A great many use antitoxine with | interesting point is the forming of the too much fear, not using large enough line of demarcation, and later the castdoses. I should say the minimum dose ing off of the membrane. should be about $4.00 worth; many use but half of that. The more generous the dose the better the effect. I had a case recently three years old. On the second day the tonsil was covered; third day both tonsils and one side of soft palate were covered with a typical membrane; there was obstruction to the breathing. I injected 2,000 normal units, and in twelve hours the breathing was better; in twenty-four hours the line of demarcation formed, and in forty-eight hours was well. This has been my experience in a number of cases. Of course, I have had some fatal cases, but we cannot claim that it will cure all. Of all contagious diseases, this one is the hardest to explain and make out. I have seen one member affected in a tenement house with miserable sur roundings, the other children escaping; and in other cases, again, they would all have it. How valuable antitoxine is as a preventive measure I cannot say, but as a curative one it is beyond a doubt. There is a remarkable visible effect, that appears like a culture-tube test. DR. G. I. BAILEY: Last winter I had the opportunity of seeing Prof. Monti, of Vienna, demonstrate the effects of antitoxine, which were remarkable and just as Dr. Twitchell has said, the red line of demarcation first appearing, with later the melting and disappearance of the membrane. I remember some bad cases in which the nares and fauces were affected, and one case required a tracheotomy. In these cases on the third day after the injection the disease had disappeared. Most of the cases were accompanied by albuminuria. In another case, where the disease disappeared on the third day, there was an eruption, starting at the point of injection and extending over the body; this disappeared a few days later. Another case, when admitted, had a croupous pneumonia; under antitoxine the diphtheria disappeared and the child recovered, to die six weeks later from the pulmonary trouble. The DR. G. B. ORR: I have never used antitoxine in the treatment of diphtheria, because I have believed the principle wrong. I cannot see why the putting in of more diphtheritic poison (even if it is attenuated) is going to cure; it is not the same proposition as that of the treatment of small-pox by vaccination, for in small-pox the idea is to prevent, and not to cure. I have always treated my cases of faucial diphtheria with applications, two or three times a day, of Monsel's solution of iron, also tinct. iron internally, whisky internally, soft, good food, inhalations of 1 to 4,000 of bichloride of mercury, and when the disease invaded the larynx, either intubation or tracheotomy. I have been able to cure about seventy five out of one hundred cases. Of all the cases in which I have performed tracheotomy only one was successful. DR. B. P. GOODE: In reply to remarks of the former speaker, I desire to call attention of the Academy to the differention of catarrhal laryngitis and stenosis of larynx due to diphtheria. In the former phonation is maintained and the cough is loud and shrill; in the latter there is little cough and the voice is reduced to a whisper. Medication will relieve the one, while intubation and antitoxine will be required for the other. I have observed that when antitoxine is used in cases that show signs of beginning stenosis the tube is often not called for, and if an intubation is made the tube can be removed much earlier. I am removing tubes at the end of two days when antitoxine is used; formerly four and a half days was the average time when no antitoxine was used. DR. JOSEPH RANSOHOFF: I arise to speak in reference to the surgical part of the treatment of certain cases of diphtheria, for a very important surgical measure in such cases has been disparaged. I have had nine cases of tracheotomy, and four have recovered. One of them is Dr. Rothenberg's brother, who I believe is a hearty lad to-day. DR. ROBT. W. STEWART: It cannot | system. I desire to remind him that in be denied that antitoxine does not cure epidemics cases that were exposed to all cases, but it has been demonstrated smallpox, if vaccinated, had a modified that if used in the first twenty-four form of small-pox. The last case of hours the mortality is but 4.8 per cent., death from diphtheria that I have had which certainly means some will die. Dr. Orr saw with me. I have not lost If used on the third or fourth day the a case from diphtheria in two years. Of mortality is three or four times greater. course, my experience is not large, but It has been said that it does not follow I have seen others who were not as that it goes through a family, but that is successful. To be effective, antitoxine not against the grandmother getting should be used early. well in the case reported. My experience has been limited. This summer I had two cases in which antitoxine was effective. I noted the left line of demarcation. The first case died on the fourth day after the disease had disappeared; the second child recovered. If the statistics show a mortality of but 4.8 per cent. if used in the first twenty-four hours, that is far better than under the old treatment, with 50 per cent. DR. W. D. HAINES: Despite the quasi-philosophical aphorism, "Convince a man against his will, he's of the same opinion still," surely the brilliant results obtained and reported by those present to-night should be convincing to the most skeptical. These reports, taken together with the vast accumulated records upon the therapeutic use of antitoxine, are not the outcome of an hour's thought or a single experiment where enthusiasm and the flush of success might cause imagination to displace judgment, but the deduction of a long, scientifically conducted series of experiments covering a series of several years. DR. W. E. KIELY: After listening to the discussion I think Dr. Orr will use antitoxine, and that before. he is sixty years of age. I have had more success in the last two years in the treatment of diphtheria than in the Some years ago, in discussing the fifteen previous years. My treatment is subject of diphtheria before this society, the early use of antitoxine. We have the speaker expressed an opinion that in no occasion for fear where the breathing a given case where diphtheria had been is loud and can be heard in the next diagnosticated the final result either room, but those cases where the breath-confirmed or refuted the diagnosis; in ing is low, with depression below the sternum-those are the ones we fear. In reference to the early removal of the tube, I generally remove it after sixty hours. In one case that I intubated the doctor did not like the breathing and cough and removed the tube, when a lot of membrane came away; there was no occasion for its reintroduction. If the remedy proves anything it is that we can remove the tube early with safety. Formerly we allowed the tube to remain in seven days; now three or four days are sufficient, which shows that it does good. The case reported by Dr. Greiwe, in which he used antitoxine on the third day, was one of sepsis, and the drug cannot influence that condition; besides, we cannot get the effects of antitoxine in less than twenty-four hours. other words, if the patient survived the Dr. Orr mentions that vaccinia was used before the disease was in the | theria. The magnificent reports of our confrères here assembled, and the incontrovertible evidence that occupies columns of almost every medical journal in circulation, stamps antitoxine as being second to none, and probably the greatest remedy that painstaking science has handed suffering humanity. It is the only remedy at this period that is worthy of mention in the sense of a direct curative measure in connection with the treatment of diphtheria. One word more: A little more care, gentlemen, in establishing the diagnosis. Apply the touchstone, demonstrate the Klebs-Loeffler bacillus, and your reports will not be subject to the stigma of Disraeli anent statistics. DR. HENRY WALD BETTMANN: I cannot forego this opportunity of calling attention once more to the fact that the physicians of Cincinnati are in a worse position to discuss diphtheria scientifically than the physicians of any large city in America. Even smaller municipalities, such as Buffalo, Cleveland and Indianapolis, have provided at public expense means for the correct diagnosis of throat lesions, while we in Cincinnati are unable to tell in many cases whether we are dealing with diphtheria or not. This society is certainly at fault in not insisting upon the establishment of a bacteriological bureau. Regarding the use of antitoxine this question has passed beyond the stage of doubt. It is now thoroughly proved that antitoxine has lowered the mortality from diphtheria in the whole civilized world; and the conclusions obtained are less open to cavil because they have stood the test of experience not for six months or a year, but for several years. It is useless, however, to argue with one who is contented with a mortality of 25 per cent., when antitoxine has reduced the mortality to below 10 per cent. or 5 per cent. It is useless to argue with one who calmly quotes from "eminent surgeons" to the effect that tracheotomy is a hopeless procedure. For the experience of the past few years has shown conclusively that the death-rate of tracheotomized cases has been materially reduced by the use of the antitoxine. DR. KIELY: What effect does antitoxine have upon cases in which the Klebs-Loeffler bacillus is absent, but which are caused by the staphylococcus and streptococcus ? DR. BETTMANN: The cases in which only streptococci and staphylococci are found do not require antitoxine, and get well without it. Experience has shown that about 98 per cent. of all cases in which the Loeffler bacillus is absent recover under any treatment, and only when the Loeffler bacillus is present is the case one of true diphtheria and the mortality is high. This is no longer conjecture, but proved fact, and the steps to the conclusion are ancient history. DR. N. P. DANDRIDGE: How is the action of antitoxine explained? DR. BETTMANN: No theory is accepted. The antitoxine probably heightens the cellular resistance to toxines and enables the patient to resist the diphtheritic poison. It may also contain a substance which neutralizes in a chemical sense the poisonous products of the bacterial growth. It certainly does not make the soil unfertile, for the bacilli continue to grow in the throats of convalescents for days, and sometimes even for weeks after the injection of antitoxine. not DR. KIELY: How do you explain cases in which the bacilli were found, and which were nevertheless followed by paralysis? DR. BETTMANN: This occurrence is exceedingly rare, and in such instances the bacilli must have been overlooked. Experience everywhere has shown that the bacillus is found in dangerous and paralytic cases in the vast majority of instances. DR. ALBERT H. FREIBERG: Dr. Bettmann forgot one explanation. It is certainly true that the Klebs-Loeffler bacillus is present, but may not come up in the culture, probably not being caught upon the swab. DR. JOSEPH EICHBERG: It has been a matter of some surprise to me that more extensive quotations have not been made by any of the gentlemen taking part in the discussion from the report of the Collective Investigation Committee, submitted to the American Pediatric Society at its last spring meeting. It may be said, at the outset, that the character of the gentlemen composing the committee is a sufficient guarantee for the fairness and reliability of their report. The latter is exhaustive enough and embraces a sufficiently large number of cases to give it the stamp of authority. It embraces the experience of careful physicians in private practice and hospitals in all parts of the country; this removes it from the possible criticism of dealing with a local epidemic of reasonably mild character. The number of cases presented was 5,500, including children and adults, moribund and mild cases, diphtheria of the larynx, pharynx and nares. It would appear from the report that too great stress cannot be laid on the earliest possible use of the antitoxine. Hours are of great moment to the patient. A particular increase in mortality seems to occur when more than forty-eight hours have elapsed before the remedy is employed. Of cases receiving the antitoxine injection after the third day the mortality was four times as great as when the injection was given before that time. A special class is made of cases dying within twenty-four hours after receiving the injection. It would seem as though the full effect of the remedy could not be relied upon until that time had elapsed. Of those dying within twenty-four hours after receiving the injection, a very large percentage was really moribund at the time the antitoxine was given. In adults receiving the injection before the third day, the mortality, exclusive of the class just mentioned, was 2.4 per cent. Of children, 4.8 per cent. Certainly no results with any other plan of treatment now before the profession will compare with these figures. Gentlemen have stated that the true test of the value of treatment can be deduced only from its effects in cases of laryngeal diphtheria. Accepting this as a basis of comparison, the results of the antitoxine in treatment are still im measurably superior to any other. Of 1,500 cases of laryngeal diphtheria 50 per cent. recovered with the use of antitoxine alone. In the remaining 750 cases the dyspnea was so severe that intubation had to be performed, the antitoxine being also used; of this number 75 per cent. recovered, making a total of recoveries of 87 per cent. of the whole 1,500 cases. No better evidence could be adduced in its favor than the report made by Virchow, a man not prejudiced in favor of serum therapy, to whom, as will be remembered, we owe the exposure of the injurious effects of the tuberculin injections. In the Friedrichshain Hospital of Berlin a number of cases had been treated with a mortality of 56 per cent. The supply of antitoxine-this was in the period of its early trial-unfortunately was limited; during its use, the mortality dropped to 28 per cent., only to return to its original figures when the supply was exhausted. Several months elapsed before antitoxine was again at the disposal of the hospital authorities, the mortality constantly remaining at the higher figure. With its employment there was again the prompt decline to 28 per cent. So impressed was the famous pathologist by what he had seen, that he declared it to be the duty of every physician to use it in every case of diphtheria. Nor should its use be limited to cases known to be diphtheria. When there is any doubt, the antitoxine should be employed, not waiting for the bacteriological test to decide a doubtful clinical diagnosis. The time element is too important to admit of any delay in resorting to the remedy. One of the speakers has said he is opposed to its use upon principle. Surely, this is a mistake. To hold this position would be to range himself with that large contingent in the community which immured in an insane asylum one of the earliest students of the power of steam, and drove from his practice, in London, William Harvey, because of his discovery of the circulation of the blood. The opposition. will fall after the first trial of the antitoxine; the results will speak for themselves so strongly that further argument will be unnecessary. The results follow so speedily that the eflect is little short of magical. There can be no finer scientific triumph than that which the medical profession has achieved in the discovery of antitoxine. Vaccination has been a marvelous boon to the human race; the discovery of Jenner stands as a great achievement, though it was due wholly to observation of facts. The discovery of antitoxine was the result of a carefully-prepared logical induction, based upon sound principles of pathology, and as such represents a greater triumph. It is my firm belief that, before many years, it will not be asked whether one believes in antitoxine, but the physician who refuses his patient the benefit it confers will be held culpable of malpractice. DR. ORR: I am glad that I have made the remarks that occasioned such a warm discussion, and, although the members have scored me thoroughly, it has resulted in the bringing out of most important and convincing facts; the speech of Dr. Eichberg especially was so favorable to antitoxine, his quoted statistics of 48 per cent. only of mortality was so much better than anything that I have ever been able to accomplish, that I am thoroughly converted. NORTH-WESTERN OHIO MEDI CAL ASSOCIATION. The North-Western Ohio Medical Association held its fifty-second session at Defiance, beginning December 10, at 2 P.M. The preliminary work was carried out according to the programme, the following physicians being elected to active membership: W. S. Powell, Defiance; C. A. Heaton, McCutchenville; O. L. Norris, Deshler; Frank B. Entrikin, Findlay. The following physicians were elected to honorary membership: D. Tod Gilliam, Columbus; C. B. Parker, Cleveland; N. Stone Scott, Cleveland. Dr. Charles E. Slocum, Defiance, read a very interesting paper on "A Peculiar Case of Lanced Aneurism, Causing Extensive Blood Effusion in Thigh, Cured by Ligation of Femoral Artery." Discussion by Drs. Thorn, Stephens, Hines and Slocum. Dr. J. P. Baker, Findlay, read a paper on "Some Recent Experience in the Treatment of Diphtheria." Discussion by Drs. Thorn, Porter, Hubbard, Hiner, Maerker, Kimmell, Entrikin, Carrothers, Woods, Ewing, Hurd and Baker. Dr. A. P. Baker, Cleveland, then read his paper on "Pyogenic Brain Diseases as the Result of the Disease of the Middle Ear." Discussion by At the evening session Dr. N. Stone Scott, Cleveland, exhibited some skiagraphs, and gave an interesting description of cases. Discussed by Dr. Parker. DR. GREIWE: I think the case I reported of five years of age really died from a mixed infection, and where that takes place we cannot expect a good result in every case, even if used within | Drs. Thorn, Hubbard, Stueber, Slocum the twenty-four hours, for I do not and Baker. believe antitoxine can do any good. Concerning the demarcation, I looked for it, but it absolutely failed to appear. The membrane extended over the uvula and down upon the epiglottis, showing that the antitoxine had no effect upon it. The remedy was used upon the second day, before the first twenty-four hours were up. We looked for the demarcation that night, but there was none. From the reports we cannot rely upon our individual experience, for from the observation of the Pediatric Society, in justice to our patients and to ourselves, we should use antitoxine. BETANAPHTHOL bismuth is a good remedy in the diarrhea of infants. Dr. Chas. Graefe, Sandusky, Presi dent, then delivered his address on "Fin-de-Siecle Medicine," reviewing the great progress made in medicine, and referring to still greater possibili ties for the future. Dr. Miles F. Porter, Ft. Wayne, Ind., took for his subject "The Physician in Literature." Discussion by Dr. Woods. Dr. W. D. Hamilton, Columbus, read a paper on "Allingham's Method of Doing Inguinal Colotomy." Dr. G. W. McCasky read a very |