LECTURES

CLINICAL LECTURE ON DIPII THERIA, *

VILLIAM PEP

The patient, a heaUhy gîrl, siï years âge, had a sharp attack of diplnheria al the loth of last December. The uiembi disappeared on the fifih, or sixlh day, bui curred 48 hours later, and she was very m more ill than at first, with very extensive for-

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:roscopical ex- The vomiting was i resisled every effort of a most d for four days. On the 29lh r a consultation of ihe staff was case and it was delermined to stop ail food by the mouth; to give injections of Valentine'sbeef extract with gr. iij of quinia, and gtt. îj of tincture of opium, every four hours, and by moulh to administer a powder composed of one ihiid of a grain of calomel, and two and a half grains of the bicarbonate of soda every tliree hours. A blister was applied to the epigastrium. She was then very restless, tossing from side to side: the pupils were dilaled, surface very pale, extremities not cool, longue sHghtly coaled, dryish; epithelium rough, and papillœ prominent. Il was difficult to ascertaîn whether there was epigastric tenderness: it cerlainly did not seem to be intense. More minute examination was avoided for fear of producing vomiting. The next day she seemed better, had vomited only once in the twenty-four hours, and had begun lo retaïn a few ûrops at a time of niilk and of lime waler, The injections had ail been relaincd. The longue was a Hltle less dry, but the child was quiet and indisposed to speak. The jnilse was small and weak, but not more so than seemed natural, considering the exhauslive characler of the attack. The powders were now ordered to be given less frequently; injections also at longer intervais, and a little more nourishment, with a few drops of brandy cautiously given by the moulh. On the 3lst of December, vomiting had entirely ceased; ihe child had retained teaspoonful doses of nourishment about every two hours; the injections had also been laken regularly and retained. The surface was pale and perhaps slighlly cool, but this was not specially noticed; puise small. butregular, 85-90 to the minute. There was no cough. The '"Sli^-'art and lungs were expmined and nothing uih^sual noticed. There was no valvular murmur, the sounds were faint, but neither tumultuousvor conn,ised. About twelve drops of tincture opii deodor. had been given, in dtvided doses during the twenty-four hours. The aniount of nourishment by the mouth was increased, FuU doses of quinia were continued by llie rectum. Two or three hours afler the consultation it was noticed that the child's feet became cold, and that this soon extended to the knees and arms. The child's appearance changed; she gave

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