work. It is said that not only is his whole system delusive, but that he has put it forward fraudulently, and by frauduleut means and arti

It is said that he begins with great dexterity by playing upon the fears of those to whom he is addressing himself, dwelling upon the terrible and fatal character of consumption, and that this is done to work upon the fears of his readers. I am not sure that this is necessarily the fair way of putting it-it may have been done with that object, but I can understand that a person deeply impressed with the importance of the subject, and writing a work upon it, might at the outset, with a view of interesting and impressing his readers, dwell upon the fatal character of the disease. But then it is said that he goes on to excite the fears of his readers, with a view to drive them to become his patients. He tells them that every cold, if it becomes chronic, is capable of causing consumption, which will be fatal. Now, as most of us catch colds every winter, this is somewhat startling. And evidence is given with a view to show that all this is not only untrue, but so untrue that no medical man could really have believed it. It is said that the evident object is to induce every nervous, timid person, who may find himself laboring under any of these affections, to imagine that from such trifling ailments may arise such a dire disease, the end of which may be fatal. This is so grossly erroneous that no medical man could have believed it, so that the only object must have been to frighten people and work upon their fears, so as to lead them to suppose that they have no safety but in a particular remedy, to be sought for in no hands but his. And if you come to that conclusion, then it goes a long way to show you, not only that the plaintiff's whole system of treatment is delusive, but that in putting it forth he had the sinister design of exciting, first, exaggerated fears, and then exaggerated hopes, with the view of putting money in his pocket. And if so, then it will be for you to say whether the article which describes him as a scoundrel and an impostor is at all too strong. And there are some passages in the book to which I must really draw attention, with the view of judging as to the honesty or dishonesty of its publication. I find it in such passages as these: "Catarrh is the first step toward consumption. Chronic catarrh of the nose, if not arrested, will assuredly go on to the destruction of the bones of the nose, and may end fatally." Rather an alarming prospect for any one who has a cold in his nose. (A laugh!) Then, as to sore throat, if dealt with under the ordinary system, we are told that "it proceeds slowly, but surely, toward the lungs, and the unfortunate patient soon learns how short is the step from sore throat to confirmed consumption." That may have been

honestly written, but it is certainly calculated to excite an alarm to be told that if any one has a sore throat, and it is dealt with by his ordinary medical attendant, it will terminate fatally!

[Conclusion in next number.]

Practical Observations on Diphtheria. BY W. NEWMAN, M. D., Lond.

The growing tendency of medicine in the present day would seem to be the recognition of general constitutional disturbance as the cause and factor of definite local changes, in place of the older creed, which treated with little of doubt or cavil, as special entities, local conditions, yet owning a common origin. Hence the acknowledgment of diseases as due to alterations in the circulating fluid itself; and as one in the now long catalogue of blood disorders I would wish to consider and to write of Diphtheria, a disease manifesting local distinctive characters, yet general from its earliest commencement.

The analogies of the affection might lead to the impression (by some authors indeed advanced) that it was an exanthem: yet though with scarlet fever, for example, certain similarities may be traced, there are many more points of well marked divergence, notably in some such directions as: That an attack of scarlatina confers on the patient no immunity from subsequent diphtheritic seizure and vice versa, no particular skin rash of definite onset and duration is noted in diphtheria, though a roscolous efflorescence may occur for some few hours, not followed by desquamation. The throat and fauces are implicated in both diseases, yet the ulceration and tissue destruction of the scarlatinous affection have little in common with the exudation of lymph characteristic of the other disease. Again, too, the one has sequelæ, indicative of intense nervous implication, while the former induces, by a somewhat less evident link, mischief either about the chest or the kidney.

I believe it more accurate and more wise to look on diphtheria as a disease in which some morbid material is received into the blood-the system as a whole sympathizing subsequently more or less severely, and the further progress being marked by the exudation of lymph about the mucous membrane lining the throat, pharynx and upper part of the air passages, while the general skin, especially if denuded of its epidermal layer, may show the same state. Yet to speak of the affection as if this local state were the constant or necessary attendant, or as if from the physical changes about the throat the constitutional disturb. ance were afteward evolved, I hold to be incorrect in observation and untrue in theory; for the sufferers, too, a belief fraught with possible

serious mischief if it, by logical deduction, lead the practitioner to deal with the tangible mischief, instead of addressing himself to the whole systematic depression.

I can not substantiate by aid of statistical tables the impressions which I have derived from a fairly large experience of the disease in question; the statements put forward as to its characters and treatment must be accepted as personal deductions, and claim only that weight which may reasor ably be asked for the honest declarations of a single observer.

Isolated cases of the disease are not unfrequently met with-more commonly an epidemic seems to sweep through a village or district; any single case, however slight in its symptoms, may prove a focus for spreading the affection. Whether the resulting attack be severe or trivial, seems to depend more on the exact health standard and general vigor of the recipient, rather than on the conditions of the primary

source.

In this point of view, experience teaches that children suffer most, and the younger the patient the less chance of recovery. Direct contact with an invalid is not necessary to the inducing diphtheritic mischief, but the breathing a tainted atmosphere, or close dealing with the secretions poured out from the affected surfaces, may readily determine its transmission.

I believe that the poison may be handed on to others by the wearing clothes on which expectorated matters have remained, and that this, from poverty and carelessness, is by no means uncommon with the poorer classes.

Defective hygienic conditions do not seem to develop these disorders, yet I have no question but that they intensify their virulence, and, most probably, by the indirect mode of diminishing the normal vigor of the residents; thus, in one block of cottages isolated, sadly deficient in space, air, and water supply, and abominably dirty, nearly two thirds of the cases attacked died-a far larger proportion than that furnished by the rest of the district; and in those, too, who lived through the active stage the sequelae were well marked, and recovery very tedious.

As a rule, the period of incubation seems to be short, most so when the exposure to the toxic influences has been very complete. In no case that I have been able to watch has the time appeared to exceed seven or eight days; most frequently it has been two or three only.

Systematic writers have with reason marked out different forms and stages of this disease; but however well such divisions may answer the

purpose of pointing a moral to a class of students, or of defining sharply the indications for one or other special plan of treatment, there is yet the same substratum, the essential part of the disease is alike throughout, varied as its after appearances may be from local changes or constitutional peculiarities.

Adopting the most usual classification of diptheritic affections, I would refer to them as simple or malignant, grouping the laryngeal form under the first named, and the nasal complication under the last

division.

Simple Diphtheria.-The early symptoms are most frequently severe; burning skin, pain in the limbs, and malaise, usher in the attack, with usually but a brief prelude of shivering. Not unfrequently the sudden invasion of illness has led me to expect the after development of diphtheric exudation, an impression verified by the result.

A common local occurrence is that of oedematous infiltration of the mucous membrane of the uvula and tonsils; the uvula becomes thickened, glistening, and lies helpless on the tongue; swallowing is thus difficult, and the voice is altered from its natural tone. Or again, there may be no special oedema of the lining membrane, and then exudation of 1pmph is more speedily noted, and there is more complaint of soreness about the throat generally.

In either case the uvula, palate, or fauces, soon exhibit one or more spots of lymph deposit, which may remain distinct deposits, or are covered with a whitish film of more uniform thickness. The surrounding mucous membrane is intensely injected, and when a few hours have gone by, the punctated spots will be seen to have become larger and to have coalesced, or the general filmy coating will have increased in thickness and extent.

Many of the simple cases hardly exhibit so much of local change. The effused lymph soon clears away, and the throat resumes a fairly natural appearance. Yet much more actual debility will be found to result than the precursory symptoms would have seemed likely to warrant, and this perhaps also will be followed by conditions of disturbed innervation.

More serious cases, still simple in character, are to be noted. The exudation tends to increase in extent and cohesiveness, so forming a complete pellicle, which may often be stripped off with forceps, then leaving bare the mucous membrane, either raw and bleeding, or but little altered from its ordinary state. The pellicle is in such cases usually distinctly fibrinous to microscopic examination, while in a different state of system, or more serious form of the disease, it is found

to be more friable, less adherent, and corpuscular in its intimate struc-,

ture.

The duration of this form of the disease is from a week to ten days in the milder forms; from fourteen days to three weeks where there is more local mischief.

There are, too, cases seen in practice, where diphtheric poison seems to seize on a patient without producing local manifestation, or at the utmost, the throat may be somewhat sore, and the fauces be found to exhibit a trace of redness, without lymph deposit. Subsequent marks of depressed health and nervous disturbance are to be met with.

Such instances seem to happen in the same house with, or in the vicinity of, already existing cases; and, probably, like the masked form of scarlatina, owe their being to a partial implanting of the poison in an uncongenial soil, the constitution sympathizing more or less, although the customary local changes do not appear.

Nor can such instances be treated as of light moment. In 1860, I was asked to see a lad about fifteen years of age, who was living with and working for a baker. He had been in contact with some diphtheric cases, and was weak and prostrate, but there was no pellicle about the throat, nor any thing more than a general redness of the fauces. The depression and rapid pulse were the only symptoms of serious mo

ment.

The master wished me to sanction his immediate removal home, a distance of fourteen miles; but this I declined to do, and spoke plainly of the risk the lad would run. The next day, however, the fifth day of his illness, the father took him home in a covered cart. The patient was very much exhausted at the end of the journey, and died very soon afterward, no change in symptoms having occurred.

On these comparatively simple cases it would seem as a rule that the laryngeal complication supervenes-usually, too, but a few days from the first declaration of illness. So that, in any given case, if the patient have been suffering for eight or ten days, the probability of the downward extension of the exudation of the air passages is very much lessened.

Where this complication does occur, the earliest symptom seems to be a little, husky, dry cough, with alteration in the voice; no special renewal of febrile disturbance; then follows whistling inspiration, with metallic, croupy cough, and the ordinary sequence of symptoms which point unmistakably to narrowing the channel of the air passages. In by far the great majority of these cases, death closes the scene in a comparatively short time.