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January 12th.— Temperature, 97° to 97.4° F.; pulse, I was called in to see patient in February, 1893, and 99 to 102.

found him suffering from an exaggerated case of mucoJanuary 13th.— Temperature reached 98° at 5.30 purulent conjunctivitis in both eyes. I soon discovered P.M., with pulse of 100. General condition about the the great protrusion of eyeballs, and on closer examsame.

ination found I had a typical case of exophthalmic goiJanuary 14th.—Temperature ranged from 97.2° to tre to deal with. The thyroid gland was greatly en97.9° F. ; pulse, 8o.

larged. Pulse reached 150 beats per minute, and he January 15th.–At 9 A.M., temperature dropped to was very excitable. He then told me the above his96.2°, with cool extremities ; some pallor and depres- tory, and also of his having fallen a few weeks prevsion. At 10.30 A.M. temperature was 96.4° F.; at ious. “The lower limbs simply giving down." He 12.45 P.M., 97° F. ; at 3.15 P.M., 96.4° F. From that is a man of very strong intellect and I had no trouble time on it ranged from 97° to 97-3° until 9 A.M. on the in securing a good history. He gives no family history 17th, when it again touched 98° F. At 6.30 P.M., tem- of this trouble. His mother is still living in good perature was 98.3° F.

health. His father died a number of years ago from January 18.–At 4.30 A.M. temperature was 97°, and other trouble. I saw that he not only needed my serfrom then on ranged from 97° to 98° F. On the 19th, vices, but a general physician, so he called his family at 4.45 P.M., it reached 98.2°, and from then on doctor, Dr. F. M. Hicks, and we together have had sumed normal.

him in charge since. The inflammation of the eyes These temperatures were all taken by axilla, the soon subsided.

The treatment consisted of iodide, thermometer being left in position for fully ten min- hydriotic acid ; infusion of digitalis ; galvanism daily utes. This was done because it was found practically over the thyroid ; freedom from business of any kind; impossible to take it by rectum, as it caused too much complete rest mentally as much as possible, and also disturbance.

physically, which is very essential. The home and surOn December 25th the child's mother had slight de- roundings were very pleasant. When excitement would posit on left tonsil, with slight chill and temperature. On be very great would apply ice-bags to thyroid. Result December 26th there was also deposit on right tonsil. of the treatment has been very satisfactory. There On that date 15 c.c. of serum were injected, and on the has been a general improvement in every respect. 27th 10 c.c. were injected. She was also ordered Protrusion of eyeballs greatly diminished. Pulse avertinct. ferri chloride and whiskey, and irrigations with hot age beat now from 8o to go. No excitement; very boracic-acid solution. Five days after the first injec- calm. Thyroid much reduced, so can button collar tion she had an eruption appearing first on the toes and of shirt easily. He has now resumed work. feet, and afterward on the hands and arms. described as being in wheals and welts, intensely itchy, burning, and stinging. It always appeared at night,

PERIOSTEAL INDURATION OF THE MAXand was so faded, or practically gone, in the morning,

ILLA RESULTING FROM EXOSTOSIS OF that I never saw it. This was repeated for three or

TOOTH ROOTS. four nights. It was not accompanied by any constitutional disturbance.

BY CHARLES G. PEASE, M.D., D.D.S., 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 I have been influenced, in presenting this short paper, Ioth to January 18th. Also the fact that the mother's by an appreciation of the fact that these conditions are rash appeared five days after the injection, was evanes- not fully understood by the average practitioner, who cent in character, and accompanied by no constitutional finds it difficult or impossible to make an accurate diagdisturbance.

nosis, 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, REPORT OF A CASE OF EXOPHTHALMIC far more helpful than treating of it in general. GOITRE-TREATMENT-RECOVERY.

Mr. K—, aged twenty-eight, had been under treat

ment for some weeks for swollen face with abscess, for BY FRANK D. BOYD, M.D.,

which no apparent cause had been discovered. Patient

had lost twenty-five pounds in flesh, had grown sallow, The occurrence of this disease in the male is of such depressed, and nervous. No appetite.

No appetite. Abscess had comparative rarity that I desire to report this case that been freely lanced. has recently been under my care : Mr. R—, aged On examination externally, I found a hard indurated thirty-two. Previous to this general health was very tumor on a line with the lower maxilla, left side, extendgood. First noticed mental excitement and rapidity of ing from the angle of the jaw to a point identical with heart-beat in 1891, caused, he thinks, by financial re- the six-year molar. Within the oral cavity I found an

He then went south to Old Mexico in the fall abscess discharging at a point opposite the buccal asof 1891, and resided there a few months. Travelled pect of the twelve-year molar. By the use of the probe over the interior of Mexico in railroad-coach and horse- I was not able to satisfactorily determine the origin of back at altitudes varying from five thousand to ten the trouble. thousand feet without apparent inconvenience, some- The teeth were sound so far as caries was contimes climbing in the saddle three thousand feet in one cerned, and by the use of a small piece of ice applied hour's time with no unpleasant feelings. Then in the

to the teeth separately, I was able to exclude devitalspring of 1892 he returned to an altitude of seven thou- ized pulps, each tooth giving the response indicating sand feet and went in the banking business, and at this vitality. There was no soreness on tapping the teeth, time he first noticed a continual nervousness, much and the patient had no pain or soreness associated worse at times than at others, becoming almost uncon- with them either just before or during the existence of trollable when anything unusual happened. Any men- the tumor,

The masseter muscle would not relax fully, tal worry would cause great nervousness. Also noticed but sufficiently to make examination. My interrogaa general decline in health. Appetite became very bad ; tions were then put with reference to the history of the would have bilious attacks at repeated intervals ; im- wisdom-tooth, and I learned that its eruption, eight years pairment of digestion. In October, 1892," bie first no


previously, had been accompanied with soreness and ticed the neck began swelling and eyeballs protruding, swelling, which signified little, as these conditions are which reached their maximum December 1, 1892. very often present as concomitants.




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Four years after eruption of the wisdom-tooth there had been a hard swelling at the angle of the jaw, which

Correspondence. 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

OUR LONDON LETTER. much thickened by exostosis, and at the apex of the

(From Our Special Correspondent) distal root a spicula as sharp as a needle. Patient made a rapid recovery.

ANNUAL MEETING OF MEDICO-CHIRURGICAL SOCIETYThe writer has treated quite a number of these SPECIAL DISCUSSION AT PATHOLOGICAL SOCIETY tumors, invariably in connection with the lower jaw. TRACHEAL DIPHTHERIA—MALFORMATION OF HEART He does not think they are often found in the supe- WITH HÆMOPHILIA-GANGRENOUS UMBILICAL HERrior. 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

LONDON, March 6, 1895. upper jaw. The tumors either remain fixed in charac- SOCIETIES are very much en évidence just now. On ter after growing to the size of a walnut, or in very bad Friday the Medico-Chirurgical held its annual meeting, subjects they degenerate into abscess, and, discharging when the alterations in the by-laws that have been thus the offending body, correct themselves. This is officially proposed with a view of rendering the meetpossible where the septic gases of a devitalized pulp is ings more popular, were duly passed. The president, the cause, but not in the case cited.

Such spontane

Mr. Hutchinson, gave his annual address, in which he ous cure is, however, not common.

alluded to the losses by death during the year, and to If the diagnostician will keep exostosis of the tooth the changes now made to adapt the society to the conroots in mind, especially with relation to the wisdom- dition of the times. The exhibition of patients and tooth, it may help him in perplexing cases.

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 re

ported that the first such discussion has been already LARGE DOSES OF MORPHINE.

opened by the president himself, on the nervous comBy W. A. CLARK, M.D.,

plications of early syphilis. This debate has been adjourned until next Tuesday. Meantime another special

discussion has been provided for us by another society The following is the history of a case in which I —the Pathological. This was opened by Dr. Bertram failed to obtain any narcotic effect from some quite Hunt last evening, who was followed by Drs. Hayward, large hypodermic injections of sulphate of morphine. Powell White, and Kanthack, when the debate was ad

Mrs. M- aged sixty-seven, widow, no children, journed to the 19th. The subject being the“ pathology laundress. About two years ago was given several of diphtheria,” is of immediate interest and is being hypodermic injections of morphine for severe abdom

ably discussed. inal pain. Powders containing the drug were soon sub- At the Clinical Society on Friday, March ist, Mr. stituted and gradually increased, until before her death

Langton, vice-president, took the chair, saying he had she was consuming twelve grains of morphine daily. been requested by the council to fulfil the duties of

January 16th.- Aneurism of abdominal aorta diag- president until the end of the session. He gave apnosed, and being in considerable pain, she was given propriate expressions to the loss inflicted on science, the following:

on surgery, and on the society by Mr. Hulke's death, B. Morph, sulph... Xxx,

and the society passed a formal vote of regret. Aqua...

Mr. E. W. Goodall related an unusual case of traSig.: Teaspoonful every quarter-hour until relieved.

cheal diphtheria in a boy aged four, who was admitted The hospital steward being called during the night,

into the Eastern Hospital with faucial diphtheria. On gave the following quantities at quarter-hour intervals :

the ninth day after admission he expectorated a cast of One-quarter grain, hypodermatically : four grains by

the trachea, and during the next week he brought up the mouth: two grains, hypodermatically: three grains

several casts of the trachea or bronchi, and several respectively; no result.

shreds of membrane. There was albuminuria lasting January 17th.—Remedy repeated as before. I was

for about a month. At the end of three weeks from called about 7.30 P.M. and found her in intense pain.

admission paralysis of the palate, ciliary muscles, and I gave the following quantities hypodermatically, at

lower extremities supervened. The boy recovered and quarter-hour intervals, commencing at 8 P.M.

left the hospital quite well at the end of another seven Three grains, five grains, seven grains, in two injec

weeks. The point of interest in the case lies in the tions, eight grains in two injections, six grains; no effect.

fact that, in spite of the extensive formation of memEight grains by the mouth was then given until 11 P.M.,

brane in the trachea and large bronchi, there were never when the stock on hand gave out, making a total of signs of laryngeal obstruction. Only during the expuleighty-three grains consumed in three hours, with no

sion of the largest casts was there dyspnea. It is reaappreciable effect. The sulphate of morphine had been

sonable to suppose that in this case the larynx was prepared by a reliable firm, one-quarter grain from the

unaffected. Three similar cases had come under obsame bottle giving a full effect in another patient. I

servation. He particularly called attention to the fact might add that she had been consuming, daily, eight that the membrane missed the larynx, though it affected

, ounces each of whiskey and port wine, and a quart-bot

the respiratory tract above and below. Some conversatle of beer, until about two weeks before her death,

tion followed in which the relation of such cases to which occurred January 21, 1895:

plastic bronchitis was referred to. Dr. Lee Dickinson At the post-mortem examination no aneurism was

related a case of malformation of the heart in a girl found. Under the right kidney half of a hair-pin old

aged eight, with pronounced congenital heart disease and corroded was discovered, with considerable local

and hæmophilia, and asked how far these diseases are ized peritonitis and old adhesions.

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 conMedical Students in France number over ten thou

genital heart disease, the child not being cyanosed sand. Their number has more than doubled in the

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while under his observations, though this was said to have been the case once or twice. There was no club

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bing of the fingers or other indication of chronic cir- which were solvents of cholesterin. He believed that culatory trouble. There was no history of hæmophilia stones did sometimes form after operation with astonin the family.

ishing rapidity, which he thought might be due to a Mr. Gilbert Barling related a case of gangrenous um

lack of such solvents, or an excess of this product as bilical hernia in a female, aged forty-nine, for which a consequence of stagnation of the bile in the gallresection was performed and immediate union effected bladder, by Murphy's button. She was admitted to the hospital Dr. Wallis Ord and Mr. Cottrell then read notes of four days after strangulation commenced. On the day a case of microcephalus treated by linear craniectomy. of admission symptoms ceased suddenly. Strangula- Dr. Shuttleworth questioned whether the case was, tion was by a severely constricting band which involved properly speaking, one of microcephalus, seeing that about five inches of small intestine, and the upper or the circumference of the head exceeded nineteen entering portion was gangrenous at the point of con- inches, whereas eighteen inches was usually assigned striction. The patient's general condition being good,

as the limit. He himself had had under observation the strangulated gut, with a V of mesentery, was re- three cases of microcephalic idiots in whom the operamoved and the divided ends of the intestine approxi- tion had failed to confer the slightest benefit. mated 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.

Medical Stems. Mr. A. Pearce Gould commented on the curious absence of collapse in this case, and suggested that the Contagious Diseases—Weekly Statement.—Report of symptoms of "indigestion " from which the patient suf

cases and deaths from contagious diseases reported to fered subsequently to the operation might be explained the Sanitary Bureau, Health Department, for the week by the arrest of the button at the ileo-cæcal valve.

ending March 23, 1895. 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

Tuberculosis on the patient's condition. He asked how long the

Typhoid fever. operation had lasted. He did not agree with certain Scarlet fever

Cerebro-spinal meningitis. surgeons of the German school, who held that these op

Measles.. erations did not necessarily involve any collapse.

Diphtheria Mr. Barling, in reply, remarked on the difference ob

Small-pox served in the way that patients reacted to peritonitis in illustration of the curious absence of shock. He Morbidity in the Indian Army.--According to a pointed out that the "indigestion ” occurred on the recent report concerning the British forces in India, no fourth day and followed the first ingestion of food by the less than fifty thousand out of seventy thousand men mouth. That was earlier than one would expect the composing the army have been under hospital treatbutton to have become detached. He admitted that ment within the past two years. in some cases the button sojourned in the intestine an

A Gift.--Drs. A. V. L. Brokaw and C. D. Mooney inconveniently long time, but on the whole he thought

have contributed one thousand dollars toward the comthe risk of its becoming arrested in its onward passage pletion of a clinical amphitheatre in St. Luke's Hospiwas slight. The operation took fifty minutes.

tal, St. Louis. Dr. Hector Mackenzie related a case of hysterical contracture of the legs of two years' duration, which

Alumni of Jefferson Medical College.- Many memhad been cured by massage, etc., in a young woman of

bers of the class of 1879, Jefferson Medical College, of twenty-three.

Philadelphia, are desirous of having a class reunion on At the Medical Society on Monday, February 25th,

the occasion of the 15th anniversary of their graduaMr. Malcolm related all the cases of liver and gall- tion. Owing to changes, comparatively few addresses stone on which he had operated. In three of these are known, and therefore this means is resorted to with cases death followed, but the fatal termination was the the hope that every member of the class of 1879 who natural sequel of the diseases from which the patients

reads this notice will communicate at once with their were suffering, and was in no wise attributable to the class President, Dr. Philip R. Koons, Mechanicsburg, operation. The other cases comprised two of multiple Cumberland County, Penn. hydatids, and three of gall-stones removed by operation. The New York Medical College.—A short sketch of These five cases were all successful. He suggested the this institution was written and printed in 1883, but following points for discussion: 1. The signs to be re

has only just been published. It is of considerable lied upon in distinguishing between gall-stone and can

historical value, and especially interesting to the not incer. 2. The possibility of gall-stones being overlooked considerable number of graduates of this college still in the ducts, and the possibility of their collecting engaged in medical practice. The sketch was written within the liver substance and coming down after the

by Dr. Edwin Hamilton Davis. other stones had been removed. 3. The length of time which must elapse before a patient can be con

Modern Greek as an International Language.-In sidered safe against recurrence of hydatid growths. 4.

the "Register and Manual of Information," published Whether the presence of shrivelled daughter cysts was

by the New York County Medical Association, we are a sign that the cysts were undergoing retrogression, in

pleased to see a recommendation that Greek be adopted spite of the fact that there had been no diminution in

as the common language of science. It is suggested

. size of the cysts previous to operation.

that the medical writers of this city officially endorse Mr. Doran asked how long gall-stones took to form,

the proposition to adopt this most beautiful, most flexiand Mr. Lane related four fatal cases, only one of which

ble, and most expressive of tongues as the means of could be referred to the operation, and he had had a

inter-communication between scientists throughout the

world long series of successes. Mr. Henry Morris discussed the diagnosis of hyda- A Statue to Lavoisier is to be erected in Paris

. tid cysts, and thought the formation of gall-stones was Many subscriptions in aid of its erection have been obpromoted by anything which interfered with the forma- tained from professors and students of German univertion of cholesterin or by deficiency of the bile, and sities.

A Weekly Fournal of Medicine and Surgery

Vol. 47, No. 14.
Whole No. 1274.

NEW YORK, APRIL 6, 1895.

$5.00 Per Annum. Single Copies, roc.





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isolation and expectant plan of treatment. I could Original Articles.

not diagnose anything but acute laryngitis. The following day, however, October 30th, I again saw the

child, and found the following clinical picture : Severe PRACTICAL POINTS IN THE TREATMENT dyspnea, very plai

dyspnea, very plain pseudo-membranes were visible OF DIPHTHERIA WITH ANTITOXIN-IN

on the pharynx posteriorly, and on the right tonsil. DICATIONS AND CONTRA - INDICATIONS Temperature, 100° F.; pulse, 104; respiration, 82 ; no FOR THE SAME, WITH DEMONSTRATION. cyanosis. The submaxillary glands somewhat enlarged, BY LOUIS FISCHER, M.D.,

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 HOME FOR CHILDREN; PHYSICIAN TO THE CHILDREN'S DEPARTMENT OF THE

this case was one typically suited for antitoxin treat

ment, I sent the child to the Willard Parker Hospital, ALTHOUGH the new diphtheria-healing and prophy

with a letter, stating that I wished this case reserved lactic remedy called serum and diphtheria antitoxin,

for treatment by Dr. George F. Shrady. I went to was discovered in 1890, it took until the last year to the hospital with him at 1.45 P.M., October 30th. place it on a proper clinical basis, i.e., by experimental

Found temperature 100.2° F. ; pulse, 130 ; respirawork on both healthy and sick to determine the exact

tion, 32. Child was injected by him with 12 c.c. antitherapeutic properties of the same. In Berlin, Pro

toxin. At 2.25 P.M., dyspnea was so severe that it was fessors Behring, Wernicke, Hans Aronson, and a great

necessary to intubate the child. Soon after the breathmany others have labored diligently to give us all the ing improved. At 3.25 P.M., temperature 101.8° F.;

, data relating to the same. It was, however, necessary

pulse, 140; respiration, 32 ; 5.25, temperature 103° F.; to study the statistics and reports of the various hospi- pulse, 160; respiration, 48. The child seemed to tals in order to arrive at a proper understanding of the swallow in the regular way. The reaction following value of the remedy. It is hardly a year ago that we intubation disappeared slowly during the night. found so little in literature pertaining to the same, which The highest temperature during October 31st was was chiefly owing to the scepticism of the various col

102.4° F.; pulse, 144; respiration, 44. The temperaleagues, owing to the misfortune in using Koch's tu

ture remained under 101° F., until November 4th, on berculin in 1891. To-day, however, we have about

which date a small quantity of albumin was found in two thousand two hundred authentic cases, which have

the urine. The quantity increased until it reached placed the remedy on its proper footing. When I

twenty-five per cent. by volume. On November 5th was in Berlin last summer there were two kinds of

the temperature was 103° F. ; pulse, 148; respiration, antitoxin for sale: Aronson's and Behring's; both,


On November 5th the membranes disappeared. however, were almost sold. Since that time quite a The child coughed with a muco-purulent expectorachange has come, and there is at present all the anti

tion, which was, however, not very severe. On Notoxin desirable in the market.

vember 7th there were slight traces of albumin in the Permit me to introduce to you the various kinds of

urine; the temperature sank to 99° F. Intubation antitoxin, and also some practical points about the

tube was removed on November 7th, at eleven o'clock

in the morning. The breathing was at once labored The first publication in this country appeared in the

and it was necessary to reintubate the child in a MEDICAL RECORD, October 6, 1894, by Professor

quarter of an hour, at 11.30 in the morning. There Baginsky, and in the same number also one by myself.

was hardly any reaction following the reintroduction Later, reports appeared from Dr. A. Campbell White,

of cannula, and the temperature did not rise above of the Willard Parker Hospital, who reported twenty 99° during the day. On November 8th the temperacases in the same journal (the MEDICAL RECORD,

ture was 99° F.; pulse, 134; respiration, 32. The November 17, 1895); in the same number there ap- child seemed to feel very well during the course of peared a second article by myself. In the cases of

this treatment, and had no emaciation, no loss of flesh, White, Aronson's serum was used only ; in the cases and was discharged cured. The healing was complete which I reported, I have used also Aronson's; later,

in this case. however, I used Aronson's and Behring's, as Aronson's

Bacteriological examination of the membrane was was not to be had. In the American Journal of the

made on October 31st, or the day following the child's Medical Sciences for January, 1895, a very elaborate admission to the hospital, and typical Klebs-Loeffler article appeared by me, describing thirty-four cases, bacilli were found, proving the diagnosis of diphtheria. and also a series of cases which I attended in the

The child was subsequently carefully examined by Municipal Hospital of Philadelphia. In that class of

me, readmitted to the Messiah Home, and here a cases I used principally Aronson's serum, and my slight form of paralysis followed, lasting in all about mortality was 5.8 per cent.

two months. The fluids on swallowing regurgitated Permit me to describe a few typical cases.

through the nose. With mild form of treatment, prinCase I.-A. G-, three and one-fourth years of cipally strychnine and faradization, the child made a age, male, was attended by me on October, 29, 1894, in

complete recovery. the Messiah Home for Children. Examination showed

Another typical case is the following : I was called hoarseness, normal temperature, regular pulse. The in consultation by Dr. A. Kessler, on December roth, throat, as far as we could see, tonsils, pharynx, and uvula,

to a boy, about six years of age, who had been attended was clear. No membrane was visible. I ordered

by the doctor for several days previously, with a severe 1 Paper read at the German Medical Society, March 4, 1895. pharyngeal, tonsillar, and laryngeal diphtheria. The


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December 11th
December 12th
December 13th
December 14th

99.5 100, 2 100.8 90.5 99 100 99 98.5

140 130 120 124 112 108 IIO 102

30 26 24 24 23 22 22 22

99 IOI 99.5 98.5

145 1 24 120 108 112 114 IIO




December 17th
December 18th


whole pharynx showed thickened membranes com- scapular region, in the presence of Dr. Bullard. There pletely covering the throat ; besides, the child appeared was no reaction following the injection of the serum to be somnolent most of the time. This latter symptom which could be ascribed to the serum itself. In the proved to Dr. Kessler the severity of the case. When twenty-four hours following the injection Dr. Bullard I saw the child, on December 1oth, it was at once de- noticed a red circle surrounding the membrane on the cided to inject antitoxin. Owing to the severity of the uvula. The redness increased as the embrane de symptoms I decided to inject 20 c.c. of the same, creased. On January 2, 1895, which was the third day using the ordinary aseptic precautions, consisting of after the injection of the antitoxin, the membranes were sterilization of the skin with soap and water, followed almost invisible on the uvula and tonsils. The child's by an antiseptic solution, and injecting the antitoxin appetite improved in twelve hours after the first injecdeep into the subcellular tissue and applying a drop of tion. collodion over the puncture to seal it. In this case, as The second child in this family was taken ill on the in all cases, I did not use any massage after the injec- same day I injected the first child, and for prophylactic tion to permit the absorption of the healing serum. All reasons it was decided by Dr. Bullard and myself to of my cases, with a few exceptions, were injected in the inject 2 c.c. of antitoxin, to produce immunity if posinterscapular space, as practised by Professor Bagin- sible. Although no typical diphtheria could be proved, sky, and also endorsed by a great many others, chiefly still the pharynx showed a slight milky coating, which Aronson, in Berlin.

looked suspicious. This child remained ill only about On December 11th, the day following the injection, one day, and was well after that time ; had no fever, the temperature was

and did not contract diphtheria. Still more interest

ing, however, in the same family, is the fact that the Morning.


mother of these two children, who had been around Tempera

nursing and looking after them, was taken sick with a Respira


mild infection of the throat, pain on swallowing, and (Deg., F.) (Deg., F.)

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. December 15th


A child, two and one-half years of age, with a diagnoDecember 16th

sis 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 On December 1oth the child was injected by me. cyanotic and had a pulse of 180; cold extremities; On December 16th Dr. Kessler wrote to me that the extreme dyspnea. Although I was sent for to inject tonsils, pharynx, and uvula were free and clear of all antitoxin, the urgency of the symptoms demanded visible membranes, also, that he noticed, a few days prompt relief, which was given in the form of hot musprevious, the gradual melting away of the same. This tard foot-baths; internally, strong coffee and brandy child was discharged as cured on December 18th. Re- and other excitants, besides a rapid intubation. The covery complete. The local treatment consisted of child's breathing was immediately relieved after the

. antiseptics, strong stimulating diet ; careful hygiene intubation, and when the child recovered from the was also carried out. In this case a bacteriological reaction following the same, I then injected 20 c.c. examination of the pseudo-membranes was also made, antitoxin, using the ordinary antiseptic precautions, in and the report sent to Dr. Kessler showed the exist- the interscapular region. The dyspneea was so much ence of Klebs-Loeffler bacilli, which corroborated his improved that the child immediately went to sleep. clinical diagnosis.

The temperature was 100° F.; pulse, 130, within one The following two cases were seen by me, in consul- hour afterward. The appetite was good. I ordered tation with Dr. W. E. Bullard, in this city :

raw scraped steak, buttermilk, and semi-solid nourishA child, male, four years of age, was attended by ment as long as the tube was in place. The course of Dr. Bullard for a severe form of diphtheria. Plain this child's disease was very protracted. The glands visible pseudo - membranes could be seen in the of the neck were extremely swollen, and the membranes pharynx, which appeared dark gray. There was a fetid seemed to disappear very slowly. A distinct improvesmell of the breath, enlarged submaxillary glands. Dr. ment was first noticed two days, or about fifty hours, Bullard made a culture, sent it to the Board of Health, following the injection of the antitoxin. I allowed the and received the report, showing Klebs-Loeffler bacilli. cannula to remain five days, when Dr. Krog and myThe child was so restless and hard to manage that the self agreed that the stenosis being so much improved, physician could not do anything with medication by and the membranes not visible, appetite and sleep mouth. The doctor decided to apply local applica- both normal, to extubate on January 11th. A caretions, and even these were strenuously opposed. It re- ful examination of the urine, using Éschbach's albu. mained then for Dr. Bullard to decide upon antitoxin, min metre, showed five pro mille and a few epithelial and the child was seen by me on December 26th, or and hyaline casts. A careful examination of the exabout three days after the first appearance of the symp- tremities showed no ædema of the body. This contoms. The temperature was 99° F. The mother told us dition of nephritis lasted in all about eleven days, and that the child had been ill a few days ; had had fever, also a small trachitis and cough remained, which I asand had vomited on the day previous. The membrane, cribed to the irritation and probable pressure caused as first examined, covered the velum palati, both tonsils, by the tube, as nothing could be diagnosticated by an and as much of the laryngeal wall as could be seen with examination of the lungs. The child did not lose any the eye. Dr. Bullard prescribed a tincture of chloride flesh during the course of treatment, and the albumin of iron, ten drops every hour, but he is positive that the disappeared gradually until the fourth week following child received little or none of it. The patient con- the injection of the antitoxin, when the urine appeared tinued to grow worse, the membranes were thicker and normal. The cough also subsided, appetite returned, thicker, until the seventh day of the illness. When I

child slept well, and was discharged cured. first saw the child the temperature was subnormal, 97° The most interesting portion is the bacteriological F., and on the day following the injection the temper- examination in this case. The first culture proved the ature was normal and rose until it reached 99° F., presence of Klebs-Loeffler bacilli. The day on which which was the highest it attained during the whole we declared the child cured and the question of disincourse of treatment. I injected 12 c.c. antitoxin, fection of the apartments came up, I made another cultusing ordinary antiseptic precaution, in the inter

ure, which again showed the presence of virulent

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