often insist 
upon something laxative, fully persuaded by their 
old-time physicians, that almost any disease may be 
removed by free purgation. 
In our practice we have found that the worst cases 
are attended with diarrhoea; and we always look 
upon such a condition as unfavorable. 
If too much fruit is allowed, or other means used 
to move the bowels, it is frequently a difficult matter 
to control them; and the patient is in no condition 
to stand reducing measures. DIPHTHERIA. 
If strong- medicines are given to relieve constipa- 
tion they often irritate the stomach and bowels and 
thus offer a well-prepared surface for the lodgment 
of the fingus, where it is not easy of recognition or 
removal. 
Mechanical Means. It has been the custom of old- 
school physicians, for years, to cauterize the throat 
and make other irritating applications, which not 
only do no good but are positively hurtful. 
One of the latest writers and highest allopathic 
authorities on Diphtheria says :—1 
“ As far as concerns the mechanical detachment of the pseudo- 
membranes, as being sources of inflammation, it certainly re- 
quires only a brief reference to the pathology of the process to 
make evident the uselessness and danger of such an interference. 
It can not be enough insisted on, that in diphtheria of the mouth 
and throat the contagious material is not confined to the false 
membranes, but is present throughout all the mucous membranes 
involved, as well as noticeably in the fluids of the mouth, in 
greater or less quantity. 
If now we attempt the mechanical detachment of the deposit, 
which in the beginning of the process is still quite firmly adher- 
ent, it always results in the production of small wounds of the 
surface of the mucous membrane, as shown by bleeding points 
1 Oertel in Ziemssen’s Cyclopaedia, Vol. I, p. 672, ITS PA THO LOG Y AND TREA TMENT. 
39 
where the individual capillaries have been torn. The possibility 
of an easier and more considerable entrance of vegetable para- 
sites and products of decomposition into the tissues is thus read- 
ily afforded, and, as proved experimentally, the life of the patient 
is put in far greater danger. 
The immediate result of such mechanical violence is, as a 
rule, the rapid reproduction of the pseudo-membranes : and at 
the same time they spread over a greater extent, owing to the 
increase of local inflammation and fibrinous exudation. 
But the final results, where such a procedure has been resorted 
to, are extraordinarily bad; the vast majority of patients, and, 
where the diseased process is intense, the whole of them, suc- 
cumb to the infection of the general system.” 
Caustics. On the use of caustics the same writer 
says : 
“Not only is it impossible completely to annihilate the diph- 
theritic contagious material, even by repeated cauterization, 
when it has once become diffused throughout the whole buccal 
cavity,—though every patch be never so carefully destroyed,— 
but it is also impossible to combat the local disease by attempts 
to convert the specific inflammation into a simple one by these 
cauterizations. 
The immediate result of even the most prudent cauterization 
is always a certain degree of mechanical violence to the inflamed 
mucous membrane, and the more circumspectly we endeavor to 
destroy all the grayish-white deposits, the more is the sub-epithe- 
lial tissue of the mucous membrane laid bare, the resulting 
slough failing to afford thorough protection in the way of a cov- 
ering. 40 
DIPHTHERIA. 
In the cavity of the mouth, and in the mucus and saliva it 
contains, growths of micrococcus, as products of decomposition, 
are present in sufficient quantity to easily find their way into the 
lacerated parts of the mucous membrane, even though these be 
scarcely as large as a pin’s head, or only discernible with the 
microscope; and besides, the increased inflammation caused by 
the mechanical and chemical irritation furnishes a much more 
favorable soil. 
There can be no doubt, then, that the unfavorable results 
which have been attained on all sides by cauterizations, more or 
less energetically practiced, must put a stop to this procedure, 
even if in its stead we should be obliged to resort to the opposite, 
the purely expectant and symptomatic treatment.” 
Oertel goes on to show the uselessness of attempt- 
ing to dissolve the membrane by powerful chemical 
means and the evil effects which follow such a pro- 
cedure. 
In the Nashville Journal of Medicine and Sur- 
gery 1 an extract is given from The American Med- 
ical Bi- Weekly, which mentions that, at a recent 
meeting of the Therapeutical Society, various rem- 
edies for diphtheria were discussed, the result being 
in favor of a tonic treatment and the resorting to 
local applications as little as possible, those of a 
caustic nature to be avoided altogether. Two of 
the members agreed in condemning the use of caus- 
Vol. XX—new series—July, 1877, p. 43. ITS PATHOLOGY AND TREATMENT. 
tics, the nitrate of silver in particular, it being an 
especially unsafe application, known to produce true 
wounds in the pharynx. 
Is it not strange, then, in view of these facts, that 
caustics and other severe local applications are still 
used by the majority of practitioners ? 
DIETETICS. 
Recognizing the peculiarly weakened condition of 
the digestive organs care should be taken not to 
overburden them. * 
The disease having been pronounced asthenic— 
one characterized by great debility—it has been cus- 
tomary in the ordinary practice to cram the stomach 
with rich and stimulating food. As a rule we give 
all the good, nourishing food, that the stomach is 
capable of receiving and digesting. It has been a 
favorite practice of ours, and beneficial to the throat, 
to have the patient eat crackers dry, or dry toast, 
without drinking; and sometimes we have allowed 
parched corn. 
The object is twofold, first to excite saliva, an im- 
portant solvent to act upon the false membrane, and 
second, to operate mechanically, yet gently, in break- DIPHTHERIA. 
ing away the membrane and so clearing out the 
mouth and fauces. 
In prescribing the use of alcoholic drinks, I wish 
to be understood, as placing them among remedies, 
and not among articles of aliment. 
They must be carefully and moderately used. In 
the form, of toddy, French Brandy, or American 
grape Brandy is to be preferred to any other alco- 
holic liquor. S PA THO LOG Y AND TREA TMENT. 
43 
CASES. 
Since the last week of September, 1876, a period 
of eleven months, we have treated one hundred and 
seventy-six cases of well-defined diphtheria, in re- 
gard to which I shall give a few facts. 
Number of cases treated, 176 
Number of cases cured, 165 
Number of cases died,... n 
SEX. 
Of this number sixty-three were males and one 
hundred and thirteen females. 
AGE. 
Under five years, 54, of which 7 died. 
Between five and ten years, 38, “ 3 “ 
Between ten and twenty years, ...44, “ 1 “ 
Over twenty years, 40, “ none “ 
Total number of cases, 176, “ 11 “ 
More of the cases occurred in October than in 
any other month. 44 
DIPHTHERIA. 
CONCOMITANTS. 
As concomitants of this disease we have found— 
Rash—a miliary eruption—sometimes general and 
again only in the axillae or on parts of the body 
where there is the greatest amount of heat. 
Four, of our one hundred and seventy-six pa- 
tients, had this eruption. 
Rheumatism: is also occasionally an accompaniment 
of diphtheria. 
We had two cases, both of which yielded read- 
ily to Bryonia and Rhus Tox. 
Epistaxis: is not uncommon and may occasion con- 
siderable trouble. 
In the five cases presenting this symptom we 
found Belladonna, Capsicum or Nitric Acid most 
useful. 
Strangury: may be present in some cases; but we 
found it readily relieved by a few doses of Can- 
tharides. 
Coldness: or spells of chilliness and sinking may be 
troublesome. 
We have employed Camphor and China, tem- 
porarily, with'success in such cases. ITS PA THOL OGY AND TREA TMENT. 
45 
SEQUELS. 
Diphtheria, like Scarlatina, has its sequelae, which 
sometimes are of a most serious character. I shall 
mention such as we observed in our cases. 
Cough: frequently follows an attack of diphtheria, 
and must be treated according to the indications. 
In our cases nine required special after-treat- 
ment for cough, which was cured by Bryonia, 
Kali Bichromicum, Hepar Sulphur or Tartar 
Emetic. 
Glandular Abscess: is met with occasionally. 
We had it in one case and Hepar Sulphur was 
our remedy. 
Otorrhoea: is also a sequela of this disease. 
We found Pulsatilla and Calcarea Carb. suc- 
cessful in our one case. 
Ozaena: may sometimes be quite troublesome. 
In four cases it occurred and we used Pulsatilla, 
Mercurius and Aurum with success. 
Erysipelas: we have seen in but one case out of the 
whole number, and treated it successfully with 
Belladonna. 46 
DIPHTHERIA. 
Ulcers. After the false membrane is broken away 
the tonsils or walls of the pharynx may be left in 
an ulcerated or sloughing condition. 
In such case it may be necessary to employ the 
Nitric Acid again, one of its observed effects, when 
used in an undiluted form, being a sloughing and 
gangrene in the throat. 
Arsenicum is sometimes indicated, especially when 
Mercurius Iociatus has failed to reduce glandular 
enlargements, or when Nitric Acid has failed to 
remove ulcers from the mouth or throat; especially 
when there is great prostration, looseness of bowels, 
nausea, pallor or bloatedness of face, thirst and 
burning in throat, difficult swallowing, and aversion 
to food. 
Dr. Grauvogl1 advises the use of Arsenicum, 
sixth attenuation, to overcome the “gangrenous 
tendency,” and thinks the alcohol and this remedy 
should be used in conjunction. As I have already 
mentioned we have used the Donovan’s Solution of 
Arsenic with better results than the Arsenious acid. 
Ulceration very rarely occurs in cases where alco- 
hol has been used. 
In this connection I may mention that we have 
1 Raue’s Pathology and Diagnostics, p. 123. ITS PATHOLOGY AND TREATMENI 
47 
been investigating the antiseptic and anti-fungous 
powers of another promising agent, the Oil of Sas- 
safras. We can not, at present, speak of its uses, 
as we hope to do at a future time. 
Paralysis: generally local or partial, but sometimes 
general, is an occasional effect of diphtheria. We 
have seen it in a few persons, in a progressive 
form, affecting almost every portion of the body; 
but have never yet had a fatal case, except where 
the heart was involved. We have not seen this 
trouble last any great length of time: nor has it 
returned after having once disappeared. Nature, 
if let alone, will often overcome this form of par- 
alysis, but we have used with greatest benefit 
Nux Vomica and Rhus Tox. 
Albuminuria: in diphtheria occurs at various stages 
of the disorder—in some cases even during the 
first few days. It not rarely comes on insidiously, 
and may manifest its presence by no peculiar con- 
stitutional symptoms. There can be, however, 
little doubt of the grave import of its appearance, 
though as yet its exact significance has not been 
accurately defined. 
Hillier1 examined thirty-eight very severe, cases 
1 Diseases of Children, Meics and Pepper, p. 67^5. 48 
DIPHTHERIA. 
in regard to this point, and found albumen pres- 
ent in thirty-three, thirty-two of which proved 
fatal, while of the five free from albuminuria, all 
recovered. 
Bouchut has known it (the albumen) to persist 
after convalescence, and finally produce, as in 
Bright’s disease, anasarca and hydrothorax. 
When this trouble is met with it must be treated 
according to the indications. 
When death results from one of the Sequelae, 
either disease of the kidneys or paralysis, it may 
be deferred for weeks, or even for several months. 
But I would not be understood as attaching spe- 
cial value to the presence of albumen in the urine 
of a diphtheritic patient, as a diagnostic sign or 
characteristic. 
It is found, likewise, in cases of scarlet fever, 
pneumonia, measles and yet other forms of acute 
disease. Sometimes, weeks or months after an ap- 
parently full recovery from diphtheria, Bright’s dis- 
ease is developed out of lymphatic, venous or cardiac 
derangements left behind. 
Cantharides, Arsenicum, Nitric Acid, and perhaps 
also Kali Bichromicum, are among the remedies best 
calculated to anticipate or remove such conditions. ITS PATHOLOGY AND TREATMENT. 
49 
MODES OF DEATH. 
When diphtheritic patients do not recover, death 
usually comes from the extensive blood poisoning 
and exhaustion, and occurs usually from the seventh 
to the tenth day of the disease. 
The croupoid form is more suddenly fatal, death 
occurring sometimes in twenty-four hours or less. 
In nine of our fatal cases death occurred from 
general blood poisoning and exhaustion. 
In one of these there was gangrene; in another, 
severe hemorrhage from mouth, nose and bowels ; 
and in another, extensive cutaneous as well as epi- 
thelial development of membrane. 
One patient, with the croupoid form of the dis- 
ease, died by strangulation on the third day ; and one 
died from paralysis of the heart—a girl seventeen 
years of age—whose throat had been clear of mem- 
brane for more than a week previous to the day of 
her death. 
I should mention that, this subject had never 
menstruated and had always been delicate. 50 
DIPHTHERIA. 
PREVENTIVE MEASURES. 
In the way of medicines we have found no pro- 
phylactics. When diphtheria has been prevalent 
we have advised particular care to be taken to avoid 
colds, disordei'ed stomach, and to be watchful and 
prompt in treating any affections pointing to the 
throat and nasal ducts. 
When the disease has appeared in families where 
there were children, we have had those in health at 
once removed from the sick, and kept away until 
the disease had disappeared and the sick-room was 
as thoroughly disinfected as possible. 
L would here mention that my preventive, as well 
as curative, measures have been in accord with my 
views of the pathology, especially the aetiology, of 
the disease7 and yet, if the causa morbi be not veg- 
etable fungi—micrococci—but some other invisible 
influence not yet recognized, I could, with present 
knowledge, pursue no other course of treatment. 
Our therapeutics should not be based exclusively 
upon any theory; but must be governed by all 
that we can learn of the nature and causes, as well 
as immediate symptoms, of disease. ITS PA THOLOG V AND TREA TMEN'I 
51 
While we recognize the law simiha, in special 
therapeutics, we must not fail to recognize other 
laws in general therapeutics, where we have to deal 
with things mechanical, chemical and hygienic— 
things preventive and disinfective. 
Future investigations may demonstrate the un- 
soundness of our present views of the specific cause 
of diphtheria and may teach us many things we do 
not now so much as dream of. When that time 
comes doubtless our therapeutics will be changed. 
We are required to act up to the light of to-day 
and not that of to-morrow. 52 
DIPHTHERIA. 
CONCLUSIONS. 
I. Diphtheria is a contagious and infectious 
disease. 
II. It does not attack persons in health. There 
must be an inflamed or hypersemic mucous 
membrane, or an abraded skin, for the lodge- 
ment and propagation of the peculiar germs. 
III. The specific cause of diphtheria dwells in mi- 
nute vegetable organisms—fungi—commonly 
called micrococci; and without such there can 
. be no diphtheria. 
IV. The disease is at first local, confined to the 
point of infection, but quickly becomes general 
by penetration, absorption and diffusion through 
the body. 
V. Caustics are not successfully used in diphthe- 
ria because they are too irritating. They only 
plow and harrow the field for a wider and 
deeper planting of the typical germs of the dis- ITS PATHOLOGY AND TREATMENT. 
ease, without the ability to destroy or arrest 
them. 
VI. Alcohol is destructive to the germs, while it 
quickens the circulation in the parts affected 
and so hastens the detachment of the mem- 
brane ; and if used in season it may be sufficient 
to arrest the development of the disease. 
VII. The physician when called upon to treat 
diphtheria, in the prodromic stage, must employ 
the means usual in ordinary sore throat, plus 
the alcohol gargle. But when he finds the typ- 
ical membrane present other means, such as 
Nitric Acid, Kali Bichromicum, Calcarea Chlor., 
etc., must be brought into use. 
VIII. The croupoid form of diphtheria can be 
cured, and the prognosis in cases, in general, is 
not so unfavorable under the influence of Kali 
Bichromicum, Spongia, Hepar Sulphur, etc. 
IX. External applications such as liniments, poul- 
tices, and packs are not advisable, except the 
slice of fat bacon in the croupoid form. 
X. Cathartics are not needed, are only produc- 
tive of harm and should therefore be prohib- 
ited. 
XI. In diphtheria Tracheotomy is almost always 
fatal, and should not be practiced. 54 
DIPHTHERIA. 
XII. The food supply should be such as the stom- 
ach can readily digest; anything beyond that 
being positively hurtful. 
XIII. The isolation of the patient is of great im- 
portance, as it lessens the intensity of the dis- 
ease and protects other members of the house- 
hold and the community from infection. 
XIV. The disinfection of a room, or of articles in 
it, is best accomplished by the free use of alco- 
hol, in spray and vapor, and the burning of 
sulphur, every particle of mouldy or loose wall- 
paper being removed. 
Articles of clothing, used by the patient, 
should undergo a fumigation with sulphur; and 
all linen and blankets should also be well 
washed and then sprinkled with alcohol before 
being laid away for future use. 
XV. The convalescent diphtheritic patient should, 
for some weeks, avoid over-taxing the digestive 
organs, the muscular system, the brain and 
nerves, and likewise keep from being chilled. COX TEXTS. 
CONTENTS. 
PAGE. 
HISTORY OF DIPHTHERIA, 5 
Rates of Mortality, 6 
PATHOLOGY, DIAGNOSIS, 8 
Stages—hyperaemia—exudation, 12 
Lodgement and propagation of fungi,.... 13 
Worse in certain persons, *6 
Characteristics of the exudate, J7 
Origin of the fungus, *8 
TREATMENT, 20 
Camphor, Aconite, Capsicum, 21 
Belladonna, Merc. Iod., Gargles, 22 
Nitric Acid, 23 
Arsenicum, Chloride of Lime, 25 
Potash preparations, Carbolic Acid, 26 
Alcohol, 27 
Salicylic Acid, 3° 
Flowers of Sulphur, 31 
Spongia, 32 
Kali Bichromicum, 33 
Hepar Sulphur, 34 
Bromine, 35 
INJURIOUS TREATMENT, 36 
Tracheotomy, 3^ 
External Applications, 37 
Cathartics, 37 
Mechanical Agents 38 
Caustics, 39 
DIETETICS 4i 
CASES TREATED, 176 in number, 43 
Concomitants, 44 
Sequelae, 45 
Modes of Death, 49 
PREVENTIVE MEASURES 5° 
CONCLUSIONS 52