Issue 10, pp. 753-832, October 1861, SMSJ

1861.] Diphtheria. 7801. To arrest the spread ot' the pseudo membrane.'2. To alter the character of morbid action, upon whichthe formation of this membrane depends ; and'>.To sustain the patient until these shall have benn accomplished.These necessarily involve both a local and generaltreatment.The local treatment consists chiefly in the application ofcaustic and astringent substances, in one form or another,to the affected part. Of these, the most usual are nitrateot" silver, either solid or in solution, powdered alnm, chlorideof lime, chloride of soda, sesqui-chloride of iron, andhydrochloric acid.M. Bretonneau almost invariably employed the last ofthese remedies as a local application in his own practice,with the most marked success.The hydrochloric acid maybe employed very nearly of the strength of the dilute acidof the shops, or considerably reduced in strength—dependentupon the severity or mildness of the attack. The bestmethod of applying it is to moisten a small sponge attachedto a probang, or a camel's hair pencil with the fluid, andwhile depressing the tongue with the left hand, to carry thebrush foiward with the right, until the fauces are reached,when those parts of the tonsils, uvula, or soft palate onwhich the membranous deposit appears, may be moistenedwith the fluid, and the instrument withdrawn. The hydrochloricacid should be applied not only to the membranoussurface, but to the parts immediately surrounding it, bywhich means the spread of the membrane is often arrested.The application should be renewed several times a day.Care, however, must be taken not to apply it of too greatstrength, or too often at the onset of the disease, especiallyif the symptoms are not of an aggravated character; otherwisethe local disease may be enhanced, by the unnecessaryinjury inflicted upon the surrounding parts. The symptomsoften appear momentarily aggravated by the local application,which is not unfrequently followed by an attempt todislodge the membrane by vomiting. Should this latterresult follow, the tonsils and palate will appear ashrunken in substance, and spotted here and there with afew drops of blood upon the surface formerly occupied bythe membrane.When this does occur, the application may hereneweddirectly upon the surface of the gland, in order to arrest tie-