[Reprinted from The Medical News, October 8, 1892.] 
A CASE OF DIPHTHERIA IN WHICH THE MEM- 
BRANE PERSISTE D FOR A LO N G TIME, 
WITH NEPHRITIS AS A SEQUENCE. 
By J. A. HAWKINS, M.D., 
OF AVALOXj PA. 
The case herewith reported is of interest on account 
of the duration of the disease, as well as of the way in 
which the sequel manifested itself. 
Walter W. ,ten years old, presented a good family and 
personal history. He was the eldest of six children, all 
of whom were living when the patient was taken ill. On 
June 3d I was called, and found the boy with a temper- 
ature of 1020 F. The pulse was 98, and pretty strong. 
He complained of headache, malaise, and slight sore- 
throat. On inspection I found the tonsils enlarged, con- 
gested, and of a dark-red color, the right being the more 
swollen. No membrane could be seen. The glands of 
the neck were slightly enlarged. I told the parents to 
put the boy to bed in an isolated room. He was given 
six grains of calomel at once, and tincture of the chloride 
of iron, ntvijss in sufficient glycerin to make a dram, 
every two hours, without any water for fifteen minutes 
after each dose. 
I saw the boy again on the following morning. The 
temperature and the pulse were about the same as on 
the preceding day. There was also a spot of membrane, 
as large as the nail of the little finger and raised at least 
half a line. This I succeeded in stripping off with for- 
ceps, leaving a bleeding surface. I immediately directed 2 
the administration of mercuric chloride, grain, every 
two hours, in addition to the tincture of iron, which was 
continued as before, except that it was given in a wine- 
glassful of cold water. The throat was swabbed every 
hour with a solution of mercuric chloride, % grain to 4 
ounces of water, the swab used being of cotton and being 
thrown away. 
This treatment was kept up for about six days, and 
still the membrane spread. It involved the naso- 
pharynx, travelled on to the uvula and soft palate, along 
both cheeks, completely lining the buccal cavities, and 
thence to the under-surface of the tongue. At this time 
a sister was taken ill with the same disease. She was 
well in the course of two weeks. As the boy's heart 
began to weaken, he was given half an ounce of whiskey 
every two hours. At no time did he present any symp- 
toms of mercurial intoxication, but at about this time he 
refused to take the iron. To show him the bottle would 
make him " boke," as the family designated the gag- 
ging. I then directed five drops of the iron to be given 
in half a tumbler of water, but still it was vomited. The 
addition of some lemon-juice failed to help matters. 
The whiskey also came up ; and port wine was tried, but 
with no better results. 
I attributed the vomiting to an overdose of eggnog, on 
which he was largely fed alternately with beef-essence. 
The boy now refused egg in any form, as well as milk, 
but craved for bean-soup, which was given him. 
Things went on in this way for fully two weeks more, 
oil of eucalyptus and carbolic acid in glycerin and 
water being substituted as a swab. The mercuric chlo- 
ride had been withdrawn on the tenth day, and, as the 
boy could not be gotten to take iron or whiskey, he was 
given tincture of digitalis, three and a half drops every 
two hours, and oil of eucalyptus (leaves), two drops 
every four or five hours. The eucalyptus was given not 
only as an antiseptic, but also as a deodorant, for the 3 
patient's breath was simply horrible. I have come to 
the conclusion that the fetor of diphtheria, like that of 
carcinoma uteri, is characteristic of the disease. 
The membrane now began to disappear, not to re- 
turn. Previously it would return a few hours after 
having been removed. In the course of the next three 
days, all had disappeared, except a thin film on the right 
tonsil. The right side of the throat and the right cervical 
glands were the most involved throughout the course of 
the disease. 
The boy was now allowed to sit up, and in a few days 
he was walking around, although he still could not eat. 
I now tried a fifteen-volume solution of hydrogen 
dioxide as a swab, and succeeded in removing the last 
spot of membrane, just about four weeks from the com- 
mencement of the disease. 
The urine examined during the four weeks in which 
the membrane was present had a specific gravity of from 
1.010 to i.o[2, gradually reaching the norm in the last 
week. Albumin was present during three weeks. 
The urine in the case of the boy's sister maintained a 
specific gravity of from 1.004 to 1.006 for six days, but 
presented no trace of albumin, as tested for by heat 
and nitric and picric acids. 
Two weeks after the boy was around, he again began 
vomiting. I tested his urine once, and found no albu- 
min. Bismuth, calomel, carbolic acid, and ice were all 
tried with no results. The vomiting persisted for two 
weeks, during which time he was nourished by enemata 
of peptonized milk and whiskey. 
Dr. J. Chris. Lange, of Pittsburg, suggested that I 
again examine the urine, and, if not of sufficient quan- 
tity (not less than one pint per day) and containing albu- 
min, that I give him diuretics, and also try calomel 
again in one-eighth-grain doses. 
On examination his urine was as follows : It was found 
that the boy was passing about one and a quarter pints of 4 
urine in twenty-four hours. The secretion was of an 
acid reaction, had a specific gravity of 1.016, and con- 
tained albumin. An eighth of a grain of calomel was 
now administered every three hours. At least two of 
every three doses were rejected. Seven and a half 
grains each of potassium citrate and potassium bitartrate, 
in a half-glass of cold water, were given every two hours. 
These also were rejected. The quantity of urine con- 
tinued to grow less, and for three days the child passed 
on an average only six ounces per day. His heart be- 
came weaker. His stomach seemed unable to retain any 
fluid. To satisfy his thirst he received ice-cream. He 
was then given the diuretics already named in but little 
water. The urine now began to be excreted more freely, 
and, after a sound sleep, of four hours, the boy awoke 
and asked for a dish of sliced tomatoes. Instructions 
had been given to permit him to have anything he spe- 
cially desired, as it was thought that he could not live 
without eating, for only that morning his bowel became 
irritable and refused to retain the enema. He next 
asked for fried potatoes and onions. He received that 
day four sliced tomatoes, each as large as a ten-year-old 
boy's fist, four dessert-saucers of fried potatoes and 
onions, and nine ounces of ice-cream. In the night the 
child was expected to die. His pulse was 140, and the 
heart became irregular, and had lost its first sound. It 
seemed a question of life or death, and I gave him a 
hypodermatic injection of -j^y grain of atropine sulphate. 
In half an hour his pulse became stronger, and I left 
three more atropine tablets, of which one was to be taken 
every five hours. On the following day the dietary of 
the previous day was repeated; in addition, the boy ate 
one-fourth of an apple-pie. During the night he had 
another weak spell, which yielded to the treatment pre- 
viously employed. Since then he has been steadily 
improving, although he is still so weak that he cannot 
bear his own weight on his legs. 5 
The boy is now taking: Reduced iron, one grain ; 
arsenious acid, one-fiftieth of a grain; strychnine sulphate, 
one-sixtieth of a grain, after each meal, in addition to 
quinine sulphate, one grain, before each meal. 
On the fifth day of the disease the patient presented 
an urticarial eruption closely resembling that of measles. 
It commenced on the feet, and spread, in two days, all 
over the body. It left in the same order as it came. 
This case was the first of seven in one family, all of 
the others of which recovered in from eight days to two 
weeks, except one girl, four years old, who died on the 
sixth day, from diphtheritic poisoning, the nose being 
completely filled with membrane.