Treatment 
OF 
DIPHTHERIA. 
BY 
E. N. CHAPMAN, A. M., M. D. 
Late Professor of Obstetrics, etc., L. I. College Hospital. 
Reprinted from Buffalo Medical and Surgical Journal, October, 1S77. 
Buffalo: 
PRESS OF BAKER, JONES & COMPANY. 
1877. TREATMENT 
OF 
D1 P H TJH E RI A. 
By E. N. CHAPMAN, A. M., M. D., 
Late Professor of Obstetrics, etc., L. I. College Hospital. 
The treatment of diphtheria has, the last ten years, been so 
thoroughly and exhaustively discussed, that it would seem the 
height of folly, at this late day, to question the matured opinions 
of practitioners and writers the world over. Nevertheless, from 
the fatality of this deadly scourge, as it is universally considered, 
I am induced to offer my experience in a plan of medication w'hich 
has, after a trial of more than fifteen years, been crowned with a 
success that throws every other, however pretentious, into the 
shade. To substantiate this bold statement I shall appeal for 
proof to the records of the Board of Health of this city, a set of 
books as certain to dissipate groundless assumptions as to establish 
sterling facts. The revelations of microscopy, the researches, of 
chemistry, the flights of theory, and the deductions of reason are 
of little avail in the face of the enemy, when the urgent practical 
question,—the empirical fact—what will cure the patient, waits a 
solution. 2 
DIPHTHERIA CHAPMAN. 
In 1859 and 1860, whilst employing the means then in vogue, I 
lost every third or fourth case, a frightful mortality, yet one many 
physicians bemoan even now; but immediately after instituting an 
opposite treatment, though the epidemic was at its worst, not more 
than one in twenty. This treatment, which I have since seen no 
reason to change, or even to modify in any essential particular, was, 
together with the cases presented in its support, published in the 
Boston Medical and Surgical Journal, February 5th, 1863. In 
this article, reasoning from results to causes, 1 came to the conclu- 
sion that diphtheria is a disease of the blood, a disease tending to 
rapidly destroy the vitality of that fluid; that the exudation is 
secondary to this contamination, a local manifestation of a general 
dyscrasy; that the fever is sympathetic, the turmoil excited by the 
intrusion of a deadly agent; that alcohol counteracts, neutralizes, 
or destroys the poison, whatever it may be, acting, in fact, like a 
true antidote, if promptly and liberally given ; that the membrane 
falls and does not reappear directly the blood fails to offer the proper 
pabulum for its continual growth ; and that bark and iron are the 
only aids required, aside from substantial food, to conduct ninety- 
five per centum of all cases to a successful issue. 
Acting on these principles from December, 1860, to the conclu- 
sion of my report, January, 1863, it appears that, of the twenty 
cases treated with brandy, quinine, and iron, I lost one only, a re- 
sult so far surpassing what had been attained by otheis, that I hoped 
the profession would be induced to give these remedies a fair trial; 
but, as yet, this hope has not been realized. For this failure, it is easy 
to allege a sufficient reason. The misfortune of a name often 
clouds a writer’s ideas or, when these are fully grasped, ensures 
their prompt rejection. 
Under ordinary conditions, alcohol is a stimulant; but in diph- 
theria it lacks this property, a quantity which would in health in- 
duce intoxication having no excitant effect: it is thrown off in 
the breath; but in diphtheria,unless the dose is disproportionately 
large, no odor is perceptible until the disease begins to yield: it 
is contraindicated in acute attacks of fever, especially if attended 
with local inflammation; but in diphtheria the contrary holds true: 
it is demanded, when the vascular excitement lessens and nervous DIPHTHERIA CHAPMAN. 
3 
energy flags, to support the vital forces in the effort to rally from 
the shock, and regain their supremacy; but in diphtheria the poi- 
son has, at this stage of the disease, done its work so thoroughly 
that alcohol no longer, or but feebly, manifests its antidotal prop- 
erty. 
Hence, from the more common action of alcohol, and the more 
common use to which it is applied, it is well-nigh impossible to 
gain a hearing, when, on the strength of clinical data alone, one 
asserts that alcohol in diphtheria is not a stimulant, but a febrifuge; 
is not an excitant, but a sedative; is not a tonic to support the 
strength, but an antidote to neutralize the poison; its full efficacy 
being shown at the outset of the disease when fever is high and 
inflammation acute. In fact, it is as much a specific for the diph- 
theritic poison as quinia for the malarial; each breaking up a special 
morbid process, and rendering a prompt return to health possible, 
through an unknown potency that has as yet defied the search of 
science. So, also, the analogy holds as to the prophylactic quali- 
ties of these two remedies; what is curative being equally preventa- 
tive in each instance. 
From the treatment I commenced at the close of the year 1859, 
and published two years later in the Boston Medical and Surgical 
Journal—a treatment which has to this day made no advance in 
professional favor—I will make the following extract, inasmuch 
as it inculcates the therapeutical principles that have since, by a 
singularly small ratio of mortality, been notably vindicated, if, per- 
adventure, success for a series of years is the touchstone by which 
to test medical doctrines. 
“ With a singular uniformity, the stimulating treatment, whether 
in the acute or chronic stage—that of excitement, fever, and in- 
flammation, or of prostration, rheumatism, or dropsy—had the same 
happy effect; and it was in all conditions, that had a diphtheritic 
origin, uninterruptedly followed; since we only regarded the cau- 
sation, not its manifestations—the root of the evil, not its offshoots 
—and directed our efforts to the removal of a special state of the 
blood. This state of the blood, which is prone to occur in scrofu- 
lous children, or adults reduced by disease, or of feeble constitu- 
tions, in a certain endemic condition of the atmosphere, is marked 
by a diminished vital power which, being exalted by stimulants, 
the symptoms are checked, the inflammation subdued, the mem- 
brane removed, a rapid recovery effected, and relapses prevented. 4 
DIPHTHERIA CHAPMAN. 
In other words, this plan of medication is radical, strikes at the 
heart of the trouble; whereas most others that have been proposed 
are but an ineffectual warfare against symptoms. The blood, 
which is similarly affected in the mild or severe cases, in the first 
or later stages, only differing in the degree of its dissolution, alone 
claims our attention. Against this condition, before the disinte- 
gration is irreparable, we bring to bear the most powerful means 
in-our hands, to buoy up the constitutional powers, and sustain the 
activity and energy of each function. The first link in this mor- 
bid chain being this retrograde movement in the vitality of the 
blood, when this is checked, fever, inflammation, haemorrhage, ex- 
udation, collapse, paralysis, dropsy, &c., disappear almost magically, 
from the simple fact that the cause has been rendered null and 
inoperative, and the prime pathological change removed. 
“Of the remedies that have been employed in diphtheria, two 
only have proved themselves in my hands worthy of confidence, 
with the exception, in the chronic stage, in favor of the salts of 
iron. These two remedies, alcohol or cinchona in one of its forms, 
are administered in such doses and at such intervals as to secure one 
effect—the fullest stimulation of the nervous and vascular systems. 
Either, singly, may suffice when the vital force needs but slight aid 
to maintain the integrity of the blood; but the two united have 
more than a double power, and call out the greatest possible amount 
of resistance, since the nerve-centres and blood-vessels—the great 
life-factors—are exalted to the highest point. Alcoholic liquors, 
when given in such quantities and at such intervals as to occasion and 
keep up a steady but not excessive excitation, not only quicken the 
functional offices of each organ, but act more especially on the 
nervous and vascular systems. They bring out the latent powers, 
arousing them when dormant, and freeing them when oppressed by 
a load of morbific influences; and thus give, for the time being, 
the greatest energy to the entire organism. Herein, according to 
the views of many therapeutists, alone consists the value of this 
class of stimulants in any disease. The patient lives over the crisis, 
or the poison is spent or eliminated; and thus recovery becomes 
possible. This is but a partial estimate of the remedial action of 
alcohol, which not only produces the effects just mentioned, but 
others of much greater importance in the present disease—the in- 
creased vitality of the blood itself. It is well known that the habit- 
ual use of spirituous beverages augments the blood-making process, 
renders the blood richer in all of its important constituents—the 
red globules, albumen and fibrin—and of a greater crasis; by which 
means, there arises an excess of organizable material, that often 
occasions inflammatory diseases in bonvivants. This condition is 
the opposite to that existing in the diphtheritic subject, whose 
blood has, invariably, been rendered poor by exhausting disease, or 
impoverished by the demands of increase and growth, as in the in- DIPHTHERIA—CHAPMAN. 
5 
stance of children. These causes are intensified and rendered 
operative by a scrofulous or syphilitic taint. 
“It is a noteworthy fact, that, in my experience, diphtheria 
never attacks those habituated to the use of spirits. This, if con- 
firmed, may be more than a remarkable coincidence. 
I, therefore, from clinical observations and therapeutical deduc- 
tions, arrive at the practical conclusion, that alcohol is not only a 
stimulant to the system at large, but also to the blood itself, quick- 
ening its vital elaborations, and increasing its vital status, through 
which a direct barrier is thrown in the way of the disease. In 
other words, the results produced by the disease, and by the alco- 
hol in the blood, being directly opposite, they neutralize each other; 
and thus, the stimulant assumes in my eyes the position of a true 
remedy, a trustworthy antidote. Hence its medicinal power being 
not only remedial but prophylactic, it will prevent the extension of 
diphtheria in the other members of the family, as well as cure the 
one atfected. This conclusion is a necessary sequence, if the 
pathology of diphtheria and the modus operandi of alcohol have 
been correctly appreciated. 
In malignant cases of diphtheria, we might desire to avail our- 
selves of a co-operating remedy—of one, like quinia, that particu- 
larly excites the great ganglionic nerve-centres; by which means 
we should attain a maximum of power, and carry stimulation to the 
highest possible degree. The various preparations of the cinchona 
bark fulfil this indication; and, when pushed to the extent of caus- 
ing tinnitus aurium, are our most potent nerve-stimulants. Their 
efficacy is shown in all diseases when the innervation is weakened, 
disordered, or perverted ; in fevers from malaria, in fevers from a 
blood-poison, and in a variety of morbid conditions attended with an 
exhausted or defective nervous energy. As a tenderness of the 
gums is a mark of the saturation of the system with a mercurial, so 
the ringing in tne ears indicates that the brain is fully under the in- 
fluence of cinchona. Both it and the alcoholic stimulant, whether 
used singly or united, should be given with regularity, and in suffi- 
cient doses to obtain their full effects; and then the latter, in a 
lessened quantity, continued for two or more weeks atter the disap- 
pearance of the disease and its sequelae. From the outset to a per- 
manent restoration to health, one, or perhaps both of these reme- 
dies, are to be continuously administered. 
In the more tedious cases that retain a haemorrhagic tendency, 
the substitution of a sesqui-salt of iron for the cinchona might, for a 
time, be advisable, when the peculiar effect of the latter on the brain 
had been attained. These salts of iron, like the alcohol, increase 
the crasis and coagulability of the blood, as 1 have experienced in 
several instances of internal haemorrhage; but they affect the body 
of the blood too slowly to be a trustworthy reliance in acute cases. 
Their action would be slight, short of two or three days; whereas 
the progress of diphtheria brooks no delay. Indeed, one of my 6 
DIPHTHERIA CHAPMAN. 
cases was attacked with the disease, although the persulphate of 
iron, in free doses, had been in use for haemoptysis for more than, 
forty-eight hours. At least fifteen drops of the muriated tincture, 
or five drops of the solution of the chloride or persulphate of iron, 
should be administered every third or fourth hour whenever we de- 
sire this peculiar change in the blood; but in chronic cases, with 
more time at our disposal, the dose may be less, since usually our 
main object is now to remedy the anaemia. 
“ Most writers insist strongly on the importance of giving large 
quantities of animal broths to sustain the strength of the patient, 
and thus enable him to ride out the violence of the disorder. This, 
as a medicinal means, cannot but be erroneous in the early stages, 
since most ol the patients are taken while eating heartily of animal 
food, and enjoying their usual health. We could not expect that 
nourishment, however concentrated, which did not prevent the ac- 
cession of a disease whilst the digestion was vigorous, would cure it 
when digestion, assimilation, ancl nutrition are completely destroyed. 
The change of food into the living structures is something more 
than its ingestion into the stomach, or its absorption into the blood- 
vessels; andpiutriment, unappropriated, can be only an incumbrance, 
—a foreign element—which will be carried off by the kidneys with 
the effete matters. Most of my patients took little or no nourish- 
ment before convalescing, when it was ordered for the same reasons 
that we order it in other ailments. 
“It is important to avoid close, hot, and badly ventilated rooms, 
and secure a free circulation of air. As soon as practicable, the pa- 
tient should be taken out of doors, and no fear need be entertained 
of catching cold; the disease having no analogy with tonsillitis, pha- 
ryngitis, or any other mucous inflammation whatsoever.” 
Since writing the above, I have come to rely more and more con- 
fidently on alcohol in some one of its many forms, as the remedy par 
excellence not only for diphtheria, but also for all diseases with which 
it is complicated; for example, croup, scarlatina, pneumonia and 
albuminuria, and I might say, perhaps, gastritis and meningitis. 
In fact, diphtheria so contaminates the circulation that recovery is 
scarcely possible in slighter ailments than these unless this, the 
major disease, which overrides all else, is promptly attacked by the 
only agent that will neutralize its venom, and effectually check 
blood, degeneration. This being done, the case is usually so simpli- 
fied as speedily to terminate in recovery with little farther aid from 
art. Often, indeed, these several complications are simply varied 
expressions of the diphtheritic poison, signs of a general infection 
of the system, that demand even more urgently the use of stimu- 
lants and tonics in full doses. DIPHTHERIA. CHAPMAN. 
7 
Still more, diphtheria makes a decided impress, when generally 
prevalent in a community, on all other diseases by imparting a low 
type that forbids depressing medication, and demands early stimu- 
lation. Antimony, ipecacuanha, and hot baths should in croup 
soon give place to brandy, quinine, and good food; immediately if 
the fauces appear at all suspicious, and directly if the reducing 
plan fails to subdue the rough, rasping cough. Thus the formation 
of the croupous membrane, which, doubtless, in a certain epidemic 
state of the air is always of a diphtheritic nature, may be fore- 
stalled. So, also, in cases of mucous, follicular, and glandular 
inflammation of the tonsils, the alcoholic treatment heads off the 
enemy, should it lie in ambush, and more certainly than any other 
ensures a prompt and satisfactory recovery. The exudation fully 
declaring itself, whatever may precede or attend it, the alcohol is 
to be implicitly relied upon to the exclusion of all else, unless the 
sulphate of quinia be an exception, and given with the same 
precision as is requisite to the proper administration of any other 
important medicine. The conditions of success must be observed 
scrupulously, as otherwise the alcohol may be robbed of its specific 
virtues, and the contamination of the blood go on unchecked. 
Whatever makes a call on the nerves and lessens their tone like 
cathartics, emetics, and foul air; and whatever deteriorates the blood 
and impairs its crasis like mercurials, alkalies, and poor food, is to 
be carefully avoided. Consequently the patient should be in bed, 
the room cool and well ventilated, evacuants interdicted, the secre- 
tions undisturbed, and the fever, local symptoms, or other accessory 
conditions disregarded. The one indication alone obtains; to wit, 
the introduction, as promptly as practicable, of a sufficient quantity 
of alcohol into the circulation to counteract the effects of the 
poison and prevent morbid changes in the blood. The more speedy 
the resort to the antidote, the more speedy the cure, a day or two 
being often sufficient to restore the patient to his usual health; but, 
if the alcohol be held in reserve until the fever is allayed and the 
system prepared for stimulants, it will be shorn of its potency, as 
now the damage has been done and there is no vitality left to res- 
pond, though the stomach were flooded with alcohol and stuffed with 
food. The administration of alcohol, therefore, at the inception of 8 
DIPHTHERIA CHAPMAN. 
the diseas#, and in a sufficient quantity to prevent the peculiar 
fermentation in the blood induced by the diphtheritic poison, is 
necessary to the full play of the specific virtues of the remedy; but, 
on the contrary, that of quinia at a later stage and in a moderate 
dose to sustain the nerve-centres and arouse the latent energies of 
the system. Nevertheless, to intensify the power of alcohol by im- 
parting through the nerves more vitality to the blood, it is safer in 
bad cases to inaugurate the treatment with both, and, in this way, 
anticipate the depression that soon follows the appearance of the 
membrane. 
The office of iron is much inferior to that of quinia. It is not 
to fight the battle but to complete the victory; not to defend the 
citadel but to rebuild its shattered walls; and yet, in order to re- 
move every evidence of the terrible struggle, and restore the vital 
forces to their wonted supremacy, the aid of alcohol is needed 
more or less constantly. 
To show the sufficiency of these three agents, unaided by others, 
medical or surgical, I will here append the histories of certain typi- 
cal cases which illustrate both the routine of my treatment, and its 
success in the most desperate straits. 
A boy three years old was taken in the evening with croup. At 
first emetic, and then nauseating doses of ipecacuanha were given, 
but in the morning, to head off any lurking tendency there might 
be to the membranous form, fifteen drops of whiskey every two 
hours. The third day, the mother had a small diphtheritic patch 
on one tonsil. Two teaspoonfuls of whiskey and one grain each 
of quinoidine and sulphate of cinchonia were directed every two 
hours. The whiskey ordered for the boy was now given to his brother, 
two years younger, in ten drop doses. On the fourth day the first, 
and on the eleventh the second son, were attacked with scarlatina 
in a mild form. The alcoholic treatment was followed without 
addition until convalescence was established. On the twelfth day 
the daughter, twenty-one years of age, the only remaining member 
of the family was attacked with a raging fever, intense headache, and 
membranous inflammation of both tonsils. In her case, the same 
medicines were prescribed as those taken by the mother. All re- Dir IITHERIA CHAPMAN. 
9 
covered promptly, and suffered from no secondary disorder; except 
the mother who had, some ten days after the fall of the membrane, 
a dimness of vision that forbade reading, sewing, or other contin- 
uous application of the eyes. This symptom necessitated a return 
to the original treatment for a couple of weeks. 
A gentleman who had for many years been superintendent of a 
large brass manufactory, where his nerves had at length become so 
shattered by the roar of machinery and the reverberation of metal 
that he was about retiring to a farm in Connecticut, was taken 
down with pneumonia and diphtheria simultaneously. Brandy 
and quinine carried him quickly and safely through these diseases 
whereupon the country air, imparting tone to the nervous system, 
restored the full vigor of former years. 
A child seventeen months old, badly nourished, and subjected to 
the adverse conditions of the back basement of a tenement house, 
came under my care the third day of its illness. The exudation 
covered the fauces, and filled the nostrils. The voice was extinct, 
the head thrown back, and the inspiration laborious and whistling. 
I held out no hopes to the parents of recovery, but told them that 
their only chance was to give, as long as the child could swallow, 
the following prescription. 
ft. Quiniae sulp gr. vi. 
Acid. sulp. aromat. . qtt xx. 
Sp. frumenti %i. 
Aq. fontanae .... fij. M. 
S. A teaspoonful every hour and a half in water. 
This was given singly and uninterruptedly until convalescence 
was established, when the whiskey alone was relied upon. 
On the third day of my attendance, as the membranous secretion 
gave place to a purulent one, and the respiration improved, the ears 
became filled with the same deposit, and the cervical glands enlarged 
by a low form of inflammation. Two of these glands quickly 
suppurated and were lanced. In the mean time the exudation 
having disappeared, the medicine was given at longer intervals and, 
lime-water and condensed milk substituted for the mother’s milk, 
which was watery and insufficient. 10 
DIPHTHERIA CHAPMAN. 
In a day or two the child began to struggle for breath, as in 
membranous croup, when the quinine and whiskey were re-ordered 
as at first. The effect was a copious purulent secretion, a disinte- 
gration of the membrane, and the relaxation of the spasm. As 
soon, however, as this danger was past, a graver one, if possible, 
presented itself—the extension of the exudation to the bronchial 
tubes. The child did not expand its chest, had a livid, bronzed 
look, was bathed in a clammy, profuse perspiration, and felt as 
cold as a piece of marble. 
I directed an emetic of ipecacuanha, sinapisms to the chest, dry 
warmth to the extremities, and a continuance of the prescription. 
The emesis, bringing up a large amount of muco-purulent matter, 
gave instant relief. Afterwards, the child vomited once or twice a 
day spontaneously. My attendance extended from February 19th 
to March 11th; but ten days before the last date, the recovery was 
assured. This was not retarded, or marred by any secondary 
trouble whatever. 
* 
A boy six years of age, was taken with diphtheritic sore throat; 
and, though the local disease remained much the same, he rapidly 
grew worse. His blood seemed saturated with the poison; as shown 
by the stomach rejecting all food and drink, by the heart acting 
feebly and irregularly, by the extremities being cold and shrivelled, 
and the skin having a dusky, sodden look. At first, one and then 
two teaspoonfuls of brandy were given every two hours; but soon the 
larger dose every hour. Food in any form would not remain on the 
stomach; and quinine, promptly rejected, induced a retching that was 
slow to subside. The brandy, only tolerated in divided doses, had to be 
often repeated to make good the loss. On the third day, there was 
a typhus-like fever; lividity of the surface, oppression of the brain, 
muttering delirium, and a quick, feeble pulse. On the fourth day 
scarlatina made its appearance. The eruption, save mottled 
blotches on the face, was confined to the trunk, and had a deep 
raspberry hue. As the symptoms assumed greater gravity, the 
brandy was given in three drachm doses every hour, and aided, as 
far as the stomach would permit, by quinine, and lime-water and 
milk. At the advent of the eruption, the membrane began to DIPHTHERIA CHAPMAN. 
11 
spread over the fauces and extended up the posterior nares, and, at 
its decline, to be detached in putrid flakes and discharged in 
purulent #puta. The active treatment extended over two weeks, 
and resulted without accident in a speedy and perfect recovery. 
A girl, nine and a half years old, deficient in constitutional force, 
weakened by too rapid growth, and afflicted with lateral curvature 
of the spine, was taken with diphtheria. The exudation on the 
third day covered the fauces, filled the nostrils, and extended along 
the roof of the mouth. The symptoms became more and more 
typhoid, and the putrescence more and more pronounced. Food 
and drink were not tolerated, quinia induced violent retching, and 
brandy was vomited unless given in small quantities. The case 
seemed desparate, as it presented all the signs of malignancy. Be- 
ginning at first with smaller doses, the brandy was soon increased 
to four drachms the hour, and when rejected was made good. As 
the stomach became more tractable, lime-water and milk, scalded 
in a thin decoction of farina, was given for nourishment; as the 
disease began to yield quinia was administered in suppositories; 
and, as the membrane lost its hold and was supplanted by a puru- 
lent secretion, the tincture of iron in small and frequent doses was 
conjoined with the brandy. In two weeks convalescence was 
fully inaugurated; and in three, when the local disease was com- 
pletely subdued, a semi-paralytic state of the heart showed itself, 
and necessitated the removal of pillows and a rigid enforcement of 
the horizontal posture. Eventually, she was restored to her usual 
health without a drawback, excepting a discharge from the right ear. 
On the fifth day of this patient’s illness, two of her younger 
sisters were attacked with scarlatina. The whiskey which they, to- 
gether with the other members of the family, had been taking as a 
prophylactic was now continued as a medicine. The only addition 
was a diaphoretic mixture. They passed through the fever in the 
most satisfactory manner, it being neither aggravated by compli- 
cations, nor prolonged by secondary disorders. The others in the 
house, some twelve in number exclusive of the servants, escaped by 
the virtues of the antidote, though the scraping of walls, the burn- 
ing of clothes, the tearing up of carpets, etc., were omitted. 12 
DIPHTHERIA CHAPMAN. 
I was called on a Sunday evening by Dr. , a friend of mine, 
to see a lady whose child had died the morning previous of diph- 
theria. She had held the child most of the time of its illness, and 
kissed it repeatedly and frantically on the lips, as prutrescent mat- 
ter flowed from them in its last moments. Friday and Saturday 
she had had an exudation of moderate extent in the fauces, but 
now in addition a diffused intumescence and induration of the neck. 
Seeing that the patient had inhaled the child’s breath for six days, 
had had patches on both tonsils for two, and had applied her 
mouth to the poison many times, I mentioned to. the Doctor that 
we had all the conditions present, foreshadowing a malignant case, 
and that, regarding alcohol as a true antidote, I would advise its 
administration in full doses, the same as when the disease was at 
its height. Besides the quinine previously prescribed, the patient 
took a tablespoonful of whiskey every hour with this result; she 
attended the child’s funeral on Tuesday, and in a day or two re- 
gained her usual health. In this case, the abortive power of alcohol 
was fully manifested—a power it rarely fails to assert. 
To further substantiate the virtues of alcohol in the treatment 
of diphtheria, I will in conclusion appeal to the records of the 
Health Board of this city. From the figures furnished me by two 
persons connected with this department, it appears: 
In 1874 there were reported 1651 cases of diphtheria; in 1875, 
2669 cases, and in 1876, 2329 cases; making in all 6649 cases. 
During the same years, respectively, there were reported 580, 
965, and 810 deaths from diphtheria, and 318, 451, and 412 deaths 
from croup, making the total mortality from diphtheria 2355, from 
croup 1181, and from diphtheria and croup 3536. 
Now if it be assumed that all the cases reported as diphtheria 
were genuine, and that the majority of deaths from croup had a 
diphtheritic origin, as doubtless is true, then there will be slight 
grounds for congratulation over the progress made by therapeu- 
tics. The mortality is truly appalling. Even including the 
croupous, among the diphtheritic cases the exhibit is far from 
flattering. 
From Jan. 10th, 1874, when I lost a young girl ten years of age, 
to this date Sept. 15th, 1877, I have reported 78 cases of diphtheria DIPHTHERIA—CHAPMAN. 
13 
and lost one only. This even does not rightfully belong to the 
list, as the child had been under the care of a homoeopathic phy- 
sician several days. A younger child lay dead in the house when I 
was called. Beside, the patient refused all food and medicine, and 
died in thirty-six hours. An older child promptly recovered. 
To these 78 cases should be added some eight cases, or more, 
which, from the slight local trouble or other cause were not reported; 
but which, from the course of the disease, I am convinced were 
really diphtheritic. Three of these cases, from the delay in resorting 
to brandy and quinine at the outset, required much longer treat- 
ment than usual. Thus it appears that, in a period of three and a 
half years, 85 cases of diphtheria have been treated successively 
without a failure. What is more, not a death appears under the 
head of croup, or other disease, the sequel of the diphtheritic 
poison. 
The following report was furnished me as to the cases and causes 
of death—old age, 2; heart disease, 2; softening of brain, 1; can- 
cer, 1; apoplexy, 1; phthisis, 2; preumonia, 1; congestion of 
lungs, 1; jaundice, 1; typhoid fever, 1; cerebro-spinal meningitis, 
1; cystitis, 1; Bright’s disease, 1; puerperal fever, 1; diphtheria, 
1; scarlatina, 1; cholera infantum, 5; marasmus, 2; convulsions, 
2; chronic eczema, 1; whooping cough, 1; and dentition, 2. 
The above success, verified beyond cavil, was/due almost wholly 
to the systematic use of whiskey or brandy in definite doses and at 
fixed intervals, whether the cases were suspicious, mild, or well- 
marked. A croupy child, if not speedily relieved by the usual rem- 
edies, was treated in the same way; as also other members of a 
family, when one of them had decided diphtheritic symptoms. 
Several of my medical friends who have been induced to make 
trial of the alcoholic treatment, assure me that it gives far better 
results than any other they had previously employed. Should 
other members of the profession, from the facts presented in this 
article, do me the like honor, I am certain they would soon meet 
diphtheria without fear, treat it with confidence, and attain a suc- 
cess surprising to themselves.