Gonorrhea, Gleet and Leucorrhea.-Kennedy's White Pinus Canadensis gives perfect satisfaction in gonorrhea and gleet; have used it in cases within the last six months that resisted all other remedies. Have also used it successfully in cases of leucorrhea and ulceration of the os uteri. I am highly pleased with its effects, and certainly recommend it to the profession. The White is preferable-leaving no stain on the clothing.

Colorado Springs, Colo.

J. R. WILCOX, M.D.

Elixir Maltopepsine.-Dr. X. T. Bates, M.D., Powkepsie, N. Y., in March Notes on Pharmaceutical Products, speaking of Elixir Maltopepsine (Tilden), says: Malt and pepsin are the component parts, combined with hydrochloric acid and phosphoris acid. This is an important factor for the conversion of starchy matter into dextrin, another to supply the place of the natural digestive ferment, another to assist the solvent power of pepsin, which is the true exponent of its value, and still another which acts as a refrigerant and nerve tonic.

Maltopepsine is a most excellent combination. and seemingly meets a wide range of application. On account of the diastase and phosphorus which it contains, it is a tonic at once suggested in nervous dyspepsia and inanition. In disorders of alimentation and assimulation consequent on neurosthenia, and also in the convalescent stages of protracted fever and wasting disease, it is especially indicated.

Summer Diarrhoea.-In the large class of summer diarrhoeas of children and adults, with griping in the bowels and flatulence, the use of Listerine, in doses varying from ten drops to a teaspoonful (with or without water), has a most salutary and pleasing effect.

It can be administered at short intervals after eating, as soon as regurgitation, distension or acidity occurs. Its action in arresting excessive fermentation is prompt; besides, it exercises a decided sedative influence on the mucous membranes of the stomach.

The thymol, menthol and boracic acid which, with the quota of alcohol necessary to their proper admixture, form the principal elements of Listerine, lend to this compound a special value in this class of cases. New York Medical Journal.

Indigestion.-Dr. C. G. Clark, Toledo, O., says: My son George, aged nineteen, had been sick with indigestion and was anemic. I tried various remedies for the past six months with no success. I put him on the Seng, and having used three bottles I was convinced that I had met the remedy that he needed. After commencing its use his digestion improved, his appetite increased, and he commenced increasing in flesh; while his skin changed to a healthy color and his vitality was restored in every particular-in fact he is well. I am convinced it was Seng that cured him, as I gave him no other remedy whilst treating him with Seng.

Cardiac Derangements.-Dr. J. J. Thomas, Winamac, Ind., says: Cactina Pillets are of great value in cases of heart troubles. especially those of neuralgic character, weak heart. exhausted energy, nervous prostration and some neuroses. It also gives the best satisfaction in cases of anemia.

A Great Nervine.-Dr. C. M. Little, Washington, D. C., says: I have prescribed Celerina for nervous complaints, viz.: fits, hysteria, epilepsey, headache from alcoholic excess, with successful results. As a remedy and sure cure for impotency it has no equal. Suffice to say, Celerina as a nervine is great.

THE ST. LOUIS

Medical and Surgical Journal.

Whole No. 674.

VOLUME LXXII. -FEBRUARY, 1897.-No. 2.

Original Communications.

IS THERE" DIPHTHERIA?" By GEORGE B. H. SWAYZE, M. D.

It is Christmas. The time is again here when the winter's housing of subjects will mature the material for the usual increase of cases of diphtheria, prior to the return of open-air living of summer.

Diphtheria has too long been most contagious of diseases. misapprehension and imitation. Misapprehension and the severities and mistakes it entails are often worse than disease. The battle of the pathological giants about the actual constitution of diphtheria has prevailed near a half-century, and the end is not yet. Each successive doctrine, though defended with the fresh enthusiasm of patriots, presently fails to make the theory fit the exigencies of the disease, and vice versa.

writ down" by all hands as the This has been the natural result of

The presence of the Sir Klebs-Löffler" bacillus in the debris of the disorder is voluminously advocated by savants and servitors of bacteriology, as the last and only reliable index to diphtheria, and the true source of its poison. But more extended experiments are demonstrating that this bacillus, or this expres

sion of ferment, evinces increasing evidence also of much variableness of manifestation, and is often devoid of its supposed specific qualities. Hence, if this assumed specific cause of diphtheria prove to be variably non-contagious, the claim of the contagiousness of the disease it is supposed, theoretically, to originate, and also the disease itself, logically, fall without true props.

An inflamed throat, with devitalized exudation on tonsils, palate, or lining of nose, fever, languor, and other varied systemic disturbance, have usually made up the skeleton composite known as diphtheria in sufficiently tangible feature for a rational basis. of treatment.

For differentiation, it was supposed that the local exudation, patches of plastic material, often really patches of desquamating mucous membrane of surfaces inflamed, were somehow characteristic, and therefore diagnostic of this particular disorder. But how? Then there was division among diphtheria debaters. One side argued that the ulcer in the throat tissues and the exudate started the disease, ignited the fever, poisoned the system, spread the blight of rapid dissolution. Others contended that the disease was ab initio a systemic distemper, an initial manifestation of which was sore throat with the characteristic exudations; but that an essential contagiousness dominated all.

The contention that a small patch or ulceration on the surface of a tonsil could so speedily spread such devastation to constitution and vitality, as often witnessed in diphtheria, never impressed me as vindicated reasoning. I am similarly convinced by the absurd inferences of those modern bacteriologists who are hyper-ambitious to ingraft the doctrine that a "loafer" bacillus, gaining entrance to the mucous covering of the pharynx, by propagative process, consummates a galloping contamination of system with poison and rot! This untenable postulate is disproving itself with the passing of the microbe flurry.

From Daheim we learn that secretions of mucous membranes, and especially of the salivary glands, are remarkably antiseptic and neutralizing to bacterian existence. What material chance, then, would bacteria meet in the generality of cases to inaugurate systemic poisoning and frequent collapse of patient in a few days' time?

Méry and Boulloche, Hygiene Department, Faculty of Paris,

announced in 1891 that the pneumococcus and streptococcus are numerous in children's saliva who have measles. But the pathogenic force of this is neutralized by the corollary which immediately follows, that these bacteria are also found in healthy saliva, the saliva offering a favorable means of development. Thus bacterial research is constantly running amuck its prophetic inductions.

Dr. Booker, John Hopkins University, after patient investigation of "the properties of the bacillus diphtheria," as I understand his paper, found so much diversity of results as to make the exceptions broader than the rule of microbian infection. Since bacteria and surface-exudation or pseudo-membranous exfoliation were prominent in cases where the Löffler bacillus was not sought or not demonstrated, by rule of exclusion they are stood over to the class denominated in plain words false diphtheria and pseudo-membranous scarlatina. Already we see that the cases are becoming too "mongrel and mixed" for practical distinction as to origin or treatment.

I quote concisely his descriptions of morbid products found in his scarlatinal angina" and "diphtheritic angina." Of the

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"Microscopic examination of the pseudo-membrane shows an infiltrated or necrotic mucous membrane; an infiltration of leucocytes (dead white blood corpuscles) and changed epithelium; sometimes a half-purulent mass on the surface of the deep ulcer. In fatal cases the process of ulceration is not limited to the throat, but extends outside of the neck and to remote organs. The diseased foci show under the microscope necrotic tissues filled with micrococci; micrococci are also found in the surrounding infiltrated tissue." Next, of the latter, which he teaches is true diphtheria: The essential change in structures, in which the false membrane develops, is characterized by the death of the superficial parts. The affected tissue undergoes the form of necrosis known as coagulation necrosis, effected through coagulation of the dead epithelial cells. Inflammatory products, leucocytes (dead white blood corpuscles), red blood corpuscles, serum and fibrin participate in the formation of the false membrane, and the underlying basement membrane undergoes similar changes. The most superficial layer is made up largely of a great number and variety of organisms. On the fibrinous layer, the thickest part of the false membrane, few or no bacilli are here found."

He cites Ortel then, to say: "These lesions consist of death of cells, which suffer fragmentation of nuclei, complete disintegration, and then a fibrinous metamorphosis takes place, extending to lymphatic glands adjacent to the affected parts, and found in distant glands and other structures." Booker supplements: "The bacilli do not invade the blood and tissues of the body. The injection of the toxic products of diphtheritic bacilli, while causing the general and specific lesions of the disease, do not give rise to the false membrane."

The medical world owe a debt of profound gratitude to Dr. Booker, for his precise analysis of the exudates in diseased conditions of the throat; but it is evident to those whose eyes have not been wearied by these minute scrutinies that the distinctions he has shaded in the result are practically distinctions of degrees and variations of intensity, rather than of cause and microbe. Any liberal interpretation of the intended difference this esteemed authority (Archives Pediatrics, September, 1892) so carefully endeavors to illustrate between the pseudo-membrane of scarlatina and of diphtheria is virtually lost in words of similar import. For diagnosis and treatment they are practically the same thing-simply death and sloughing, or casting-off of the mucous surfaces that have been poisoned, inflamed, excoriated, damaged by inhaling irritant gaseous breathing-air by the child, children, family-the poisoning element most frequently being the toxic and devitalizing carbonic oxide gases, fire gases, illuminating gases and allied products breathed with house-air at home or abroad, or both.

It deserves particular note that the author takes pains to avoid certifying that the (diagnostic) Klebs-Löffler bacilli were present to hold high revel in the "necrotic membrane," constituting the exudation of tissue in diphtheria; but he does say "the most superficial layer is made up largely of a great number and variety of organisms; few or no bacilli are found on the basement membrane of the mucosa.”

But germ diagnosticians encounter yet more confusing difficulty, as gathered from the same authority: "It is necessary to consider that there is great variation at times in the virulence of the diphtheritic organism; a bacillus occurs whose morphology is identical with that of the true diphtheritic bacillus, but it is free from pathogenic properties; is to be identified only by the inocu