he referred again "to the greatest of all God's blessings- dilute Sulphuric Acid, in diphtheria.'

Following these come Salicylic Acid and Cream of Tartar, with a local application of Labaraque's Solution of Chlorinated Soda, the use of which remedies cannot be too highly commended.

As the greatest success in the treatment of diphtheria is obtained from the application and administration of an acid, or acid salt, is it not probable that the whole pathology of this disease is dependent upon the presence of a peculiar alkali in the blood, which, when neutralized by the acids administered, secures success in treatment; or, perhaps, upon the presence of a substance not an alkali, but that which acts as a base to an acid, producing the morbific influence? May not this "base," when in combination with an acid, be rendered incapable of further injury? So strongly was I impressed with this being a fact that, during the treatment of some cases, after I had cleared the throat of the membranous deposit, I have stopped my acid treatment to observe its appearance, and subsequently renewed treatment successfully. Such tests point strongly to the possibility that the pathology of this disease is dependent upon the presence of an alkali or other basic substance in the blood, causing a constitutional disease by blood-poisoning. Indeed, the cure of some mild cases have come under my notice by means of the use of Phytolacca Dec. Baptisia Tinct. and Ignatia, the best known antiseptics in bloodpoisoning.

Let me give a case in practice to illustrate the treatment: Mrs. T., æt. thirty-two, of this city; sanguino-encephalic temperament. First noticed a swelling of tonsils, accompanied by a slight sore throat, after which the salivary glands began to swell, accompanied by extreme lassitude, and white patches appeared upon the fauces. She became alarmed and sent for her family physician who, with these symptoms, in conjunction with an active pulse, was correct in his diagnosis of diphtheria, and ordered the following treatment:

Sig: Take one teaspoonful every two hours, and

B Potassæ Chloras., grs. viij.

Aquæ Crotoni,
M.

3 iv.

Sig: Use a teaspoonful as a gargle every hour.

The next morning all the symptoms remained; the lassitude was aggravated, and the membranous deposit extending. He changed the gargle to

B Potassæ Bichrom., grs. vj.

Aqua,
M.

3 iv.

Sig: Use one teaspoonful as a gargle every hour.
The arterial sedations were continued as before.

The next morning, being called in consultation, I found the patient with pulse 120 per minute; membranous deposit covering fauces and extending to posterior nares, and involving the soft palate; shortness of breath and complaining of great general debility. Prescribed

B. Fl. Ext. Pinus Canad. (Kennedy's), 3 ij.

Aqua (Fervens),
M.

3 iv.

Sig: When cool enough use one teaspoonful as a gargle, after which let the patient swallow one teaspoonful; use in this way every hour. For diet, use milk punch.

The next morning I found the throat entirely cleared of pseudomembranous deposit; breath less oppressive; diphtheritic condition much improved, but patient suffering from nervous irritablity that prevented her from sleeping. She declared she would surely die if she could not sleep soon. In this emergency I prescribed, in addition to the other medicine,

Sig: One teaspoonful every hour for four hours, then every two hours.

I ordered milk punches as strong and as often as the patient would take them.

The next morning the attending physician reported no appearance of deposit in the throat; pulse, ninety; nervous irritability very much relieved; had slept at intervals, after taking Gelseminum twice, and shortness of breath much relieved. Recommended the Pinus Can. to be continued at intervals of every two hours; Gelseminum four times a day, and continue milk punches or other stimulating diet. If she continued to improve next day, increase the intervals between the administration of Pinus and stop the Gelseminum altogether, continuing the nutritious diet.

Under this treatment the patient recovered.

The adjunctive treatment in this case was the administration of the Gelseminum, without which the patient would have surely died from the depressing and exhausting influence of the nervous irritability, notwithstanding the use of our "specific," Pinus Canadensis.

NITRATE OF AMYL IN POISONING BY GELSEMINUM.

BY MARK NIVISON, M. D., of New York city.

The case that I am about to present is one that I called your attention to at the November meeting, and which I was requested at that time to write up and present to the society.

Believing as I do that Nitrate of Amyl, in this case, at least, aided very much in restoring the patient, and that it may be the means of indicating a possible course for others under like circumstances, I have complied with your request.

I will not say that Nitrate of Amyl is a certain antidote to the effect of Gelseminum under all circumstances, but that it establishes an action the very reverse to that produced by an overdose of Gelseminum. The latter being so persistent and powerful a relaxant, that the nerves controlling the heart and the circulation generally, become powerless. All the organs cease to perform their functions from want of nerve force. The heart expands, but has no power to contract. Death, of course, follows.

Knowing that Nitrate of Amyl had been used with the happiest results in cases of asphyxia from Chloroform, the idea suggested itself to my mind that it might do the same in an overdose of Gelseminum. After getting this idea in my mind, I had not long to wait for a chance to test it. A gentleman stopping in the same house in which I had my office, supposing he was taking a simple tonic, took at the lowest estimate two ounces of the tincture of Gelseminum. Discovering by the taste that he had made a mistake, he looked at the label on the bottle, and found that he had taken, as he himself expressed it, "a big dose of sure death." He came immediately to my room and called me (for it was in the night). I dressed myself quickly, but by that time he was taken with the primary symptoms; a general spasmodic action of the muscles, but particularly the muscles of the chest and heart. These spasms would occur about every two or three minutes at first, and would last probably from ten to fifteen seconds. As soon as the spasm ceased there was sudden and excessive relaxation.

I got him into the office as soon as possible, which was probably not more than five minutes from the time he took the Gelseminum, and gave him at once a powerful emetic of Sulphate of Zinc, and directed those that were assisting me to repeat as soon as the stomach had rejected the first dose, while I went to the drug store to get the Amyl. By the time I returned he had vomited thoroughly. I repeated two or three times, until I thought every thing that it was possible to do in this direction was accomplished. For perhaps ten minutes after we ceased with the emetics the spasmodic action first

spoken of continued, but got fainter every time until they ceased entirely, and, in proportion as this action stopped, the secondary or characteristic effect of Gelseminum obtained, which, up to this time, had been retarded by the reaction, caused partly by the emetics and partly by the spasms. Now, my idea was, just at this point, to try and create a reaction by producing spasm. In this I succeeded, with the Amyl, by allowing him to take from the bottle one or two full inspirations. This, I will say here, is an unsafe way to administer it, but my want of time was my excuse. Two to five drops on a handkerchief is all I believe that, under ordinary circumstances, it is considered safe to give. At every inspiration of the Amyl we got a prompt reaction-an increased action of the heart. The face and neck would flush, showing a forced capillary circulation and a sort of rigidity of the muscles. This was continued at intervals for four hours from the time the Gelseminum was taken - never failing to bring on reaction with the Amyl. Then the treatment was stopped, the patient given strong coffee, and ordered to keep quiet. Twelve hours afterward he was feeling the effect of Gelseminum, to the extent of being nearly blind, and the whole system much relaxed, showing that, in spite of the prompt measures used to empty the stomach, there had been quite a quantity absorbed. In the course of twenty-four hours these symptoms had entirely subsided, and he had no further trouble. The tincture was the officinal tincture of the dry root.

I will state, however, that I believe the condition of the stomach at the time the Gelseminum was taken was in as favorable a condition as possible to withstand a mild officinal tincture, for, according to his own statement, he had been drinking all the evening. Had drank brandy, champagne, ale, etc. Just how far the emetic and the condition of the stomach aided in the recovery, I leave you to judge. If I have interested you sufficiently in this subject to give it an investigation, I shall have accomplished my object in presenting it. 336 West Thirtieth Street, New York.

TRANSACTIONS OF THE BROOKLYN ACADEMY OF MEDICINE.

(RGANIZED 1856; INCORPORATED 1861; RE-INCORPORATED 1865.

OFFICERS AND MEMBERS.

OFFICERS:

President, B. F. Chapman, M. D.; Vice-President, Wm. Barker, M. D.; Recording Secretary, W. E. Crowell, M. D.; Corresponding Secretary, L. B. Firth, M. D.; Treasurer, James E. Danelson, M. D.

Board of Censors-D. A. Smith, M. D.; T. Van Skelline, M. D.; S. M. Hersey, M. D.; D. E. Smith, M. D.; Robert Gahrer, M. D.

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