January 12th.-Temperature, 97° to 97.4° F.; pulse, 99 to 102. January 13th.-Temperature reached 98° at 5.30 P.M., with pulse of 100. General condition about the same. January 14th.-Temperature ranged from 97.2° to 97.9° F.; pulse, 80. January 15th.-At 9 A.M., temperature dropped to 96.2°, with cool extremities; some pallor and depression. At 10.30 A.M. temperature was 96.4° F.; at 12.45 P.M., 97 F.; at 3.15 P.M., 96.4° F. From that time on it ranged from 97° to 97.3° until 9 A.M. on the 17th, when it again touched 98° F. At 6.30 P.M., temperature was 98.3° F. January 18.-At 4.30 A.M. temperature was 97°, and from then on ranged from 97° to 98° F. On the 19th, at 4.45 P.M., it reached 98.2°, and from then on resumed normal. These temperatures were all taken by axilla, the thermometer being left in position for fully ten minutes. This was done because it was found practically impossible to take it by rectum, as it caused too much disturbance. On December 25th the child's mother had slight deposit on left tonsil, with slight chill and temperature. On December 26th there was also deposit on right tonsil. On that date 15 c.c. of serum were injected, and on the 27th 10 C.C. were injected. She was also ordered tinct. ferri chloride and whiskey, and irrigations with hot boracic-acid solution. Five days after the first injection she had an eruption appearing first on the toes and feet, and afterward on the hands and arms. This was described as being in wheals and welts, intensely itchy, burning, and stinging. It always appeared at night, and was so faded, or practically gone, in the morning, that I never saw it. This was repeated for three or four nights. It was not accompanied by any constitutional disturbance. The points of greatest interest were the peculiar rash appearing at such a remote date (thirteen days) after the injection, and the subsequent subnormal temperature, which persisted almost continuously from January 10th to January 18th. Also the fact that the mother's rash appeared five days after the injection, was evanescent in character, and accompanied by no constitutional disturbance. REPORT OF A CASE OF EXOPHTHALMIC GOITRE-TREATMENT-RECOVERY. BY FRANK D. BOYD, M.D., SAN ANTONIO, Tex. THE Occurrence of this disease in the male is of such comparative rarity that I desire to report this case that has recently been under my care: Mr. R-, aged thirty-two. Previous to this general health was very good. First noticed mental excitement and rapidity of heart-beat in 1891, caused, he thinks, by financial reverses. He then went south to Old Mexico in the fall of 1891, and resided there a few months. Travelled over the interior of Mexico in railroad-coach and horseback at altitudes varying from five thousand to ten thousand feet without apparent inconvenience, sometimes climbing in the saddle three thousand feet in one hour's time with no unpleasant feelings. Then in the spring of 1892 he returned to an altitude of seven thousand feet and went in the banking business, and at this time he first noticed a continual nervousness, much worse at times than at others, becoming almost uncontrollable when anything unusual happened. Any mental worry would cause great nervousness. Also noticed a general decline in health. Appetite became very bad; would have bilious attacks at repeated intervals; impairment of digestion. In October, 1892, he first noticed the neck began swelling and eyeballs protruding, which reached their maximum December 1, 1892. I was called in to see patient in February, 1893, and found him suffering from an exaggerated case of mucopurulent conjunctivitis in both eyes. I soon discovered the great protrusion of eyeballs, and on closer examination found I had a typical case of exophthalmic goitre to deal with. The thyroid gland was greatly enlarged. Pulse reached 150 beats per minute, and he was very excitable. He then told me the above history, and also of his having fallen a few weeks previous. "The lower limbs simply giving down." He is a man of very strong intellect and I had no trouble in securing a good history. He gives no family history of this trouble. His mother is still living in good health. His father died a number of years ago from other trouble. I saw that he not only needed my services, but a general physician, so he called his family doctor, Dr. F. M. Hicks, and we together have had him in charge since. The inflammation of the eyes soon subsided. The treatment consisted of iodide, hydriotic acid; infusion of digitalis; galvanism daily over the thyroid; freedom from business of any kind; complete rest mentally as much as possible, and also physically, which is very essential. The home and surroundings were very pleasant. When excitement would be very great would apply ice-bags to thyroid. Result of the treatment has been very satisfactory. There has been a general improvement in every respect. Protrusion of eyeballs greatly diminished. Pulse average beat now from 80 to 90. No excitement; very calm. Thyroid much reduced, so can button collar of shirt easily. He has now resumed work. PERIOSTEAL INDURATION OF THE MAXILLA RESULTING FROM EXOSTOSIS OF TOOTH ROOTS. BY CHARLES G. PEASE, M.D., D.D.S., NEW YORK. LATE LECTURER ON MATERIA MEDICA, THERAPEUTICS, AND PATHOLOGY, IN THE NEW YORK DENTAL SCHOOL. I HAVE been influenced, in presenting this short paper, by an appreciation of the fact that these conditions are not fully understood by the average practitioner, who finds it difficult or impossible to make an accurate diagnosis, owing to the obscurity of the primary conditions. The recital of a recent case to which I was called in consultation, will give a clinical aspect to the subject, far more helpful than treating of it in general. Mr. K, aged twenty-eight, had been under treatment for some weeks for swollen face with abscess, for which no apparent cause had been discovered. Patient had lost twenty-five pounds in flesh, had grown sallow, depressed, and nervous. No appetite. Abscess had been freely lanced. On examination externally, I found a hard indurated tumor on a line with the lower maxilla, left side, extending from the angle of the jaw to a point identical with the six-year molar. Within the oral cavity I found an abscess discharging at a point opposite the buccal aspect of the twelve-year molar. By the use of the probe I was not able to satisfactorily determine the origin of the trouble. The teeth were sound so far as caries was con cerned, and by the use of a small piece of ice applied to the teeth separately, I was able to exclude devitalized pulps, each tooth giving the response indicating vitality. There was no soreness on tapping the teeth, and the patient had no pain or soreness associated with them either just before or during the existence of the tumor. The masseter muscle would not relax fully, but sufficiently to make examination. My interrogations were then put with reference to the history of the wisdom-tooth, and I learned that its eruption, eight years previously, had been accompanied with soreness and swelling, which signified little, as these conditions are very often present as concomitants. Four years after eruption of the wisdom-tooth there had been a hard swelling at the angle of the jaw, which shortly disappeared. Being able to exclude all other teeth and surrounding tissues, I advised the extraction of the wisdom-tooth, which I did, and found the roots much thickened by exostosis, and at the apex of the distal root a spicula as sharp as a needle. Patient made a rapid recovery. The writer has treated quite a number of these tumors, invariably in connection with the lower jaw. He does not think they are often found in the superior. Such chronic conditions being in the latter relation more apt to induce caries, which disease is known to be as uncommon to the lower as it is common to the upper jaw. The tumors either remain fixed in character after growing to the size of a walnut, or in very bad subjects they degenerate into abscess, and, discharging thus the offending body, correct themselves. This is possible where the septic gases of a devitalized pulp is the cause, but not in the case cited. Such spontaneous cure is, however, not common. If the diagnostician will keep exostosis of the tooth roots in mind, especially with relation to the wisdomtooth, it may help him in perplexing cases. 101 WEST SEVENTY-SECOND STREET. LARGE DOSES OF MORPHINE. BY W. A. CLARK, M.D., RESIDENT PHYSICIAN OF ALAMEDA COUNTY INFIRMARY, SAN LEANDRO, CAL. THE following is the history of a case in which I failed to obtain any narcotic effect from some quite large hypodermic injections of sulphate of morphine. Mrs. M, aged sixty-seven, widow, no children, laundress. About two years ago was given several hypodermic injections of morphine for severe abdominal pain. Powders containing the drug were soon substituted and gradually increased, until before her death. she was consuming twelve grains of morphine daily. January 16th.-Aneurism of abdominal aorta diagnosed, and being in considerable pain, she was given the following: B. Morph. sulph.. Aqua... .gr. xxx. 3 iv. Sig. Teaspoonful every quarter-hour until relieved. The hospital steward being called during the night, gave the following quantities at quarter-hour intervals: One-quarter grain, hypodermatically: four grains by the mouth: two grains, hypodermatically: three grains respectively; no result. January 17th.-Remedy repeated as before. I was called about 7.30 P.M. and found her in intense pain. I gave the following quantities hypodermatically, at quarter-hour intervals, commencing at 8 P.M. Three grains, five grains, seven grains, in two injections, eight grains in two injections, six grains; no effect. Eight grains by the mouth was then given until 11 P.M., when the stock on hand gave out, making a total of eighty-three grains consumed in three hours, with no appreciable effect. The sulphate of morphine had been prepared by a reliable firm, one-quarter grain from the same bottle giving a full effect in another patient. I might add that she had been consuming, daily, eight ounces each of whiskey and port wine, and a quart-bottle of beer, until about two weeks before her death, which occurred January 21, 1895: At the post-mortem examination no aneurism was found. Under the right kidney half of a hair-pin old and corroded was discovered, with considerable localized peritonitis and old adhesions. Medical Students in France number over ten thousand. Their number has more than doubled in the past ten years. Correspondence. OUR LONDON LETTER. (From Our Special Correspondent.) ANNUAL MEETING OF MEDICO-CHIRURGICAL SOCIETY, SPECIAL DISCUSSION AT PATHOLOGICAL SOCIETYTRACHEAL DIPHTHERIA-MALFORMATION OF HEART WITH HEMOPHILIA-GANGRENOUS UMBILICAL HERNIA LIVER AND GALL-STONE SURGERY MICRO CEPHALUS. LONDON, March 6, 1895. SOCIETIES are very much en évidence just now. On Friday the Medico-Chirurgical held its annual meeting, when the alterations in the by-laws that have been officially proposed with a view of rendering the meetings more popular, were duly passed. The president, Mr. Hutchinson, gave his annual address, in which he alluded to the losses by death during the year, and to the changes now made to adapt the society to the condition of the times. The exhibition of patients and specimens, and detailing of new facts, is among these. So is the arrangement for special discussions on topics of general interest, which might not otherwise come up in an original paper. As to these I have previously reported that the first such discussion has been already opened by the president himself, on the nervous complications of early syphilis. This debate has been adjourned until next Tuesday. Meantime another special discussion has been provided for us by another society -the Pathological. This was opened by Dr. Bertram Hunt last evening, who was followed by Drs. Hayward, Powell White, and Kanthack, when the debate was adjourned to the 19th. The subject being the "pathology of diphtheria," is of immediate interest and is being ably discussed. At the Clinical Society on Friday, March 1st, Mr. Langton, vice-president, took the chair, saying he had been requested by the council to fulfil the duties of president until the end of the session. He gave appropriate expressions to the loss inflicted on science, on surgery, and on the society by Mr. Hulke's death, and the society passed a formal vote of regret. Mr. E. W. Goodall related an unusual case of tracheal diphtheria in a boy aged four, who was admitted into the Eastern Hospital with faucial diphtheria. On the ninth day after admission he expectorated a cast of the trachea, and during the next week he brought up several casts of the trachea or bronchi, and several shreds of membrane. There was albuminuria lasting for about a month. At the end of three weeks from admission paralysis of the palate, ciliary muscles, and lower extremities supervened. The boy recovered and left the hospital quite well at the end of another seven weeks. The point of interest in the case lies in the fact that, in spite of the extensive formation of membrane in the trachea and large bronchi, there were never signs of laryngeal obstruction. Only during the expulsion of the largest casts was there dyspnoea. It is reasonable to suppose that in this case the larynx was unaffected. Three similar cases had come under observation. He particularly called attention to the fact that the membrane missed the larynx, though it affected the respiratory tract above and below. Some conversation followed in which the relation of such cases to plastic bronchitis was referred to. Dr. Lee Dickinson related a case of malformation of the heart in a girl aged eight, with pronounced congenital heart disease and hæmophilia, and asked how far these diseases are related. The hemorrhage could not be explained by reference to the heart trouble only. The condition of the patient was not usually met with in subjects of congenital heart disease, the child not being cyanosed while under his observations, though this was said to have been the case once or twice. There was no club bing of the fingers or other indication of chronic circulatory trouble. There was no history of hæmophilia. in the family. Mr. Gilbert Barling related a case of gangrenous umbilical hernia in a female, aged forty-nine, for which resection was performed and immediate union effected by Murphy's button. She was admitted to the hospital four days after strangulation commenced. On the day of admission symptoms ceased suddenly. Strangulation was by a severely constricting band which involved about five inches of small intestine, and the upper or entering portion was gangrenous at the point of constriction. The patient's general condition being good, the strangulated gut, with a V of mesentery, was removed and the divided ends of the intestine approximated by a Murphy's button one inch in diameter. Recovery was uneventful, but the button was not passed until the twenty-fourth day, two days after the patient had been allowed to get up. It gripped a ring of necrosed gut. Mr. A. Pearce Gould commented on the curious absence of collapse in this case, and suggested that the symptoms of "indigestion " from which the patient suffered subsequently to the operation might be explained by the arrest of the button at the ileo-cæcal valve. The president referred to the tendency of stenosis to which patients were exposed after using Murphy's button, Senn's plates, and the like. The length of the operation in such cases must necessarily have an effect on the patient's condition. He asked how long the operation had lasted. He did not agree with certain surgeons of the German school, who held that these operations did not necessarily involve any collapse. Mr. Barling, in reply, remarked on the difference observed in the way that patients reacted to peritonitis in illustration of the curious absence of shock. He pointed out that the "indigestion" occurred on the fourth day and followed the first ingestion of food by the mouth. That was earlier than one would expect the button to have become detached. He admitted that in some cases the button sojourned in the intestine an inconveniently long time, but on the whole he thought the risk of its becoming arrested in its onward passage was slight. The operation took fifty minutes. Dr. Hector Mackenzie related a case of hysterical contracture of the legs of two years' duration, which had been cured by massage, etc., in a young woman of twenty-three. At the Medical Society on Monday, February 25th, Mr. Malcolm related all the cases of liver and gallstone on which he had operated. In three of these cases death followed, but the fatal termination was the natural sequel of the diseases from which the patients were suffering, and was in no wise attributable to the operation. The other cases comprised two of multiple hydatids, and three of gall-stones removed by operation. These five cases were all successful. He suggested the following points for discussion: 1. The signs to be relied upon in distinguishing between gall-stone and cancer. 2. The possibility of gall-stones being overlooked in the ducts, and the possibility of their collecting within the liver substance and coming down after the other stones had been removed. 3. The length of time which must elapse before a patient can be considered safe against recurrence of hydatid growths. 4. Whether the presence of shrivelled daughter cysts was a sign that the cysts were undergoing retrogression, in spite of the fact that there had been no diminution in size of the cysts previous to operation. Mr. Doran asked how long gall-stones took to form, and Mr. Lane related four fatal cases, only one of which could be referred to the operation, and he had had a long series of successes. Mr. Henry Morris discussed the diagnosis of hydatid cysts, and thought the formation of gall-stones was promoted by anything which interfered with the formation of cholesterin or by deficiency of the bile, and which were solvents of cholesterin. He believed that stones did sometimes form after operation with astonishing rapidity, which he thought might be due to a lack of such solvents, or an excess of this product as a consequence of stagnation of the bile in the gallbladder. Dr. Wallis Ord and Mr. Cottrell then read notes of a case of microcephalus treated by linear craniectomy. Dr. Shuttleworth questioned whether the case was, properly speaking, one of microcephalus, seeing that the circumference of the head exceeded nineteen inches, whereas eighteen inches was usually assigned as the limit. He himself had had under observation three cases of microcephalic idiots in whom the operation had failed to confer the slightest benefit. Morbidity in the Indian Army.-According to a recent report concerning the British forces in India, no less than fifty thousand out of seventy thousand men composing the army have been under hospital treatment within the past two years. A Gift.—Drs. A. V. L. Brokaw and C. D. Mooney have contributed one thousand dollars toward the com pletion of a clinical amphitheatre in St. Luke's Hospital, St. Louis. Alumni of Jefferson Medical College.-Many members of the class of 1879, Jefferson Medical College, of Philadelphia, are desirous of having a class reunion on the occasion of the 15th anniversary of their graduation. Owing to changes, comparatively few addresses are known, and therefore this means is resorted to with the hope that every member of the class of 1879 who reads this notice will communicate at once with their class President, Dr. Philip R. Koons, Mechanicsburg, Cumberland County, Penn. The New York Medical College. A short sketch of this institution was written and printed in 1883, but has only just been published. It is of considerable historical value, and especially interesting to the not inconsiderable number of graduates of this college still engaged in medical practice. The sketch was written by Dr. Edwin Hamilton Davis. Modern Greek as an International Language.-In the "Register and Manual of Information," published by the New York County Medical Association, we are pleased to see a recommendation that Greek be adopted as the common language of science. It is suggested that the medical writers of this city officially endorse the proposition to adopt this most beautiful, most flexible, and most expressive of tongues as the means of inter-communication between scientists throughout the world. A Statue to Lavoisier is to be erected in Paris. Many subscriptions in aid of its erection have been obtained from professors and students of German universities. Vol. 47, No. 14. A Weekly Fournal of Medicine and Surgery NEW YORK, APRIL 6, 1895. Original Articles. PRACTICAL POINTS IN THE TREATMENT NEW YORK, INSTRUCTOR IN DISEASES OF CHILDREN AT THE NEW YORK POST-GRADUATE ALTHOUGH the new diphtheria-healing and prophylactic remedy called serum and diphtheria antitoxin, was discovered in 1890, it took until the last year to place it on a proper clinical basis, i.e., by experimental work on both healthy and sick to determine the exact therapeutic properties of the same. In Berlin, Professors Behring, Wernicke, Hans Aronson, and a great many others have labored diligently to give us all the data relating to the same. It was, however, necessary to study the statistics and reports of the various hospitals in order to arrive at a proper understanding of the value of the remedy. It is hardly a year ago that we found so little in literature pertaining to the same, which was chiefly owing to the scepticism of the various colleagues, owing to the misfortune in using Koch's tuberculin in 1891. To-day, however, we have about two thousand two hundred authentic cases, which have placed the remedy on its proper footing. When I was in Berlin last summer there were two kinds of antitoxin for sale: Aronson's and Behring's; both, however, were almost sold. Since that time quite a change has come, and there is at present all the antitoxin desirable in the market. Permit me to introduce to you the various kinds of antitoxin, and also some practical points about the same. The first publication in this country appeared in the MEDICAL RECORD, October 6, 1894, by Professor Baginsky, and in the same number also one by myself. Later, reports appeared from Dr. A. Campbell White, of the Willard Parker Hospital, who reported twenty cases in the same journal (the MEDICAL RECORD, November 17, 1895); in the same number there appeared a second article by myself. In the cases of White, Aronson's serum was used only; in the cases which I reported, I have used also Aronson's; later, however, I used Aronson's and Behring's, as Aronson's was not to be had. In the American Journal of the Medical Sciences for January, 1895, a very elaborate article appeared by me, describing thirty-four cases, and also a series of cases which I attended in the Municipal Hospital of Philadelphia. In that class of cases I used principally Aronson's serum, and my mortality was 5.8 per cent. Permit me to describe a few typical cases. CASE I.-A. G, three and one-fourth years of age, male, was attended by me on October, 29, 1894, in the Messiah Home for Children. Examination showed hoarseness, normal temperature, regular pulse. The throat, as far as we could see, tonsils, pharynx, and uvula, was clear. No membrane was visible. I ordered Paper read at the German Medical Society, March 4, 1895. $5.00 Per Annum. Single Copies, Ioc. isolation and expectant plan of treatment. I could not diagnose anything but acute laryngitis. The following day, however, October 30th, I again saw the child, and found the following clinical picture: Severe dyspnoea, very plain pseudo-membranes were visible on the pharynx posteriorly, and on the right tonsil. Temperature, 100 F.; pulse, 104; respiration, 82; no cyanosis. The submaxillary glands somewhat enlarged. Symptoms of general malaise. The child appeared very tired and sleepy. Stools were regular. As we here had reason to believe that we were dealing with a very early form of diphtheria and laryngeal stenosis, and as this case was one typically suited for antitoxin treatment, I sent the child to the Willard Parker Hospital, with a letter, stating that I wished this case reserved for treatment by Dr. George F. Shrady. I went to the hospital with him at 1.45 P.M., October 30th. Found temperature 100.2° F.; pulse, 130; respiration, 32. Child was injected by him with 12 c.c. antitoxin. At 2.25 P.M., dyspnoea was so severe that it was necessary to intubate the child. Soon after the breathing improved. At 3.25 P.M., temperature 101.8° F.; pulse, 140; respiration, 32; 5.25, temperature 103° F.; pulse, 160; respiration, 48. The child seemed to swallow in the regular way. The reaction following intubation disappeared slowly during the night. The highest temperature during October 31st was 102.4° F.; pulse, 144; respiration, 44. The temperature remained under 101° F., until November 4th, on which date a small quantity of albumin was found in the urine. The quantity increased until it reached twenty-five per cent. by volume. On November 5th the temperature was 103° F.; pulse, 148; respiration, 40. On November 5th the membranes disappeared. The child coughed with a muco-purulent expectoration, which was, however, not very severe. On No vember 7th there were slight traces of albumin in the urine; the temperature sank to 99° F. Intubation tube was removed on November 7th, at eleven o'clock in the morning. The breathing was at once labored and it was necessary to reintubate the child in a quarter of an hour, at 11.30 in the morning. There was hardly any reaction following the reintroduction of this cannula, and the temperature did not rise above 99° during the day. On November 8th the temperature was 99° F.; pulse, 134; respiration, 32. The child seemed to feel very well during the course of this treatment, and had no emaciation, no loss of flesh, and was discharged cured. The healing was complete in this case. Bacteriological examination of the membrane was made on October 31st, or the day following the child's admission to the hospital, and typical Klebs-Loeffler bacilli were found, proving the diagnosis of diphtheria. The child was subsequently carefully examined by me, readmitted to the Messiah Home, and here a slight form of paralysis followed, lasting in all about two months. The fluids on swallowing regurgitated through the nose. With mild form of treatment, principally strychnine and faradization, the child made a complete recovery. Another typical case is the following: I was called in consultation by Dr. A. Kessler, on December 10th, to a boy, about six years of age, who had been attended by the doctor for several days previously, with a severe pharyngeal, tonsillar, and laryngeal diphtheria. The whole pharynx showed thickened membranes completely covering the throat; besides, the child appeared to be somnolent most of the time. This latter symptom proved to Dr. Kessler the severity of the case. When I saw the child, on December 10th, it was at once decided to inject antitoxin. Owing to the severity of the symptoms I decided to inject 20 c.c. of the same, using the ordinary aseptic precautions, consisting of sterilization of the skin with soap and water, followed by an antiseptic solution, and injecting the antitoxin deep into the subcellular tissue and applying a drop of collodion over the puncture to seal it. In this case, as in all cases, I did not use any massage after the injection to permit the absorption of the healing serum. All of my cases, with a few exceptions, were injected in the interscapular space, as practised by Professor Baginsky, and also endorsed by a great many others, chiefly Aronson, in Berlin. On December 11th, the day following the injection, the temperature was This On December 10th the child was injected by me. On December 16th Dr. Kessler wrote to me that the tonsils, pharynx, and uvula were free and clear of all visible membranes, also, that he noticed, a few days previous, the gradual melting away of the same. child was discharged as cured on December 18th. Recovery complete. The local treatment consisted of antiseptics, strong stimulating diet; careful hygiene was also carried out. In this case a bacteriological examination of the pseudo-membranes was also made, and the report sent to Dr. Kessler showed the existence of Klebs-Loeffler bacilli, which corroborated his clinical diagnosis. The following two cases were seen by me, in consultation with Dr. W. E. Bullard, in this city : A child, male, four years of age, was attended by Dr. Bullard for a severe form of diphtheria. Plain visible pseudo- membranes could be seen in the pharynx, which appeared dark gray. There was a fetid. smell of the breath, enlarged submaxillary glands. Dr. Bullard made a culture, sent it to the Board of Health, and received the report, showing Klebs-Loeffler bacilli. The child was so restless and hard to manage that the physician could not do anything with medication by mouth. The doctor decided to apply local applications, and even these were strenuously opposed. It remained then for Dr. Bullard to decide upon antitoxin, and the child was seen by me on December 26th, or about three days after the first appearance of the symptoms. The temperature was 99° F. The mother told us that the child had been ill a few days; had had fever, and had vomited on the day previous. The membrane, as first examined, covered the velum palati, both tonsils, and as much of the laryngeal wall as could be seen with the eye. Dr. Bullard prescribed a tincture of chloride of iron, ten drops every hour, but he is positive that the child received little or none of it. The patient continued to grow worse, the membranes were thicker and thicker, until the seventh day of the illness. When I first saw the child the temperature was subnormal, 97° F., and on the day following the injection the temperature was normal and rose until it reached 99° F., which was the highest it attained during the whole course of treatment. I injected 12 c.c. antitoxin, using ordinary antiseptic precaution, in the inter scapular region, in the presence of Dr. Bullard. There was no reaction following the injection of the serum which could be ascribed to the serum itself. In the twenty-four hours following the injection Dr. Bullard noticed a red circle surrounding the membrane on the uvula. The redness increased as the membrane decreased. On January 2, 1895, which was the third day after the injection of the antitoxin, the membranes were almost invisible on the uvula and tonsils. The child's appetite improved in twelve hours after the first injec tion. The second child in this family was taken ill on the same day I injected the first child, and for prophylactic reasons it was decided by Dr. Bullard and myself to inject 2 c.c. of antitoxin, to produce immunity if possible. Although no typical diphtheria could be proved, still the pharynx showed a slight milky coating, which looked suspicious. This child remained ill only about one day, and was well after that time; had no fever, and did not contract diphtheria. Still more interesting, however, in the same family, is the fact that the mother of these two children, who had been around nursing and looking after them, was taken sick with a mild infection of the throat, pain on swallowing, and what Dr. Bullard believed to be a typical diphtheritic infection. She also is well, and was cured in a few days. The next case was attended by Dr. Krog, in this city. A child, two and one-half years of age, with a diagnosis of diphtheria and croupous laryngitis, stenosis, etc. I saw the child in consultation on January 8, 1895. At noon I found the following conditions: The child was cyanotic and had a pulse of 180; cold extremities; extreme dyspnoea. Although I was sent for to inject antitoxin, the urgency of the symptoms demanded prompt relief, which was given in the form of hot mustard foot-baths; internally, strong coffee and brandy and other excitants, besides a rapid intubation. The child's breathing was immediately relieved after the intubation, and when the child recovered from the reaction following the same, I then injected 20 c.c. antitoxin, using the ordinary antiseptic precautions, in the interscapular region. The dyspnoea was so much improved that the child immediately went to sleep. The temperature was 100° F.; pulse, 130, within one hour afterward. The appetite was good. I ordered raw scraped steak, buttermilk, and semi-solid nourishment as long as the tube was in place. The course of this child's disease was very protracted. The glands of the neck were extremely swollen, and the membranes seemed to disappear very slowly. A distinct improvement was first noticed two days, or about fifty hours, following the injection of the antitoxin. I allowed the cannula to remain five days, when Dr. Krog and myself agreed that the stenosis being so much improved, and the membranes not visible, appetite and sleep both normal, to extubate on January 11th. A careful examination of the urine, using Eschbach's albu min metre, showed five pro mille and a few epithelial and hyaline casts. A careful examination of the extremities showed no oedema of the body. This condition of nephritis lasted in all about eleven days, and also a small trachitis and cough remained, which I as cribed to the irritation and probable pressure caused by the tube, as nothing could be diagnosticated by an examination of the lungs. The child did not lose any flesh during the course of treatment, and the albumin disappeared gradually until the fourth week following the injection of the antitoxin, when the urine appeared normal. The cough also subsided, appetite returned, child slept well, and was discharged cured. The most interesting portion is the bacteriological examination in this case. The first culture proved the presence of Klebs-Loeffler bacilli. The day on which we declared the child cured and the question of disinfection of the apartments came up, I made another culture, which again showed the presence of virulent |