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Un des symboles suivants apparaitra sur la dernidre image de cheque microfiche, selon le cas: le symbole — ► signifie "A SUIVRE", le symbole V signifie "FIN". Maps, plates, charts, etc., may be filmed at different reduction ratios. Those too large to be entirely included in one exposure are filmed beginning in the upper left hand corner, left to right and top to bottom, as many frames as required. The following diagrams illustrate the method: Les cartes, planches, tableaux, etc., peuvent dtre film6s d des taux de reduction diff^rents. Lorsque le document est trop grand pour dtre reproduit en un seul cliche, il est film6 d partir de Tangle sup6rieur gauche, de gauche d droite, et de haut en bas, en prenant le nombre d'images n6cessaire. Les diagrammes suivants illustrent la mdthode. 1 2 3 1 2 3 4 5 6 •• I. \ BlFEWLi - 1) )i im A LECTURE BY Rev, W, M, Edwakds, BLISSFIELD, NORTHUMBERLAND CO, N. B. i* .4 / y / . • \ / ./ / / / y y i I I'KIXTEI) AT THK ( HKISTIAX VI^rn.K" STKAM H. M< AM..I.ir- KomMS. HAIXT -loHV. X. i5. f i "a?"" DIPHTHERIA.--DIPHTHERITIS. A Lecture by Rev. W, M. FiIbwards, Blissfield, X. Co., N. B.. Delivered at Doaktown. X. Co., June 15th, 1882, and Published by the Unanimous Request op the Audience. The (lomjiiii of Science lies open to all who will enter in and take po.s.sension. What we chiefly need in this branch of study is to stimulate each other to greater effort to clearly investigate the causes of this disease, and by scientific research to overcome the difficulties that obstruct the way, and let the light of know- ledge shine out on the public mind, &c. True scientific men sh(mld be public benefactors, seeking truth in a spirit of entire disinterestedness ; they should hold m view the good of all mankind, without distinction of class, color, riature or creed. Any estimate of the function of science whicli falls short of this, is too low and unworthy- of the matter to which it is applied. Ira Warren, M. D., says, We have much need of liberality. That medical progress may be real, physicians must be free from bigotry. They must have no nari-ow prejudices against an}' man, or class of men ; but be ready to examine candidly any new thought or new remedy brought to their notice, from what- ever source it may come. They should not hedge themselves about with such restric- tive by-laws and societary rules as are calculated to fetter their thoughts, antl turn their investigations, by a sort of moral ne- cessity, into the narrow channels of party conservatism ; remem- bering that he who is once enclosed by such i-estrictions, mu#t have a path foi- his feet thi-ough bigotry, and even malevolence itself, before he can escape them or be a fiee man in any noble sense. The meml)ei-s of medical societies do themselves no credit, in the nineteenth century, by putting on airs and telling others to stand at a distance. This would do better, had medicine be- come an exact science ; but while the primary effects of even opium are not settled — some physicians considering it as prim- arily stimulant, othei-s as sedative, others as "stimulant to the nerves and sedative to the muscles, others as neither, and still \ k- I ^\ rf othern am altcrativo, such oxeiu.siveiie.ss seems neitliei' wise nor modest. When the professors of the healing art eaii hoard medical knowledge as misers hoard gold, and can submit its purity to equally certain tests, it will appear in better taste for them to grow exclusive. Until then, the most becoming badge they can wear is the christian direction, '' Let each esteem others better than himself." Medical societies with liberal by-laws, are iitted to do good ; but it would be hard to show that those with stringently I'c- strictive rules can operate othei-wise than as checks upon progress, [n ti'uth they are apt to become mei-e catacombs in which to embalm dead ideas. The}' ai-e very liable to be made the instru- ments for accomplishing the ambitious j)ui'poses of a few leading men. They tend to suppress all sympathy with everything out- side their organization ; and they l»eget a feeling like that which would forbid the fixed stars to drop their light into our atmos- phere without first coming down and joining our solar system. How different the charactei-of the true man and physician ! lie is genial in his disposition. lie has no dislikes and antipathies, and hates no man except tyrants. He accepts knowledge, though it come from the humblest source ; believing there is no exper- ience but will repay a study of it, and no husbandman's plough- share but turns up a soil worth analyzing, lie belongs exclusively to no party, and can be approachetl easily by I'espectable men of every stamp. Whether belonging to the same soci(^ty with him or not,you may take hold of his natui-e and draw him out, without having it slip from your fingers, and spring back from youi* presence into a thousand kinks, like a twisted thread. He is a whole man. (rod made him foi* the world and not for a party. By some strong influence you may ])088ibly, for a time, draw him from the world into some narrow sphere, but not only will his reluctant nature, like a retiring tide, run back continually to embrace the continent, but will soon bi-eak from its confinement, and like a full sea, come back, boiling and running over to bless the world. What iiij now wanted, that medical knowledge may increase. is UberaHty, in the true and full sense. We want true men in high places, who will not only let their own light shine EVERYWHERE, but WILL CEASE TO HINDER OTHER 3IEN's LIGHT FROM SHINING. Beyond this, and of nearly equal importance with it; we want MEDICAL KNOWLEDGE DIFFUSED AMONG THE PEOPLE. We Want — what the world has never seen — a popular medical literature. We want the temples of Esculapius pulled down, and the priests turned into the streets to become teachers of the multitude, rather than worshippers in the inner sanctuary. ll > I know thin will ho stoutly denied, but not, 1 think, on well- <'onsidere(l groundn. Wo do not think it necesHaiy to contino a knowledge of the soul to the ministers of religion. There is no hi'tmcii of theology, which we do not deem it proper foi* Laymen to study ; we even popularize it for our children. In the most obscure districts of the JJoniinion of Canada, Laymen who follow the ])lough or push the plane, become, in many cases, eminent theologians. Why should they not study the Lower science which relates to the body ? They have not been able to hereto- fore, because its mysteries have been properly hidden under technicalities. These coverings should be torn off. Physicians oppose the populai'izing of this kind of knowledge too often, I fear, upon the sordid ground of self-interest. They think their own services will be less sought foi*. We do not dispense with the service of ministers, because the )>eople study theology, neither shall we cease to employ teachers and p]*actitioners of medicine, when each man and woman is wise enough to study the healing art. The principal change we shall witness, will be much larger attainments in lration ; as far rs can be seen on pressins^ down the tongue the throat is swollen, and of adoej) florid red ; and on the tonsils may l)e seen white oi- grey ulcei-s, — the very same in diphtheria. In Scarlet Fevei- Ty})hoid symptoms show themselves; so they do in di]»htheria; thus we trace a strong resemblance. We have this specitic moi'hid condition of the system also in croup, (h'oup is an intlaminatiou of the mucous membrane of the larynx and winpearance, or be less or more fatal, but taking a thousand years together, things remain about the same. Now I will not stop to opjiose the statements thus made, by counter statements of my own, it is, perhaps, suflicient to say 5 thill such a belief beloni;-s to Ji species of fatality alike common to Mahometanism and Pai^aiiisni, but utterly unworthy of the sunlight of Christianity, and Christian Science. For even CHANCE ITSELF IS SUBJECT TO LAW. We believe that (iod has established certain laws within the organic domain, as well as without it, which are all fixed and immutable as those which were o'iven at Sinai. We l>elieve that obedience to all laws, whether natural or moral, has its a])pi'opriate reward here or hereafter, or both. We also believe, that disobedience to all law, whether natural oi- moral, has its tixed, and except in the case of special remission by s])ecial pi'ovision, has its api)ropriato and irrevo- cai)le, penalty. Thus we gain the c()nnecting link between the natural an prewenee conHtitiited a ])ri'vionsly nndcHcrihed variety of th«' dineaHO. Since tin.' puldicalioii of iiis obnervation in 1842. inai.j otherH have ^iven ns tlie irsuit of repeated microscopic examin- ation. J. Moore Neli^an. M. I)., M. l{. .1. A., says, "1 fully coin- cide with M. (Irnby, and I)r. Hughes Jk'nnet, as to wth, the moss growth, the seaweed growth; in diphtheria the miiHhroom growth.' Voi^el corroborates this view, as to the existence of these ^n'lowths in the human l>ody, the correctness of which has been rlcnicd by many, who dwell in claHsic iji^norance, and tell us its causes ai-e unknown. 1. Let lis see what this plant is: — Fundus a mushroo' , Order of plants clasHcd. — C'lypto^amic Ficus. — A fleshy excic- scence, often soft and j-eddish. Fun^osity or fun^'us, i's a fnnu;ns wound, M. Brcschet has proposed to restrict the tori., fun^osity to vegetation, which arises on denuded sui'faces, such as mvsh- rooms, etc. Medical Lexican, ])a ildincss, consisting ot spores and entangled filaments which anu y covering the j)arts with an abundant ashy or sooty powd m-, This is a diflfei-ent fungus, and was confounded by M. Qi )kef1 with the ergot plant. It is found as well in the non-ergottud as the Jigottod flowers, t. 1 ' n those of plants which do not bear ergot. At a somewhat advanced pe "iod of the development of tlic «phacelia there exudes, especially from the summit, a very adhesive juice, w^hich spi-eads over that structure bearing along with it un immense numoer of the seedlets or "■ spermatics," This leaves on the surface when dry an oily appearance, ;ind afterwards the spots, where it remains, become brownish or blackish. But this exudationdoes not ap]>ear until the sphacelia has ceased to constitute the whole plant. At the base of the sphacelia is produced a compact body, violet-black without, and white within, which is the ergot in a rudimentary state. With this commences the second stage in the development of the fungus. The young ergot is everywhere invested by the tissue of the sphacelia (which Tusane calls also spermogonia, from its office) but, as it increases it seems to be placed below the spertnatopherous apparatus, and raises it stead- ily out of the floral bractes which concealed it, ending by sup- porting it wholly at its summit. Sometimes are carried with it the atrophied ovary, which still shows the hairs that crowned it. and some remains of the stigmas. It results that the ergot, which is technicaily the sclerotium of the fungus, remain foi- some time concealed in the sphacelia, so that this seems to con- stitute the whole plant. But when the function belonging to this has been fulfilled, v/hich is apparently to impregnate the 8 sclerotium, il ht'i^'inH t.) I icH'onie < '•y> aiui i.s much (U- tbi'med. The ergot, on the eontruiy, increases in all directions, and some appears above the glume. As it augments, the thin coating which it has i-eceived from the spermatopherous tissue, especially below, gradually becomes thinner and seems to disap- pear ; so that its surface, instead of being uniformly violet-black, is only here and there covered with tbe i-emains of the tissue, or hy a deposit of the conidia oi' ■• spermatic." Nevertheless, the sphacelia, deformed, shrunken, and woi-n away by I'ains aneeome Iodised in the ovarv, where they I >ei2;in the course ol' life Jind i^i'Oi^iess. These seeds liave heen constituted so minute and li.u-ht, that they rise in the atmosphere, and are conveyed hy the winds aci-oss seas, oceans and continents. (Annales des Sciences >,alurelles, 8 e ser., XX. 5, A. I)., 1858) and hy Rev. Herbert W. ^[orris, A. M., on microsco[)ic seeds. AVhen wheat, yyt^, etc., ai'e just about to bloom in all their love- liness, they are stricken with a disease that beai's u stroni;- i-esem- blance to diphtheria. Wherein is that resemblance ? It exud-'s cei'tain moisture; this exudation, b}' the influence of the atmos- })here, thickens and hardens into a substance resemblini;- the spurr of a cock, something- similar to the false membrane found in the thj'oat in di])htheria. As sycosis is the development of the seed on the outside, so diphthej'ia is the development of the seed on the inside. The seeds of this cryptog-amic ])lant being carried by the euri'ents of the atmosphere, meet us in a morbid condition to i-eceive them, find a lodo-oment in our throats, and when fully developed are one of the causes of diphtheria. Another cause, is da.macjed food. Vast numbers of these seeds are not fully developed wheii 11)0 grain is gathered in, and it is eaten by us in our daily food. Fatal epidemics, in different parts of the continent ol h^ui'ope, pai'ticularlj' in certain Pj-ovinces of Fi'ance, have long been asci-ibed to the use of bread made from rye eontaminatetl with this fungus, etc. This also is the reason why it breaks out in healthy localities, where thei'e has not l»een a case for years. Why some take it and othei's do not. There must be a con- stitutional peculiarity to receive this seed, and also to pei'mitthe little seed to germinate and grow; some moj-bid state of the sys- tem. It this state does not exist, it still retains its vitality, waiting to have its day. When that day comes this disease will be fully developed, and the community will be att'righted by di])htheria breaking out among them. What kills the tish in the rivej's of (Ireat Britian and British ('olumbia? Professor lluxlev informs us, that it is a fungus mat- tei" that forms on the skin, eats into the flesh, poisons the blood, and kills the flsh. It is similar to the disease of the potato, or the diphthei'ia in human bodies. Another cause of this disease may be clearly shown to come from the medicine manufactured by us during the ])ast and pre- sent generations, Let men of science stand in the light of this subject, and consider well their own work. Does not a super- natural powei- call into existence the seeds we have been con- sidering ; the development of which is purely natural. With- 10 out nature's pi-odisposin^ causes, they may exist any length of time beibi-e their development ; to pi'ove this, please look at the longevity of seeds in general. The longevity of seeds may be i-eelconed among the greatest marvels of oi-eation. Grains ot wheat, after having lain buried with mummies for twenty-five centuries when moistened in the soil, and warmed by the sun, have gei'minated and reproduced as vigorously as if they had been the product of last hai'vest. Seeds that giew, long ages befoi'e Adam woke to consciousness, may at this day be found in the ground, possessing their original vitality undiminished and uninjured. A few yeai-s since, eai'th was brought up in England from a depth of 860 feet, and cai-efull}- covered with glass to prevent the possibility of any blown or floating seeds being de- ])osited upon it ; yet, in a short time, plants vegetated from it. Indeed alluvial and diluvial soils appeal- to be full of seeds to un- known depths, the ])roduce of ages long gone by, and which need but to be brought to the surface, to spi-out and thi-ive, as it they had but yestenhiy dropped from the parent plant. In the time of the Emperor Hadrian, a man died soon after he had eaten plentifully of raspberries. He was buried at Dor- chester. About thii-ty years ago, the remains of this man, to- gether vvith coins of the Koman Kmperoi-, w^ere discovered in a cofhn at the bottom of a barrow, thirty feet under the surface. The man had thus lain undistuibed for some ITOO yeuj-s. But the most curious cii'cumstance connected with the case was. that the raspbeny seeds wei-e i-ecovei-ed fi'oni the stomach, and sown in the garden of the Horticultural Society, wdiere the}' gei-minated and grew into healthy bushes. What a wondrous creation, then, have we in a grain of seed ! What a mystery is its life, that can thus well nigh immortalize its tiny and delicate oi'ganism, })reserving ituninjui-ed and unchanged through the lapse of hundreds and th(»usands of years! As plainly do the small and dusky seed in the soil, as the most l)i-iliiant oi'bs in the heavens, ])roclaim, "The Hand that made us is Divine." (Kenedicite). Let us ask a few more (questions: — Are not medicines sub- ject to chemical changes during their passage through the sys- tem in the human sui)ject under treatment? Are not these chemical laws disturbed and varied to some extent by the law ot vitality Just as the needle in the compass of the mariner is made to vary by disturbing ibrces ? If Doctors will give medi- cine intelligently, they must know the ett'ect that medicine will ])roduce on the living subject ; if not, they may set all these dis- tui'bing forces in motion, which ma}' I'un through the whole ])eiio(l of the natuiallife; yea, even befbie the day of birth, be made to sutler by planting in the unborn infant the seeds of the W'vy disease we ai-e considering. 11 This fnngMis is brou^^ht into the human Ixxl}' by niedicinos ]M'epare(i from excrescences found on plants sick and ain in the head, giddiness, dilatation of the ])upils, delirium, and even stupor, proving that it possesses narcotic pro- pei-ties. It is said also to excite febrile symptoms; but oui- own observation coincides with that of authors who asci-ibe to it the ])ower of reducing the frequency of the pulse. We have seen this effect produced by it in ai-emarkabledegree, even without nausea. A case is recoi-ded in wliich it produced great prostration, with an almost absent pulse, paleness and coldness of the surface, pai-tial palsy, with pricking of the limbs, and gi-eat restlessness, without stupor or delirium. ((Jazette Med. de Paris, Juilett 25, 1857.) Its long-continued and fvee use is highly dangerous, even when no immediate effects are perceptible. Death from single doses, in inferior animals, is preceded by symptoms indicating irritation of the stomach and bowels, great musclar prostration, loss of sensation, and sometimes ligiit spasms. A case of acute noisoniny; from ei-ii-ot is recorded bv Dr. Pratschke, in which un- easiness in the head, oppression of stomach, diarrh(pa, ui-gent thirst, burning pains in the feet, tetanic spasms, violent convul- sions, and death, ensued u])on eating freely of ergotized grain. (Ijond. Med. Gaz.. Oct. 1850. p. 579.) We have shown that from the same cause we have tlie second development of this disease, which is membraneous crou]), the w^orst and most fatal foi-m of the disease. We have shown in scarlet fevei', that the mucous membi-ane as well as dermoid tissue suffei', for we have the same ulceration of the throat as far as can l)e seen. On pi-essing down the tongue the thi-oat is swol- en, and ( )f a d eep f1ori( rod ; and on the tonsils nniv be seen / 12 white 01' grey ulcers, the very «ume as in diphtheria, now called ulcerated Hore throat, which is nothing but another form of this disease. We now come to the second thought on this subject, and we will show that diphtheria, not only comes, in the tii-st place, from these minute microscopic seeds, but from a germ of a living insect Avhich dwells within them. The presence of a parasitic animalcule, very much like that found in scabies, commonly call- ed itch, of the class Arachnida. This insect is much moi-e min- ute than the one we tind in the itch, always talcing up its abode on the mucous membrane. This accounts foi* its existence being overlooked by so many careful investigatoi-s. As seen through a powerful microscope when fully developed it looks white, shin- ing and globular in form. The micj-oscope faintly brings into view a liead not uidike that of a tortoise, and a pair of strong legs on each side of the head. The general outline — a little longer than broad. The germ of it is found in the seeds of this cryptogamic plant we have been considering. It is found in the foi-m of a minute worm on the interior of the gi-ain. When we consider the incompi-ehensibly delicate conti-ivance and ex- quisite beauty which enter into the frame of an animated being, ovei" a thousand times less than a mite, we cannot but be filled with adoring wonder in view of these living pivxluctions of the Creator's hand. (American Pharm. page H82. L. Homme, Paris, 1847. p. 8.) Dermoid tissue covers the whole outside of the body ; we call it the skin or cutis. It is similar in structure to the mucous membranes, which are a niei'e contijiuation of it; the mucous mem- bi'ane protecting the internal parts of the body, while the skin pi'otects those that ai'e external. There is consequent!}- a w- markable agreement between them. The skin is our medium of communication with extei-na! boilies — is the seat of Touch — by which we have the sense of feeling oi* common sensation , we say a thing is cold, or warm, to the touch ; silk is soft to the touch ; the touch of the loving hand is delightful. The skin is hai'dei'than the mucous membrane, because more ex])osed to injui-y. In deranged conditions of the skin from not keeping this tine net woi'k clean, the mucous membi-anc becomes luore or less engaged ; and in diseases which efl'ect the mucous membrane, the functions of the skin, as it i-egards absorption and excretion, ai-e also effected to a greatei* or less degree. In health it ne.'er ceases to secrete and throvv ort'a fluid which we (!all in- scnsilde perspiration, while it is in the form of an invisible VMpoi", and perspiration, or sweat, when it is inci-eased so as to be sotMi. So great is the sym|)athy between this covering of the liody and the muscous membrane, that when it is chilled so as to 13 I stop the iiiviHn)le perspiration the internal meml)rane heoome^ otteeteil, that we have a sore thi'oat, or diarrhoea, or i-unninj;' at the nose, that is to say n''l>eii the skin cannot sweat, the mucous meinhrane begins to sweat. You will sec the importance of keepin<^ the skin clean. R. V. Pierce, M. 1)., says : '' Cleanliness is indeed next to CJodliness,'" and is essential to the health and vi<;'or of the system. Its im- portance cannot he over-estimated, and it should he early incul- cated into the minds of the young. Cleanliness is the reverse of tilth and slovenliness, and has been described as analogous to puritj'of mind. " Even from the body's purity, the mind receives a secret sympathetic aid." When we consider the functions of the skin, with its myriads of minute glands, innumerable little tubes — employed in remov- ing the worn-oiU, useless matter of the s^-'stem, we cannot fail to appreciate the utility of frequent ablutions with soaj) and water. [jides.s these excretions are removed, the glands ai-e closed, theii" functions arrested, and unpleasant odors arise. Many persons think because they daily l>athe the face, neck, and hands, di-ess the hair becomingly, and i-emove the dirt from their clotliing, that {\w ultimatum of cleanliness has been reached. In a hygienic ])oint of view, bathing the entire body is of much greater im- portance. Xotwithstandijig the necessity for cleanlines;. of the body, we occasionally meet with persons who, although particular with rt\gard to their ])ei'sonal appearance, permit their bodies to be foi- WEEKS and even months without a bath. Such neglect should should never exceed one week. Plenty of sunlight, and at least t\V() or three general baths each week, are essential to perfect health. Cleanliness is necessary to health, beauty, attractive- ness, and a cheerful disposition. According to an ancient myth ; beauty — the mother of love — is the daughter of the waves and sunlight. Water and suidight still claim their otfspi-ing; and while the sunbeams aid in tinting beauty's foj'm, it is moulded into more I'ounded and gi"acetul proportions by the limpitl watei's. Again, cK'anliness should not only be ]>i'omoted by repeated loathing the person, but by a frequent change of clothing, especi- ally of that woi-n next the skin. Kvery one must have (d)served the unpleasant odoi- that the socks and other underclothing ac([uire aftei- a few days wear. This results from the impurities exhaled ihrough the skin. These impui'ities should be removed with the clothing containing them, lest by being retained in con- tact with the skin, they be ''eabsorbed into the cii'culation and become generators of disease. In Scabies we have the presence of a parasitic animalcules /■ I ' / 14 Keiicath the true skin, ojuisiiii^ this (liHease. Mode of attack : — When phiced upon the skin, the little fellow, like the squin-el and other ii;ronnd animals, sets himself to make a hole through the searf skin, with the head and fore-feet. Into this he pushes his whole body. IFe then beainiiig a foot-hold in the human body, unless they are killed or expelled, will become acclimated ; will feel themselves quite at lioine, and laugh at the boasted science that would force them to emigrate, or leave their home. Here they will stay, and fill themselves with the nature of any impui-e state existing thei-ein. Diphtheria comes by quick contagion, it comes precisely in the same way as the grain dies of the same di.sease. An inter- esting account of the insect that causes its disease and death, by Mi-. Bethune, is now before me. JIc says the midge frequents the ripening ears of grain ; the eggs are laid in the young and ten- der blossoms of the wheat, and as soon as the larva' are hatched from the eggs, they begin to feed uiion the juices of the gram kernel, and continue extracting the juices of the grain, caus- ing it to shrivel up and become utterly worthless. When the period of the ripening of the grain arrives, the larvie desceiids to the earth and remains thei'c throughout winter. In the fol- lowing spring it transforms into the pupa state, ami in the montii of .lune— earlier or later, according to the .season—the perfect insect or fly makes its ajipeaiance, just about the time when the young ciop of grain is beginning to assume the flower state. Its presence at this time of the year is made known to I ./ 16 otymolo^ists and otliorn, hylai'jL^o numbei'8 flyiiii^ in at the win- (loWH at night, covt'i'iny; the lanipH on one'H tahle, i^c. It is in this way 1 have chiefly iiotieed the j)eifeet insect. Thus, as the ini(l<^e insects, as soon as they g'ain maturity, begin to feed upt)n the juices of the grain kernel while in the young and tender hloHsom, causing it to sicken and die ; so this insect mite, AcAiirs DiPHTHRRrTis, ((K THE CLASS Akaciinida, feods ou thc young and tender blossoms of our common humanity, from the babe in the cj-adle to the young man or woman about to bloom in all their loveliness. We may well say with Longfellow : — " Death gazed at the floweis with tearful eyes, And kissed Hieir drooping leaves." So this disease spreads on the wings of the wind, like a '• destroying Angel," i-eaping the harvest of death." Blind indeed must he be, or wiiat is worse, wilfully pervei-se, who can view all this and fail or refuse to acknowledge the power of the Supreme and universal mind. All nature, and all life down to the minutest of the insect tribe, reveal a present Diet^'. Their mysterious works and ways are only intelligible in such a [)resencc. They are under Divine law and obey the Divine com- mand of their Creator with as much exactness as the mighty planets that move in their I'espective spheres, forever singing as they shine, " The Hand that made us in Divine," Were it not so, they would drive man from the face of the earth. — Thus 1 be- lieve I have tully shown the causes of diphtheria, SYMPTOMS. The incipient stage of diphtheria is generally only a slight feeling of illness, lasting for a few days, more or less, before the more serious attack. The symptoms vary in ditferent cases. In some the disease comes on gi-adually, w^hile in othei's it is malig nant from the first. This will lead us to make three divisions ot the symptoms : — 1, Sometimes during the first stage of this disease, thei'e is a slight aching sensation in the throat. We have drowsiness and chilliness, followed by feverishness, sometimes headache, and aching of the limbs. The throat feels sore, the neck is stiff, and a sense of langour, lassitude, and exhaustion prevades the system. An almost chai-acteristic symptom is a slightly swollen and ten- der condition of the glands at the angles of the lower jaw; the tonsils, one oi* both, are usually red and swollen — sometimes swollen, but not red. In young children the redness is of a rose- color, in older children and adults, ofaci'imson, or a deep scarlet. The uvula, the velum, the arches of the palate, and the back \vall of the pharynx, generally show inflammation. Swallowing, though painful sometimes, is often easy enough, even to the end I I 17 of bad (ruses. The pulse is iisually quiclvened Hi)in«^wliat. and tlio warmth of tlie skin is raised a little, though not i^reatly ahove the healthy staiidai'd. In some cases, the above symptoms con- stitute the whole of the complaint — recovery taking place with- out serioufj consequences. In othei-s they are but the beginning of more alai-ming indications. 2. The febrile disturbances increase rapidly, and are of a low typhoid charactei", the skin is hot, there is intense thirst, the pulse is quick and feeble, ranging from 120 to 150 ])er minute. The tongue is generally loaded with a dirty coat, or it may be bright red. The odor of the breath is characteristic and peculiai'- ily offensive, and there is difficulty of swallowing, and sometimes of breathing. Vomiting is sometimes jjcrsistent. If we examine the throat, we find more or less swelling of the tonsils and suj- rounding parts, which are geneially bright, red, and 8hining,and • •overed with a profuse, glai'ey, tenacious, secretion. Sometimes the parts are of a dusky livid hue, and sometimes, though rarely, ]»aiid. The false membrane, a peculiar tough exudation, soon ap- pears, and may be seen in patches, large or small, or covering the entire surface, from the gums back as far as can be seen, its color varying from a whitish yellow to a gray oi- dark ashen tint. When it is thrown off, it sometimes leaves a foul ulcerating sur- face beneath. 3. Here the hand of our God is plainly seen. He has com- manded those minute angels of Death to do their work, and it is done. Neither the prayers of the good, the tears of friends, nor the skill of the physician, can stay their work. The command has gone forth from the Eternal Throne, and as diseases are all His servants, He says to one: "Do this," and it is done. The • lisease goes on in greater severity, the colored specks or patches, which gradually enlarge or spread until they meet and form one continuous pellicle. This membrane sometimes extends into neighboring parts, as the back passages to the nose, and the larynx, wind-pipe, bronchial tubes, and gullet. These extensions make the case all the more dangerous and unmanageable. I ma^'^ add that there is great difference in the time occupied by different cases in running their course — some reaching a climax only after several days' continuance, while others dash on to a fatal termination in the brief space of a few hours. 4. Signs of approaching death. The prostration soon be- comes extreme, and small livid spots may appear on the surface ot the bod}'. There may be delirium, which is, in fatal cases, suc- ceeded by stupor (coma). The extremities become cold, diarrhoea and in some cases convulsions, mark the approach of death. Sometimes the patient dies before the false membrane forms. 7^ /■ / T 18 TREATMENT. Vivtit we miiHt look to Him who has disojisos iiiidoi' Jlis con- ti'ol, und imitate the example of His dear Son, our Loi'd and Saviour .roHiis (^iirist : who in the days of His flesh stood pre- eminently at the head of the medieal profession, healini^ all mannei" of diseases. We will take up the treatment in the same ordei* as we have given the symptoms, (xood ventilation, but no draui^lit on patient, &c., &e. Air that is admitted into the sick room should not be contaminated by passing over foul di-ains, privies, oi- other sources of infection, &c. Cleanliness cannot be too thoi-- oughly impressed upon the minds of those who have the care of the .sick. All excretions from the patient should be strongly dis- infected before leaving the sick room, and then buried ; not com- mitted to privies to communicate disease to those who frequent them. The bedding should be changed every day, if not wash- ed, sprinkled with a solution of carbolic acid, made for disinfect- ant purposes, and thoroughly aired before i-eturning. Xow look at the skin of the patient : if it is not clean, make it so, with glycerine soap and tepid water. The hands and face of the pa- tient should be bathed frequently, the liair c<)mbed, and every- thing about kept clean and tidy. Xever wake a patient while sleeping quietl}-, but if snoring wake immediately. Let all dj-inks be given warm, as cold (irinks tend to aggravate the com- plaint. As a drink give toast water. A good supporting diet should be given; beef tea, milk punch, &c., should be fi-eely ad- ministereci. The next thing to be done ; get tlie patient into a perspira- tion by the use of the s})irit vapoi- bath ; if you cannot do this, a hot foot bath will do. Give Ilia whiskey, one tablespoonful every tifteen minutes until it is sensibly felt in the head. Put herring draughts, dipped in vinegai-, on the feet. If vomiting comes on, control it by allowing the patient to suck small ])ieces of ice every tive or ten minutes. If bile is vomited, give magnesia — if a young man, a tablespoonful in cold water. Apply hot fomenta- tions to the throat. After these fomentations have done their work, take a herring, tlip it in hot vinegar, and apply it to the throat; when you take this herring otf, let the thi'oat be well rubbed with Johnson's Anodyne Liniment, also rub down the breast bone, stomach, lungs and bowels. I do not undervalue the importance of giving a gentle emetic, but when required nature does this foi- us. I pi-efer a good cathartic, which you will find in the Compound Cathartic of the U. S. Pharmacopoeia of 18*70, which can be had at any respectal)le druggist's. 19 (taikjlk. — Hkcite. — Hose watoi", (!()/>.: ^yiii]» of oiiuine ])eol, 1 oz. ; iiiuriutod tiiK't. of iron, 1 oz. ; mix. Take of fills ?nixtuiv. 1 talik>sj)oonfiil ; cold water lialf a jiint; mix well ; to l>o iise'<• HI. Our mlndTin \Li I^'tliln iw shine 4 rs. . . 'Ki'i^'nimiiess proflainiinirC' '^"tnccan w antic natod if., ,. P''eNent MVHtem Tu/} ,,'"'"''. '"Sul'ito our choice ,■, (In. , ' "'" qualifications wl,r,.i ^ "^^1 When tlie /ijifiii..ii f • '^'"'lio-s oe«tL^Siac^':n!"K:;;::"!';''-'""-o'^^^^^ -nta, ''ep,.es,on:"„,.t£;^^;'j„';" t'-^ic"'' "'■«"-P-itioa to li; ( 22 Temper and I>i8Position. — An attendant itpin the «icl< .should po.ssesB a happy, cheeiful and equal flow of >(pii-its ; ji temper not easily i-utiied, kind and synipathetie feelings ; and at the name time not such as to interfere with tii-mness. The ex- ])ression of the countenance should be open and winning, so as to attract the good-will and confidence of the inv:iHd ; a pleasing and gentle manner being more likely to gain esteem and insure obedience to the orders of the physician, than the most persuasive arguments which can be addi'cssed to the understanding of the patient. A collected, cheerful expi-ession of the countenance, in the attendant on the sick, is likely to inspii-e hope, and to aid the etforts of the phj'sician in the recovery of his patients. There is also an earnestness of manner which should, if possible, be ob- tained or acquiesced in by the nurse, as it impresses the idea that she feels deeply interested in the case ; a circumstance which is always highly appi'eciated by the patient. A nurse should be honest, as no desci'iption of servant has so much in her power. She should be true as steel ; good and true ; but the honesty of the nurse is not to be measui-e(i by her respect foi" propert}''. She must be above imposing on the physicians, with respect either to medicine oi- diet. Her i-cligion also shouM be sincere, but pharisaical ; and although she may pray, and occasionally pei-suado her charge to put his trust in God, through (^hi'ist his Savioui', and thus direct him to the true fountain of health and salvation, yet slie must recollect that pi-eaching is not hei" province, and vhen mistimed, even the best advice ma}' prove not only pi'otitlcss, but very injurious ; anil this is especial- ly likely to be the result when the doctrine which she pi'ofcsses is of a conti-oversial kind, &c., «fcc. WiTFf RESPECT TO CTOSHfPiNG. — It is u detestable habit under any circumstances, but in a nurse it may be productive of the greatest dangei*, and also may produce family fueds and a thou- sand other evils. The activity essential for a good nui-se does not imply a bustling or fidgety manner, but a quiet, steady method of pro- ceeding in the performance of her duties, equally devoid of fluster, turbulence or noise. This activity is genei'ally associated with orderly habits, a most valuable qualification, and without it the sick-room becomes a scene of confusion and disgust, itc, &c. Another quality that is much needed in a nurse is cleanliness in her own person, and in that of her charge. The dress of a nurse should be simple and neat, wi^hout trimmings ; nothing is more out of place than a fine lady attempting to perform the duties of a nurse. Education. — It may appear like too much i-efinement to talk of the education of a nurse ; but thei-e is not a greater dif- •f(» ^■^r T / 23 ferent'C between the noonday fsiin and midtiiii^lit than there its Itotween an educated and an ignorant nur.se. The former i.s often an aid to the phynician, not only in carryini^ his orders into ef- fect, but by obsei'ving and informing him of nymptoms of great importance which have occurred during his absence; whereas the lattei" is a soui'ce of constant anxiety, and too often assumes the privileges of acting in direct contradiction to his orders, and according to her own opinion, &c., dtc. The time has fully come when ignoi'ance in the sick-room must be banished, and intelli- gence take its place. Visiting THE Sick. — I)r. Ti. V. Pierce, M. D., says: •' Visit- ing the sick may be ])roductive of good or evil results. The in- fluence of the mind upon the bodily functions has ali'eady been alluded to. Mental impressions made upon the sick exei't a pow- erful influence ujton the Teiiuination of disease. The chances of recovery are in jirojioition to the elevation or depression of .spii'its. Pleasajit, cheerful associations animate the patient, in- .spii-e ho})e, arouse the vital enei'gies and aid in his recovery. W Jiile (lisiiiiTccaltlc titid melancholy associations beget sadness and desj)r)ndencv, di.scoui'age the patient, depress the vital power, enfeeble the hody any your too frequent coming or too long remaining, noi- by hav- ing too many visitors at once. Above all things, do not conHne youi- visitations of the sick to the Sabbath. M:iny do this and give themselves credit to- an ''xtia amount of |)iety on account of if, when if they would scrutinize theii- motives more carefullv they would see that it wa-i but a contemptible resort to save / / 24 time. The sick are often gi-onsly neglected during the week only to be visited to death upon the Sabbath." The Carthartic pill recommended in the ti-eatment in the lecture, will be found in the U. S. Pharmacopia of 1872, page 1323. A single pill will operate as a mild laxative. Begin with one pill at night. If it operates well, it will be all that is neces- sary, if not give another in the morning. Three is a full dose for an adult, and will act as a powerful cathartic, which may be given in bilious fevei's, or when the fevev is very high in diphtheria. WILLIAM M. EDWARDS, Professor of Mental Philosophy, Theory and Practice of Medicine, &c., &c., &c. Blissfield, Northumberland Co., June 15, 1882. 7 ■>li i.ll IlIJ Vfl)