and pharyngeal diphthérite. The latter is not a purely local affection like the former, but it is found manifestly connected with a morbid state of the whole economy." This opinion has already been offered by the illustrious Pinel. As proof of this, Dariot truly remarks that he can discover it in the miasmatic or epidemic nature of the disease; in the rapidity of its course; in its severity, which is generally but little proportionate to the apparent mildness of the local inflammatory phenomena by which it is accompanied; in the very remarkable disposition of the cutaneous ulcerations to assume the diphtheritic and even gangrenous character in their course, as in typhoid affection; and, finally, Dariot discovers this proof in the length and difficulty of the convalescence, a general indication of a deep-seated affection of the whole organism. Others have supposed it to consist of an effluvium arising from the decomposition of animal or organic matter. Again, others have thought that it is due to a parasite, which enters the blood through the air-passages, and multiplies like fungus or muguet, (oidium albicans,) or as in mildew. This last idea has a great deal of truth in it. We shall furnish below the microscopical examinations. B.-Its Appearance in Animals. The diphtheria in man was preceded, in the eighteenth century, by a similar epidemic in animals, a pulmonary murrain and sore throat, as mentioned by Drs. Brooklesby, Hurd, and Layard. Also, Ghisi, Wall, Severinus, and Maloni, mention the same fact. M. Maloni observes, in his account of the epidemic at Paris, in 1746,' that the disease among cows had already appeared in France, when children were attacked by epidemic sore throat. The same reporter, in his remarks of the disease of October, 1748, when this form of epidemic sore throat was again prevalent, says it had been noticed that oysters dis 1 Mémoires de l'Académie Royale des Sciences, page 562. 1748. agreed with every one who ate them during the month, especially before the weather became cold. I have also seen the most violent symptoms produced by eating a plate of oysters during the height of our epidemic. Both eruptive and pulmonary murrain have, in many districts, prevailed contemporaneously with diphtheria, as observed by Greenhow, of London. The fact was gathered from some respectable butchers, in extensive business. Pulmonary murrain and mouth and hoof disease have been very common among cattle during the year 1858, and the early part of 1859. In 1857, there prevailed a kind of influenza among horses in England, which was very fatal. Dr. Morris, of Spalding, informed Dr. Greenhow that he had seen a horse with swelling of the glands about the jaw, in which the mouth and throat presented an appearance similar to diphtheria. C.-Locality, Cold Air, Damp Air, etc. Diphtheria has not existed exclusively in any particular kind of locality. It prevailed, according to Dr. Greenhow, in Birmingham, Wolverhampton, and Leek, places situate on high ground, forming, as it were, the backbone of England; in Hanley, said to be the most elevated town of its size in England; in villages on the ridges near Launceston, among which some of the smaller tributaries of the Tamar take their rise; in the flat parts of Sussex, Norfolk, Kent, and Essex, and in the fens of Lincolnshire. It prevailed both at Trimingham, the highest point of Norfolk, and in the neighboring parish of Southrex, a very low and marshy district. Greenhow is of opinion that it has not prevailed to an equal extent in each of the above districts, having been, upon the whole, most common in places either marshy or otherwise damp, as from the retention of moisture by an impermeable subsoil or the proximity of water. It is also noteworthy, that the sporadic cases of diphtheria were always observed in marshy districts. On the other hand, whilst drier places have suffered very severely, damp districts in the vicinity have es caped. Dampness, therefore, cannot be the only cause. It may be regarded more as an auxiliary than the principal cause. This is the opinion of the English physicians. Still, the combined testimony is in favor of the noxious influence of moisture or dampness. With regard to the epidemic in Philadelphia, whilst during the summer or dry season the city is comparatively free from the disease, diphtheria always returns with the appearance of the rainy season and cold weather. I have observed people sitting near the window when the damp atmosphere entered, attacked by diphtheria. Several patients afflicted with diphtheritic fever from exposure to the damp atmosphere on board of vessels at Kensington wharves, were attacked by the disease for several consecutive years on the first appearance of cold and damp weather, whilst during the summer they remained entirely free. Empis also states that all the parts of the body which are completely removed from the contact of the air are preserved from the invasion of the disease. He calls this a remarkable. fact. It corresponds with my view given above. In addition, it must be mentioned that the disease was very fatal in the neighborhood of Cape May, where there are numerous marshes and swamps. Nearly every family lost one or two children. In this connection, we must also allude to what Dr. Lea J. Williamson,1 of Lardis, Mississippi, says of the influence of locality on the high-water shed between the Tallahatchie and Mississippi rivers. "On each side are broad uncultivated valleys of matchless fertility, where grows vegetation of the richest and rankest character. Superadded to this are numerous lakes, marshes, and sloughs. The first cases of diphtheria occurred on August 5th, 1859. Remittent bilious fever, the only disease from which the inhabitants usually suffer during the summer season, and which had been prevailing to its usual extent, seemed now merged in the prevailing epidemic; after the appearance of diphtheritis, not one case of fever was seen in the 1 American Journal of Medical Sciences, page 100. 1859. epidemic region, where scores are wont to occur." Dr. Williamson further remarks that the patients were always worse during wet weather. D.-Age, Strumous Constitution. Age. The greatest mortality of diphtheria is among children from the age of two to five years. From the tenth to the fiteenth year the mortality diminishes, and is trifling after the fifteenth year. The same remark is also applicable to scarlet fever and croup. After the fifteenth year, still fewer die of these diseases than of diphtheria. Of the five hundred and fifty cases which I attended from January, 1860, until January 1st, 1864, there were only about twenty adults, of whom only two were severe cases. None of these died of the disease. Dr. Greenhow remarks that sometimes all the smaller children of a family die, and then, again, sometimes all the female children. I observed the latter in one family.1 Strumous Constitution.-There is no doubt in my mind, that children inheriting a strumous and tuberculous constitution are most liable to the disease, and are most severely affected by it. The same remark holds good with scarlatina. All the deaths occurring in my practice were of such children; and although they seemed previously to enjoy good health, a closer examination generally determined me to pronounce them of scrofulous habit. Dr. J. P. Dake, in a letter to the author, October 30th, 1862, makes the following observation: "The scrofulous diathesis affords the most favorable field for the operation of this poison." Prof. A. E. Small, of Chicago, writes to the author, that in subjects of a scrofulous nature he has had but little success,-nearly all such cases having proved fatal. 1 Of the fifty-eight cases attended by Dr. Williamson, of Mississippi, sixteen were over fourteen years of age, (one was over forty, five over thirty, and nine past twenty;) the other forty-two had not reached the age of puberty. Twenty of these were between the ages of four and six. E-Chemical Examination of the Membrane. My friend Dr. Koch drew my attention to a most exhaustive analysis of the diphtheritic membrane contained in the "Monatsblatt," of the sixty-sixth volume of the "Allgemeine Homœopathische Zeitung," by W. Kuchenmeister, in Dresden. I herewith copy the whole table, as furnished by Kuchen 8. Liquor Calc. carb. 9. Natrum aceticum, concentrated solution. 10. Kali chloricum, (Chlorate of Potash.) 11. Artificial herring's brine, (prophylamin with common salt.) 12. Real herring's pickle, (remedy against croup.) 13. Acid. Muriatic. concentratum, one part to three parts of honey. 14. Acid. Muriatic. concentratum, one part to three parts of water. Ditto. Soon strong swelling up and transparency, in which state the membrane remains for days. A slight swelling up. Ditto. Ditto. Ditto. Hardly swelling at all. No effect whatever. No effect except a greater condensation of the membrane. Ditto. |