With compliments of the Author. 
Diseasesof the Aliment ary Canal 
—Treatment. 
Read before the St. Clair Co., 111., Medical 
Society, June 7, 1894. 
TREATMENT OF ACUTE AND CHRONIC 
Ulcers. 
(Published by Louisville Medical Monthly, 
August, 1894.) 
Malignant Sore Throat and Its 
Treatment. 
Read before the twenty-first annual meeting of 
the Southern Illinois Medical Asso- 
ciation, May 9-10, 1895. 
(Published by the Courier of Medicine, July and 
August Issues.) 
BY 
JAS. OSBORNE DeCOURCY, 
President Southern Illinois Medical Association, 
Cor. St. Louis and Collinsville Ave., 
EAST ST. LOUIS, ILL. 1 
DISEASES OF THE ALIMENTARY CANAL- 
TREATMENT. 
INTERNAL AND EXTERNAL HYDROTHERAPY.—MEDICATION. 
James Osborne De Courcy. 
(Read before the St. Clair Co., 111., Medical Society, June 7, 1894.) 
Cleanliness is said to be next to godliness—a very 
old adage which I have found to be no less true in the 
treatment of all diseases which have come under my 
observation. It is my custom to first make clean my 
patient, outside and inside so far as practicable, by the 
free use of pure water and good soap„ I have never seen or 
had a bad result from the use of these agents. I am of 
the opinion that in many cases all the medicine that is 
needed is the free, judicious use of water, abstinence 
from food, plenty of pure air and sunshine. 
These agents, together with a clear conception and 
observation of the laws of hygiene will figure very con- 
spicuously in the future of medicine. 
While I am a strong advocate of the free use of water 
in the practice of medicine, I also have confidence in 
the therapeutics of drugs, and as I believe, have seen 
many good results from the intelligent use of them. 
In the treatment of diseases there are three distinct 
steps. They are: i, correct diagnosis—ascertaining 
the cause; 2, absolute cleanliness by irrigation intern- 
ally and the free use of water externally, and by the use 
of disinfecting agents; 3, repairing the damage—heal- 
ing the wound—or assisting nature in her work of recon- 
struction. This should be done by the skillful use of 
the tools best adapted to the work/to be done. In treating diseases of the alimentary canal generally, 
and in the three following cases which I report to you 
I have endeavored to follow the foregoing principles. 
My results are all that could be desired. They have 
been both interesting and profitable to me, and I trust 
they may be of some interest to this society. 
Case i.—Miss Mary; aged 29; American; Faun type; 
medium size and rather stout; was taken at night with 
pain in the lower bowels, followed by watery stools. 
I was called in the early morning, March 15. Found 
her excited and suffering very much from pain in the bow- 
els; also complained of severe headache. Temperature 
was slightly elevated. Pulse regular, but rapid and weak. 
She gave history of having had several severe attacks 
of ulcerative colitis, during one of which she came very 
near to death’s door. 
There was some tenderness on palpation and percus- 
sion over the major part of the abdomen and the bowel 
was very active in evacuating itself. The stools were 
thin, and contained mucus with a little blood. When 
food was taken into the stomach, especially milk, it was 
usually ejected in curdy masses within a few minutes. 
The usual agents were used to abate the pain, to 
check the vomiting; also to restore the bowel to its 
normal condition. 
The pain was greatly reduced and the rebellious con- 
dition of the stomach almost entirely overcome; but the 
bowel persisted in its active work of draining the sys- 
tem. The stools became offensive, containing more 
blood and mucus. 
A portion of the lining membrane of the intestine 
about eight inches in length was passed with the feces 
the fourth day. Having a four ounce bottle of Glyco- 
zone, I concluded to try it. So other internal agents 3 
were discontinued, and 2-drachm doses of Glycozone 
given every four hours in a wineglassful of water. The 
bowel was washed out morning and evening with warm 
soap water, followed by an ounce of tepid water contain- 
ing an half drachm tinct. opium. 
At the end of the first day after beginning the last 
method of treatment there were marked signs for the 
better; and the patient expressed herself as feeling less 
bad. The treatment was continued with constant 
improvement in the case until the Glycozone was all 
taken, at which time the bowel and stomach were under 
good control. Pain was all gone; and after a few days 
of convalescence the patient made a perfect recovery 
without any further treatment. 
Case 2.—Ely, aged 32, medium-size man, general 
health uniformly good; blacksmith by trade. First saw 
the case at 3 p. m., March 30. 
On arrival at bedside of patient, I found him in what 
seemed to be a semi-comatose state. The odor of 
whiskey was very marked. Examination of the matter 
ejected showed it to contain blood and mucus. 
A few drops of chloroform with cold water was given, 
and a cold pack placed over the epigastrium to check the 
vomiting. The following preparation was given to quiet 
the stomach and to move the bowel 
R Calomel, gr. viij. 
Podophyllum, gr. ij. 
Subnitrate of bismuth, gr. xij. 
Bicarbonate of soda, gr. iv. 
M. Pulvis, No. 4. Sig. Dose, one powder every hour. 
The father, mother and wife of the patient gave the 
following history: 
“For the last five years the patient has been drinking 
whiskey, and for the last two years, in particular, he 4 
has been drinking too much. Last October he had an 
attack somewhat like this, but recovered in about one 
week. 
“His general health has always been good. He has 
been drinking too much every day for a week now— 
keeping his whiskey in the shop. He was well this 
morning. Worked in the shop until noon. Ate a hearty 
dinner, but was taken sick soon after eating and in a 
short time began to vomit.” 
Called again at 5 p. m. Found him quiet, but suffer- 
ing. Left some Dover’s powders to be given during 
the night if necessary. 
At 2 a. m., March 31, was called again. Found him 
excited and suffering very much. Quick pulse and 
slight elevation of temperature. Gave him hypodermic 
injection: 
Morph, sulph., gr. 
Atropin, gr. 1-150. 
His wife gave history of his vomiting at irregular 
periods until xo p. m., after which time nothing would 
pass either up or down. Impossible to swallow water. 
Upon careful inspection the whole mucous membrane 
lining the mouth and throat as far as could be seen was 
in a state of hypertrophy. Indeed, it was simply cooked. 
(Pardon the use of the word, cooked; but it expresses 
the condition.) The stomach, also, was in a state of 
inflammation. What was to be done? 
Internal medication and alimentation was out of the 
question. Recognizing the emergency of the case, I 
determined, if possible, to dissolve the mucus about 
the affected parts, and to attempt to reduce the oedema 
of the membranes. 
The nose and throat, therefore, were sprayed every 
twenty minutes for awhile with Hydrozone and a 20 per 5 
cent, solution of the same used as a gargle every hour, 
until he could swallow water, which required forty 
hours. An enema of warm soap-water was given and 
repeated, which produced a soft stool; and he expressed 
himself as feeling better. 
Photograph of the mucous membrane expelled from the esophagus of Ely. 
Cut “A” illustrates the ragged surface of the membrane as torn from the muscular 
coat of the tube. 
Cut “B” illustrates the smooth surface of the same membrane over which food 
was passed, the membrane being turned inside out, just as when expelled. The 
size of these cuts is two-thirds that of the photograph of the esophagus. The car- 
diac end of the membrane being at the bottom of the cut in each case. 
The spraying of nose and throat, together with the 
gargle, also the enema, were continued every day. The 
inability of the patient to swallow made alimentation by 
the stomach impossible, to say nothing of the incapacity 
of the stomach to perform the work of digestion. Boiled 
milk and warm soups were regularly given in small 
quantities per rectum. 6 
On the morning of April 7 the whole lining membrane 
of the esophagus was expelled in the attempt to vomit. 
The membrane was neither broken nor perforated; but 
was turned inside out. I have preserved the specimen in 
an alcoholic solution; and take pleasure in presenting it 
herewith for your examination. 
There was some fever most of the time. The temper- 
ature running up as high as 102. The pulse varied 
from normal to 90, and a few times went up to 100. 
The general condition of the patient was fairly good 
—indeed, much better than could have been expected. 
There was little headache, but a lancinating pain in 
the left hypogastric region was greatly accelerated by 
coughing; and there was more or less tendency to cough 
during the first week. 
I might state here parenthetically that, in my judg- 
ment, the trouble in the side had no connection with 
the conditions of the mouth, throat and stomach; but 
on the contrary, was entirely and wholly independent of it. 
The history given of the case showed the last named 
trouble to have been produced some five years ago by 
prolonged arduous labor in which the abdominal muscles 
were in a constant strain for hours. Since which time 
the trouble has returned at different periods; and 
almost invariably following protracted, or great strain- 
ing of the muscles in that region. The treatment given 
was palliative. 
The odor coming from the mouth of the patient was 
offensive from the first, and continued to grow more and 
more offensive until after the expulsion of the mem- 
brane. 
The kidneys performed their work fairly well. The 
stools which followed the enema of warm water were 
rather soft and of a greenish color. There were no hallucinations, no delirium; and for 
the most part sleep was good. 
To prevent septicaemia, to assist nature in the work 
of reconstruction, as well as to counteract any mias- 
matic influence that might be present the following 
solution was given: 
3 Quininae sulphatis, 2) ij. 
Acidi sulphurici aromatici, 3 j. 
Aquae camphorae, 
Aquae destillatae, aa § ij. 
M. Sig. One dessertspoonful every two hours, being 
alternated by half drachm doses of Hydrozone, 20 per 
cent, solution, given in a third of a glass of water. 
Gradually, but slowly, the condition of the patient 
grew better, with the exception of one day, at which 
time he had no Hydrozone. The other medicine ‘‘Would 
not work without the gargle,” as he expressed it; “But 
worked well together.” 
Immediately after resuming the use of Hydrozone he 
began to feel better. Saw him April 9th. Found him 
in good condition. Pulse and temperature normal. 
Expressed himself as feeling very well. 
He had been sitting up most of the time for several 
days. I recommended that the treatment should be 
continued for some time. 
A week later his wife called at my office stating that 
she thought he was doing very well. Since which time 
I have had no official report from the case. 
My candid opinion is, that of all the agents used, the 
one to which he owes the preservation of his life during 
the first seven days of the attack, is Hydrozone. 
Case 3.—Bennie, little boy, age 9 years, orphan, 
German, was brought to my office May 20. Had diar- 
rhoea which had become chronic. Also had intermit- 
tent fever—mild form. He was very much emaciated 8 
Various and numerous agents from the list of ordin- 
ary remedies were used during the four succeeding days; 
but the diarrhoea was growing worse rather than better. 
The stools became very numerous, the actions amount- 
ing to ten or twelve at night with as many more during 
the day. The malarial fever received appropriate treat- 
ment and was readily subdued. 
May 26 I planned a new treatment. The patient was 
thoroughly sponged from head to foot once a day with 
tepid alkaline water. The bowel was washed out clean 
morning and evening with soap-water, just warm 
enough to be comfortable to the patient. After the 
bowel was washed out, two ounces of starch-water con- 
taining two drachms of Glycozone was thrown into the 
rectum, and left to be absorbed. The internal treat- 
ment consisted of a milk diet, fresh water to drink, 
impregnated with Hydrozone, and dessertspoonful doses 
of Glycozone taken every two hours during the day in 
a wineglassful of fresh water. 
Improvement began with this treatment. The skin 
and bowel was kept thoroughly cleansed every day as 
well as medicated, the bowel being irrigated twice each 
day. June 4, the child was reported well. His gen- 
eral health is rapidly improving. 
What effected the cure ? My answer is this: 
1. Removing the cause. This was done by absti- 
nence from all solid food. Aliment was restricted to 
small quantities of pure, fresh milk, beef and chicken 
soups, given at regular periods. 
2. By cleansing the affected parts, as before stated. 
3. By healing the wound. This was done by the use 
of Glycozone, which I have found to be one of the most 
reliable and rapidly-healing agents that I have yet used. 
The Hydrozone was used as a disinfecting agent. 9 
May we not reasonably expect that during the re- 
mainder of the present decade, and for all time to come 
internal as well as external cleanliness will be to suffer- 
ing humanity a boon—an heavenly unction? 
Note.—I have, for some time, substituted Hydrozone 
in my practice instead of Peroxide of Hydrogen, as 
formerly used. 
Hydrozone is “double strength” hydrogen peroxide— 
so to speak. In other words it has twice the bacteri- 
cide power, and, therefore, requires only one-half the 
quantity to accomplish the same results. 
It is not disagreeable to the patient when taken inter- 
nally, if well diluted with pure fresh water. 10 
TREATMENT OF ACUTE AND CHRONIC 
ULCERS. 
James Osborne DeCourcy. 
(Published by Louisville Medical Monthly, August, 1894.) 
1 have found no class of diseases yielding to treat, 
ment with greater reluctance than ‘‘old sores,” or 
chronic ulcers. Recently, however, 1 have adopted a 
plan of treatment which is quite different from that laid 
down in the books, and my results have been much 
better. 
Almost without exception, internal, or constitutional, 
as well as local treatment, is necessary. 
The internal treatment should be directed to the seat 
of the malady, thus eradicating the general pathological 
condition, eliminating the poisons and disease germs 
from the system. 
To accomplish this object, absolute cleanliness (inter- 
nal and external), plenty of pure air and sunshine, the 
religious observance of the laws of hygiene, and a whole- 
some nutritious diet, are more useful and restorative 
in many instances than are drugs. All the secretory 
organs of the body should be required to perform, as 
nearly as possible, their natural amount of work. 
This once accomplished, and all nature’s machinery 
kept lubricated and in good working order, the local 
treatment and work of reconstruction will be compara 
tively easy. 
The sores must be kept clean. This is done very 
satisfactorily by the application of hot water. If the 11 
parts can not be soaked in the hot water, an ordinary 
fountain syringe can be filled with water (as hot as can 
be borne, without burning), elevated high enough to 
give sufficient velocity to the stream which is played 
over the parts, by the operator holding the nozzle of 
the syringe a short distance from the seat of the appli- 
cation. The frequency of the washing will depend upon 
the nature of the case, but should be repeated as often 
as necessary to keep it clean and free from offensive 
odors. 
To destroy pus and bacteria, and to aid nature in the 
work of rebuilding the parts invaded, I have found 
Hydrozone and Glycozone superior to any and all other 
agents tried. 
Hydrozone is first applied (after the hot water) by the 
use of *n ordinary glass dropper, or hard rubber syringe, 
slowly, all over the ulcer, until the pus is destroyed. 
Chemical action with ebullition immediately follows 
and continues until the enemy is quite dead, but no 
longer. One layer of absorbent cotton is saturated 
with Glycozone and placed smoothly over the parts, and 
held in place by a cotton bandage, sufficiently tight 
to hold the cotton in place. 
Other local medication might do as well in some 
cases, but I have not so found it. The result obtained 
in the case 1 report herewith seems to confirm the 
statement as above made. 
Edw, K., aged twenty-three. American, but German 
descent. A farmer by occupation; unmarried. Rather 
small in stature, but well-built. Having taken sixteen 
bottles of “Blood purifier” and a lot of “Anti-constipa- 
tion pills” within the last eight months for ‘Tailing 
sickness,came to my office March 19th, with both legs 
most frightfully ulcerated, from knees to ankles, with considerable discharge of pus from various parts of the 
legs. Such a case should have been sent to a hospital 
or sanitarium, for the best systematic treatment obtain- 
able; but, unfortunately, he was so situated that he 
could not be sent to such a place. In a most pleading 
way, he asked me if I could do him any good. I told 
him I thought so, if he would mind me, and take the 
treatment that I would advise. He promised, and the 
treatment was begun. 
The legs were cleansed by soaking them for twenty 
minutes in hot water twice a day, after which Hydro- 
zone was used freely all over the sores, to destroy the 
pus, the pustules having been opened, and as much pus 
evacuated as possible. 
After this application, morning and evening, the legs 
were powdered all over the affected portion with a mix- 
ture of equal parts of alum, boric acid and aristol, then 
covered with absorbent cotton, and bound up with an 
ordinary cotton gauze bandage. 
This local treatment was kept up for two weeks. The 
improvement was slow, but constant. The process of 
healing advanced from the knees downward, and from 
the ankles upward, leaving the last part to heal about 
the middle of the leg, where the ulceration formed a 
thick crust, extending two-thirds around each leg. 
The constant discharge of pus from the sores caused 
the dressing to stick to the parts, which could not be 
removed without difficulty. 
The alum, boric acid and aristol powder was discon- 
tinued, and Glycozone used as a reconstructive agent, 
from the end of the second week. The sores were 
washed and the Hydrozone used as before mentioned, 
then the Glycozone was applied to the whole affected 
parts. A layer of absorbent cotton was saturated with 13 
Glycozone, and smoothly placed around the sores, and 
held in place by a cotton bandage. 
There was no further trouble about the bandage 
adhering to the sore. The granulation was much more 
rapid than at first. At the end of the second week after 
Hydrozone and Glycozone were used as the sole local 
agents, the young man said he was well and worked 
every day from that time. 
The internal treatment was changed from time to 
time as the case required. Opiates were given several 
times during the first two weeks of the treatment, to 
ameliorate the pain, which was very great at times. He 
was much emaciated and melancholy when he first came 
to me. His bowels would not move without cathartics. 
Fluid extract of nux vomica was given morning and 
noon, seven drops before each meal. Elixir lactopeptin, 
with bismuth, was given in drachm doses after each meal, 
and, occasionally laxatives at night. Later on, tincture 
chloride of iron was given, in ten drop doses, after each 
meal, for one week. 
After the third week no internal treatment was given, 
as the patient was in good condition, and cheerful. 
Hydrozone and Glycozone were left to complete the 
structure, and place upon it the capstone of a beautiful 
new integument, which they did in a way gratifying both 
to the patient and to myself. The following cuts illustrate a case of extensive ulcer resulting from Anthrax, before and after treatment with 
Hydrozone and Glycozone. 
The above picture is taken from a photograph of the patient, 
made November 1, 18Q5. 
This case reported by me before the Illinois State Medical Society in 1896; published in the New York Polyclinic 
for August, 1897. 
The above picture is taken from a photograph of Mrs. H. B., 
72 years old. It was made July 26, 1895. MALIGNANT SORE THROAT AND ITS 
TREATMENT. 
James Osborne De Courcy. 
Read before the twenty-first annual meeting of the Southern Illinois 
Medical Association, held at Carbondale, 111 , 
May g and io, 1895. 
(Published by the Courier of Medicine, for July and August Issues.) 
It is in compliance with special request from your 
distinguished president that the author ventures to add 
a word upon a subject which for several months past 
has received more scientific thought, perhaps, than any 
other one subject which concerns the profession from a 
pathologico-scientific standpoint. There are various 
forms of sore throat which may be called malignant; 
but the attention of this Association is directed by this 
paper to that acute, specific, contagious disease, begin- 
ning by an infection of the throat, characterized by 
local exudation, glandular enlargements, systemic poi- 
soning, and having various paralyses for its sequelae. 
The technical name by which it is generally called 
(derived, as it is, from the Greek diphthera, leather, and 
dipho, soften) at once portrays the peculiar nature of 
the pathological condition, and when the soft, leathery- 
like membrane has been formed and observed by the 
physician, a picture that cannot be erased is engraved 
on his mind. This malady has ever been a terror to 
the faculty, as well as to the laity, whenever and where- 
ever it has made its appearance. Since the profession has- 
had so much literature upon this subject from so many 
different standpoints, through the medical press during 
the past year, it seems that any lengthy scientific exe- 
gesis of the subject at this time could scarcely be 
expected. 16 
The more salient points, therefore, will be touched, 
some personal observations given along the line, the 
gate set ajar, that the members present may enter the 
field, unveil the materies morbi, and discuss their modus 
operandi, ad libitum. As to the cause of the disease the 
opinions of authors and pathologists of eminence have 
been at variance, and may yet be said to be divergent. 
Hueter, Oertel and Virchow were among the first to 
advance the opinion that micrococci produce the patho- 
logical condition, and, therefore, comprise the primary 
cause of the disease. On the other hand, in concord 
with various dissenting voices, by certain filtration 
experiments made by Burdon-Sanderson, serious doubts 
were cast on micrococci as the immediate agency; but 
they are found to. be necessary from either standpoint, 
and a secondary role named by the experimenter as 
being consequent upon their functional activity. More 
recently it has been scientifically demonstrated by a 
number of German pathologists, to the satisfaction of 
a portion of the profession, that this belongs to the list 
of bacteriological diseases, 
The reasons and demonstrations set forth to estab- 
lish the germ theory, so far as this disease is concerned 
—to the author, at least—seem conclusive; other opin- 
ions, possibly that of some of you, to the contrary not- 
withstanding. In regard to the contagious infectious 
nature, the sporadic, endemic and epidemic prevalence 
of the disease, it is scarcely necessary to make men- 
tion; neither its seeming alliance with scarlet fever, 
nor yet of its simultaneous appearance during epidemics 
of smalhpox, measles, puerperal and typhus fevers. 
The contagion in the poisonous exudations and secre- 
tions of the fauces is, without doubt, the chief cause of 
its spread. The author believes the variation in the 17 
period of incubation to be due to several causes, among 
which may be mentioned the physiological, or patho- 
logical condition, the age and surroundings of those 
exposed to and infected by the germs. From the stand- 
point of pathological anatomy, the first perceptible 
change is the injection of the mucous membrane of the 
fauces, quickly followed by hyperaemia of the tonsils. 
At the end of thirty hours or so a grayish pellicle ap- 
pears on the tongue, and soon is visible elsewhere on 
the soft palate, uvula or tonsils. At first these patches 
are thin and scattered, but in a very short time coalesce. 
Very soon the army of micrococci marshal their forces 
and press their way through the mucous membrane at 
whatever point may be the least strongly fortified. At 
and around this point the forces assemble as they pass 
through the broken wall, and at once proceed to throw 
up a very singular fortification—the false membrane. 
The constituent parts of this membrane, its office, 
extension into the nares and air passages, its various 
changes, together with the special forms of the disease, 
are intentionally omitted, with the hope that the more 
important points may be brought out by the discussion. 
Little opportunity is offered the general practitioner, 
outside of hospitals, for accurate observations of the 
inroads made by the disease on the various organs of 
the body. 
Symptomatology.—In the mild or catarrhal form, the 
symptoms are similar to those of acute pharyngitis, or 
tonsilitis: soreness, pain and irritation are felt in the 
throat, especially on attempting to swallow, and general 
malaise may follow. In other subjects of a nervous 
excitability; or those who are laboring under some 
pathologica condition at the time infected, the symp- 
toms may be much more severe. Nausea and vomiting may follow, marked headache, fever and sore throat. 
On ocular examination the tonsils are found oedematous, 
the mucous membrane of the fauces infiltrated, and 
membranous patches are present. So great may be the 
oedema of the tonsils that a fatal climax may be reached 
before the false membrane is produced. A thick white 
coating soon covers the tongue. In two or three days 
the false membrane appears in one or more places, 
spreading over a considerable space in a few hours. The 
membrane, at first thin, constantly grows thicker the 
longer it remains undisturbed. The color, at first a 
creamy.yellow or a grayish white, gradually changes to 
a dark red as the disease advances. About the fifth day 
the disease may take on the more severe form and vio- 
lent symptoms follow, the temperature rising to T030 to 
105° Fahrenheit. The soreness on attempting to swal- 
low is very acute, and in a few hours the membrane 
appears either on the palate, uvula or tonsils. In 
removing the tenacious membrane the mucus is peeled 
off wich it and a raw surface left through which tne 
blood percolates. Should no attempt be made to remove 
the false membrane and to arrest its reproduction it will 
spread rapidly, passing up the naresand down the tubes 
penetrating the air passage. Thus the blood constantly 
taking on poisons from the debris of the fungosus, the 
whoie system is saturated with the infection,and a septic, 
or even gangrenous condition produced. Possibly this 
condition of things may be spared byearliertermination 
of the case, by spasm of the glottis, occlusion of the 
bronchi, pneumonia or carbonic acid gas poisoning. It 
is during the septicsemic stage that the membranes take 
on the darker color, that the odor from the breath and 
discharges becomes foul and offensive. At this time, 
as a rule, there is but little elevation of temperature, if 19 
any at all; slow and Irregular pulse. Next gangrene 
sets up, and a fatal termination ushered in by paralysis 
of the heart. Numerous are the causes which influence 
the behavior, course, duration and termination of malig- 
nant sore throat. The mortality is great, though no 
precise statement of mortality rates has yet been made. 
The prognosis should be very guarded, and is usually 
grave; is augmented the more virulent the case from 
which the infection was obtained. For obvious reasons, 
the mortality is greatest in infants and young children. 
Good nursing has a decided influence upon the course 
of the disease, and should always be considered in esti- 
mating possible results. Extension into the nares and 
larynx is an alarming symptom; likewise bleeding, vomit- 
ing, purging, low temperature, cold and clammy skin 
and slow and intermitting pulse are premonitors of evil. 
Cases apparently favorable have suddenly ended by 
paralysis of the heart. As regards the hopefulness of 
recovery from the various forms of this disease, the 
catarrhal stands first, the croupous second and lastly 
the septic or gangrenous. 
Paralyses of various parts and organs of the body are 
prominent among the sequelae which often follow the 
ravages of this disease. It may come on at once, be 
delayed for several days, or even some weeks. For- 
tunately, however, this paralysis is quite amenable to 
treatment. It is hoped that the discussion will bring 
out the pathological condition thus produced upon the 
nervous system, organs of circulation and respiration. 
To make a prompt and positive diagnosis in all cases is 
a most difficult task. At present eminent authorities in 
bacteriology teach that the only actual scientific diag- 
nosis that can be made is by use of the culture fluid or 
microscope. A portion of the suspected exudate is 20 
immersed in the Klebs-Lceffier fluid, which is furnished 
in sealed glass tubes. After the fluid has been inocu- 
lated it is set away in a warm, dark place (98.6° Fahren- 
heit is about the required temperature) for the space of 
twelve or eighteen hours. If the micrococci of diph- 
theria are present they will by that time have produced 
a growth in the fluid which will be perceptible to the 
unaided eye. This method is not accepted by all. The 
microscope is regarded as the most accurate method by 
which to make a scientific diagnosis. The author has 
never yet seen two cases that were exactly alike, either 
in symptoms or in the local manifestations. Before the 
false membrane has been formed it is easy to confound 
the catarrhal variety with acute follicular ulceration of 
the tonsils, or amygdalitis, owing principally, in the last 
case to the intense oedema of the tonsils. Especially is 
this true when there are no other cases of the malady in 
the neighborhood, and when, so far as known, the 
patient has not been exposed to the contagion from any 
source. That it has been confounded with croup there 
is little room for reasonable doubt. 
Since croup is simply a local affection, non-contagious 
and not infectious, is without the characteristic general 
symptoms of malignant sore throat; for these reasons 
the non-identity of the two diseases seems perfectly 
patent. There is some analogy between malignant and 
scarlatinal sore throat, but the whole mucous membrane 
of the fauces is intensely red in scarlet fever, while in 
malignant sore throat the redness is limited to the 
infected area; in scarlet fever the exudation is soft like 
curds, and usually scattered over both tonsils and the 
palate. In malignant sore throat the membrane begins 
at one point (sometimes more), adheres closely to the 
epithelium, and has a characteristic color. In scarla- 21 
tina the symptoms are much more severe; high fever, 
with vomiting, delirium, or convulsions, commonly in- 
augurate the disease, which are wanting in malignant 
sore throat. At the expiration of twenty-four hours the 
rash appears in scarlatina, but is absent in malignant 
sore throat. 
Treatment.—Believing that local infection is the true 
cause of the disease, the following treatment is sug- 
gested, being based upon the validity of the germ theory. 
Rational treatment necessarily resolves itself into two 
distinct divisions: preventive and active therapeutics. 
In every case where preventive medicine is timely, 
faithfully and scientifically applied, the mortality should 
be zero. Unfortunately, however, this mode of treat- 
ment is at present impracticable in very many cases. 
In the application of preventive measures, the establish- 
ment and maintenance of normal physiological condi- 
tion is of primary import. 
Abundance of sunshine, the greatest of all purifying 
agents and germicides; good hygienic surroundings, 
absolute cleanliness indoors and out, internal and exter- 
nal, are axioms, so to speak, which should form the 
basis of treatment in all cases. When the disease has 
appeared in any locality the whole population should be 
informed at the earliest possible moment, so that suit- 
able precautionary steps may be taken to suppress the 
outbreak. The mouths and throats of all children who 
are under fifteen years of age and living in the infected 
district should be carefully examined from day to day. 
Mouth washes, gargles and sprays of trustworthy 
■germicide agents, should be freely used in every family 
where there are children, and especially among the 
young children, as well as all those who may be exposed 
to the poison. There are many germicides in active use, 22 
but the author has obtained the most satisfactory results 
from the use of Hydrozone. No ill effects are conse- 
quent upon the extensive use of Hydrozone; and when 
diluted can be given internally to the new-born infant. 
Immunity of children produced by the new and very 
popular agent, antitoxic serum, before, or at least as 
soon as exposed to-the infection; is already regarded by 
some as the best known preventive and active treat- 
ment. There are many things which conspire to influ- 
ence the active treatment—the age of the patient, his 
physiological or pathological condition at the time he is 
infected, the length of time the poison has been in the 
system when the physician first sees the case, the par- 
ticular form of the disease and the general surroundings 
of the patient are all to be noted, and are worthy of 
careful consideration. The earlier the disease is rec- 
ognized and the sooner the treatment is begun the bet- 
ter will it be for all concerned, and the greater the 
chances for recovery. As venom by the sharp fang 
implanted beneath the skin quickly ramifies every part 
of the living organism, producing general toxic effects, 
so it is in this disease; the infection from a single spot 
migrates into every nook and corner of the system. For 
complications that may arise during the course of special, 
cases no prescribed plan of treatment would apply. 
The physician in charge is at the helm; wisdom and 
good judgment must be brought into play as compass 
and needle to direct him in the skillful management of 
the case, so that, as the vessel advances through the 
tempest, the rocks and sand-bars lying concealed along 
the way may be avoided. Solutions of silver nitrate, 
iron chloride tr., perchloride and glycerine, acids (sali- 
cylic and carbolic), potash chlorate,borax,etc., have been 
in use as local applications for a long time; but some of 23 
them are dangerous and the author does not use 
them. He has found nothing superior to Hydrozone. 
It accomplishes all the good that can be obtained from 
any local application, routs the enemies from their 
strongholds, kills the invaders and destroys their forti- 
fications. It is quite safe and free from all untoward 
after-effects which often follow the use of some of the 
other therapeutic agents; can be used in full strength, 
or diluted, as a spray, gargle, taken internally, or used 
on cotton probang to mop up the “beasts.” It should 
be used every hour, day and night, until the false mem- 
brane ceases to be reproduced, and every particle of the 
membrane destroyed at each seance. If the fungosusbe 
removed early and kept removed hourly it is very quickly 
destroyed by Hydrozone, when applied in full strength. 
When the growth extends into the nares diluted 
Hydrozone should be sniffed up the nose, or the nasal 
douche and spray thoroughly and frequently used. 
After the poison has become general the systemic 
treatment is quite as important as the local. The treat- 
ment should be directed against the malady from a 
double standpoint, to limit spreading of the local dis- 
ease and to prevent, as far as possible, systemic infec- 
tion. Ammonia bromide, iodine (used singly and com- 
bined), iodine comp. liqr. and acid carbolic, quinine and 
alcohol have been extensively used as constitutional 
antidotes to the poison of malignant sore throat. Since 
the appearance of antitoxic serum in therapeutics the 
mortality of this disease has been so much reduced in 
the various hospitals and infirmaries where it has been 
used, it has supplanted other agents or reduced them to 
places of subordination, at least for the time being. 
The author’s experience with antitoxin is quite limited, 
having used it in three cases only; but in each case the 24 
results were all that could have been expected by the most 
sanguine. The results following its use, as reported by 
the institutions and physicians who have experimented 
with it are very gratifying; and unless “it is possible that 
the very elect are deceived” the antitoxic serum therapy 
is a success. The immunizing dose is from c. c. i. to c. c. 
vii, depending upon the age and condition of the patient. 
The medicinal dose is from c. c. v. to c. c. xxv, given 
at one injection, repeated one or more times should it 
be deemed necessary The earlier the injection is 
given the less will be the quantity of serum required in 
any given case. Stimulants and quinine may perform 
beneficial functions, but nourishing aliments are neces- 
sary from the beginning. Beef essence, eggs, egg-nog, 
pure milk and malted milk are suitable articles of food for 
diet. They can be changed and interchanged from time 
to time throughout the course of the disease. Nourish- 
ment should be given at short intervals in order, if pos- 
sible, to prevent collapse. 
It is scarcely necessary to add that every precaution 
should be taken by physicians and nurses to ward off 
infection. The clothes of the patient and nurses, the 
bed, bedding, furniture, and apartments occupied, 
should be thoroughly disinfected. The judicious use of 
quinine, iron, strychnine and electricity will generally 
subdue paralysis that may follow or result from an attack 
of malignant sore throat.