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ALCOHOL
A 
 
ANTAGONISM
OF
ALCOHOL
AND
D  I  P H  T  H  E  R  I  A
/
BY
E. N.  CHAPMAN, A.M., M.D.,
Formerly'Professor of Materia-Medica and Therapeutics,
  and Clinical Midwifery ; recently Professor of Obstet-
    rics and the Diseases of Women and Children in
      the Long Island College Hospital ; Author of
       " Hysterology: A Treatise on the  Diseases ^'-'.'.? -*"
         and Displacements of the Uterus," et^.  I^~»T

                                      ^■>>

                   ----          '';:-x
  Alcohol  is as  antagonistic to  Diphtheria
Belladonna to Opium, or Quinia to Malaria.
          B ROOKLYN :

Union-Argus Steam Printing Establishment.

               1878. 
              A' <nc\

              WCC





fiisyn  Ala.   ^Z33   Tlo.  5"
Entered according to Act of Congress, in the year 1878, by
           EDWIN N. CHAPMAN, M D.,
   in the office of the Librarian of Congress at Washington. 
PREFACE.
  I am induced to present this little work to the
profession  for several  very good and sufficient
reasons.  Diphtheria prevails  throughout the
country, and numbers its victims by thousands.
No remedy to stay its ravages,  or to check even
its onward march, has been found—albeit, chem-
istry, the microscope, and all other resources of
rational  medicine have been  taxed to the ut-
most.  At this juncture, when theory, exhausted
in empty dreams, tries to comfort itself with the
conclusion that diphtheria is a self-limited disease,
and hence admits of little modification, other than
that produced by a sustaining course of medica-
tion, I have thought  it opportune to submit to
the medical world certain  empirical facts—facts
that have been accumulating the past seventeen
and a half years.  These show, beyond cavil, that
alcohol  has,  in  my  hands, proved itself, when
most physicians have been losing every third or
fourth case, not only a valuable medicine, but a 
VI
PREFACE.
trustworthy antidote—one capable  of  saving
ninety-five per cent, in severe epidemics.  With
me, this   scourge, thus   robbed of its  terrors,
causes no more anxiety than  many common
ailments.  Of a certainty, I expect to succeed,
unless the long delay in  seeking advice  has al-
lowed the poison to do its  work, and thus fore-
stalled the specific virtues of this remedy of rem-
edies.
  These  high pretensions, that  cannot but seem
absurd to one  who has  not  submitted them to
the crucial test of practice, have been sustained
by  many leading physicians of this city who
have  done me  the honor to  try my  treatment.
All have reduced the death-rate to a low figure,
some have met with a success equal to mine, and
three having been, in propria persona, a battle-
field for  alcohol and diphtheria, have kindly al-
lowed me the privilege  of using their names in
a circular to  our brethren in  other  parts  of the
country.
  I must apologize for the dress in which I ap-
pear  in public.  Deeming it important, however,
 to  make known, with the least  loss of time prac-
 ticable, the antidotal powers  of alcohol in diph- 
PREFACE.
VII
theria, I  have been constrained, in view of the
general distrust expressed  of late in  every plan
of medication, to  throw  together, with  some
show  of order,  matter hitherto published.  I
trust, however, that my faulty exterior will not
bar  me  an audience, seeing that  the details
of treatment—the  all-absorbing subject in the
face  of disease—are fully  and  precisely given,
under many and diverse conditions.
Brooklyn, May, 1878. 
 
          ANTAGONISM
                     OF

Alcohol ki\d Diphtheria.
                CHAPTER I.
 TREATMENT  OF DIPHTHERIA, AS AFFIRMED IN '63,
           AND RE-AFFIRMED IN '77.
 The treatment of diphtheria * has, the last ten
 years, been so thoroughly and exhaustively dis-
 cussed, that it would seem the height of folly, at
 this late day, to question the matured opinions of
 practitioners and writers  the world over.  Nev-
 ertheless, from the fatality of this deadly scourge,
 as it is universally considered, I am induced to
 offer my  experience in  a plan  of medication
 which has, after a trial of more than fifteen years,
 been crowned with a success that throws every
 other, however pretentious, into  the shade.  To
 substantiate  this bold statement, I shall appeal
 for proof to the records of the Board of Health
 of this city, a set of books as certain to dissipate
groundless assumptions as to establish sterling
  * Buffalo Medical and Surgical Journal, October, '77. 
2
ANTAGONISM  OF
 facts.  The revelations  of microscopy,  the  re-
 searches  of chemistry, the flights of theory, and
 the deductions of reason are of little avail in the
 face  of  the  enemy,  when  the urgent practical
 question—the empirical fact—what will cure the
 patient, waits a solution.
   In  '58  and '60, whilst employing the means
 then in vogue, I lost every third or fourth case—
 a  frightful mortality, yet  one many physicians
 bemoan  even now;  but  immediately after insti-
 tuting an opposite  treatment,  though  the  epi-
 demic was at  its worst, not more than one in
 twenty.  This treatment, which I have since seen
 no reason to  change, or even to modify in any es-
 sential particular, was, together  with the cases
 presented in its support, published in the Boston
 Medical and Surgical Journal,  February 5th,  '63.
 In this article, reasoning  from results to causes,
 I came to the conclusion that diphtheria is a dis-
 ease of the blood—a disease  tending to rapidly
 destroy the vitality of that fluid; that the exuda-
 tion is secondary to this contamination—a local
 manifestation  of a general dyscrasy;  that  the
 fever is symptomatic—the turmoil excited by the
 intrusion  of a deadly agent; that alcohol coun-
 teracts, neutralizes, or destroys the poison, what-
 ever it may be, acting, in  fact, like a true anti-
 dote, if promptly and liberally given ; that the
 membrane falls  and  does not reappear, directly
the blood fails to offer the proper pabulum for its 
ALCOHOL AND  DIPHTHERIA.
3
growth;  and  that bark  and  iron are the  only
aids required, aside from  substantial food, to
conduct  ninety-five per centum  of all cases to a
successful issue.
  Acting on these principles from December, '60,
to the conclusion of my report, January, '63, it
appears  that, of the twenty cases  treated with
brandy, quinine, and iron, I lost one  only—a re-
sult so far surpassing what had been  attained by
others, that I hoped the profession would be in-
duced to give these  remedies a fair trial;  but, as
yet, this  hope has  not been  realized.  For this
failure, it is easy to allege a sufficient reason.
The misfortune of a name often clouds a writer's
ideas,  or, when  these are fully grasped, ensures
their prompt rejeetion.
  Under ordinary conditions, alcohol is a stimu-
lant ; but in diphtheria it lacks this property—a
quantity which would in health induce intoxica-
tion having no excitant effect: alcohol is thrown
off in  the breath ;  but in diphtheria, unless the
dose is disproportionately large, no odor is per-
ceptible until the disease begins to yield : alcohol
is contra'indicated in acute attacks of fever, espe-
cially if attended with local inflammation ; but in
diphtheria the contrary holds true : alcohol is de-
manded, when the vascular excitement lessens and
nervous  energy flags, to support the  vital forces
in the effort to rally from the shock,  and regain
their supremacy;  but in diphtheria  the  poison 
4
ANTAGONISM  OF
has, at this stage of the disease, done its work so
thoroughly that alcohol no longer, or but feebly,
manifests its antidotal property.
  Hence, from the more common action of alco-
hol, and the more common use to which it is ap-
plied, it  is well-nigh impossible to gain a hear-
ing, when, on the strength of clinical data alone,
one asserts  that  alcohol  in  diphtheria is  not a
stimulant, but  a febrifuge;  is not  an excitant,
but a sedative ; is  not a tonic to support  the
strength, but an antidote to nutralize the poison ;
its full efficacy being shown  at the outset of the
disease when fever is high and inflammation acute.
In  fact, it. is as much a specific for the diphthe-
ritic poison  as quinia for  the malarial ; each
breaking  up a special  morbid process, and ren-
dering  a  prompt   return to health  possible,
through an unknown potency that has as yet de-
fied the search of science.   So, also, the analogy
holds as  to  the prophylactic qualities of these
two remedies; what  is curative being equally
preventive in each instance.
  From the article published in the Boston Medi-
cal  and Surgical Journal,  February, '63, I will
here make the following liberal  extracts, inas-
much as it inculcates the therapeutical principles
that have since, by a singularly small  ratio of
mortality, been notably vindicated; if, peradven-
ture, success for a series  of years  is the touch-
stone by which to test medical doctrines : 
           ALCOHOL AND DIPHTHERIA.'        5

  " It requires  a certain  boldness to question
long-cherished  opinions, with  which our minds
have  become  indoctrinated,  and, thenceforth,
carry our investigations beyond the narrow cir-
cle that has hitherto bounded  our mental hori-
zon.  Certain  doctrines are held in  regard to
fever and  inflammation,  and,  also,  in   regard
to the remedies best calculated to reduce vascu-
lar action, and prevent  or remove  one of its
results—an exudation of plastic lymph—that are
so incorporated with what is  known of disease
as to give a coloring, a  bias, to  all the pheno-
mena observed at the bedside.  These doctrines
ceased,  long since, to be debatable; in fact, have
assumed the position  of principles and axioms
in medicine.  It appears  absurd and irrational
to ply  a patient with  brandy  who  has a high
fever,  hot skin,  and  rapid  pulse, and  whose
throat is closed by inflamed glands, and  covered
with a plastic exudation—unerring symptoms of
high action.  Reason—The only guide to a sound
medical practice—points out two very plain indi-
cations to be fulfilled—to wit, subdue the fever,
and remove the inflammation with its attendant
exudation.   Hence two plans of treatment—the
general and local—are in favor, and are enforced
either singly or jointly : the one is carried out by
antiphlogistics, such as purgatives, leeches, and
mercurials, or by  certain supposed  specifics,
such as the chlorate of potash ; and the other by 
6              ANTAGONISM  OF
a variety of astringent and caustic applications,
the chief of which are alum, nitrate of silver, and
nitric acid.  At length I became so impressed
with the powerlessness of these means to with-
stand the onward march of the  disease,  that
I determined, by a bold and  sudden  change, to
abandon this  system of medication, and com-
mence the liberal use of stimulants at the outset
of the disease, however high the fever or inflamed
the tonsils.  With some  hesitation  and many
misgivings, I made the  first trial, supported by
the reflection that this new course, however  pre-
posterous it might appear, could not increase the
hazard  surrounding the  patient,  or  redound
more to my mortification.
  " Formerly, I entertained as  great a dread of
diphtheria as of Asiatic cholera;  but, since  the
adoption of the stimulating treatment, I have
gradually acquired a renewed confidence in re-
medies—a confidence so great, that I give place
to the hope that this course of medication, when
generally followed, will  rob this frightful disease
of much of its terror.
  "A physician  may resort to quinine and brandy
in stimulating doses, at the outset of this disorder,
with something ot the assurance and reliance with
which he meets an intermittent disease; and, ac-
cording to my experience, a malignant miasmat-
ic fever  is  no  more amenable to the power of
cinchona, than an equally malignant diphtheritic 
ALCOHOL AND  DIPHTHERIA.
7
 state of the blood is to that  of  stimulants.  In
 both diseases, he must strike boldly and prompt-
 ly if he hopes  for success.   Every moment is
 valuable, and the hour for active interference has
 passed when prostration  and sinking announce
 the constitutional  powers tottering and  subdued ;
 for it is well known that the power of medicine is
 relative, not positive ;  is indirect, not inherent  ;
 and merely  acts  by calling out  the  reserved
 forces of the system.
  " Within the last few years, the careful trial of
 different modes of treatment, whether rational or
 not, has done much to enlighten the profession
 as to the pathology of a number of diseases hith-
 erto, and even now, I may say, too often treated
 with lowering  remedies.
  " In phthisis, though attended with local inflam-
 mation, the formation of pus and the destruction
 of tissue, blood-letting, blisters, antimony, iodine,
 confinement, and  low diet have  given  place to
 nutrients, tonics, stimulants, air, exercise, and full
 diet, to the great gain of humanity.
  "In scrofulosis, in  its hydra-headed  forms,
 though  the patient may have all  the appear-
ances of robust  health—be  even full-blooded
and well-developed—it  has  at last been discov-
ered  that  inflammation  is not  to be met by
the  means usually enforced with signal success
in constitutions untainted  by this  vice.   The
inflamed eyes  peculiar to  such  subjects   will, 
8
ANTAGONISM  OF
however high the vascular excitement, be ren-
dered worse  by depletion, antiphlogistics,  and
mercurials, and will often show prompt amend-
ment under  the use of animal  food, wine, and
quinine.  This is true of all the diseases pertain-
ing  to  the scrofulous diathesis.  They do not
originate  from external causes, but owe their
rise  and  continuance  to a  defect  in  the vital
organs.
  " Hence it is that local treatment can be  of
no avail while the fountain is poisoned.  On the
contrary, when the blood, nerves, and each organ
are brought up to the normal standard, and the
vital elaborations are made to go on harmoni-
ously, disease will disappear, or, if it still linger
locally, will  be  benefited by  appropriate ap-
plications.  It is inconceivable, the amount  of
harm that has resulted from  lowering  remedies
in scrofulous patients.   Even at the present time,
through a bias from a life-long  struggle to sub-
due fever and inflammation, many of the profes-
sion are loth to forsake old, time-honored opin-
ions, or to confess that facts are more valuable
and trustworthy than  reason.  What  but the
slow, tedious schooling of facts taught the les-
son, in cancer,  malignant  pustule,  gangrene,
sloughing ulceration,  phagedaena, and the like,
that the part affected  is  not more at fault than
the  entire  system—is merely the site of a consti-
tutional vice—and  that these diseases are not to 
ALCOHOL AND DIPHTHERIA.
9
 be subdued  by antiphlogistics or eradicated  by
 caustics or the knife?
   " In variola, rubeola, and scarlatina the hope is
 no longer entertained by the physician of cutting
 these diseases short by active interference, or of
 modifying materially their various stages; but, on
 the contrary, he confidently trusts to the natural
 powers  whilst  these are competent to the task,
 and only lends assistance when they show signs
 of giving way, and being unequal to withstanding
 or eliminating the materies morbi.
   " In typhus and typhoid fevers—and, in fact, all
 others of a low type—experience has taught him
 that a reducing plan of treatment is not to be re-
 lied upon, and that he must anticipate the com-
 ing debility by a supporting regimen and medi-
 cation, and  begin to fortify the vital powers for
 the final struggle, when the circulation becomes
 poisoned and the nervous system prostrated.
   " In this class of diseases the attention should
 not be occupied with  incidental complications
 and symptomatic manifestations;  but,  rather,
 the effort should be  made  to  reach the heart of
 the matter—the real disease—which will, if it be
 removed, carry  with it the numerous attendants,
 and the  common  accessories following  in  its
 train.
  " Rheumatism is another notable  example of a
 disease that illustrates the principles of  practice
advocated above. Bleeding, calomel, purgatives,
                       2 
10
ANTAGONISM OF
and blisters long battled with the fugitive ene-
my with ill success.  At  length, by experiment,
it  was discovered that alkalies, by neutralizing
the acid element  in  the blood, remove, so to
speak, the very food that sustains and  keeps
alive the disorder.
  " There cannot  be  a  reasonable  doubt that
diphtheria belongs to this class of blood-diseases.
Ostensibly, it is an ailment of the throat, attend-
ed with inflammation and the effusion of coagu-
lable lymph.  So, also, rheumation presents  the
appearance of an inflammation  of the ligament-
ous structures;   scrofula of  the glands and
bones ; syphilis,  of the skin, mucous membrane,
and periosteum ; and variola, rubeola, and scar-
latina, of the skin alone;  whence, they have  im-
properly been classed under the head of cuta
neous diseases.
  " If the free use of stimulants, in the beginning
and height of the disorder, subdues the fever, re-
moves the inflammation, causes the membrane to
fall, prevents  relapses, and, in  a word, accom-
plishes a cure, at once rapid  and permanent, in
almost every case in which the treatment is com-
menced  early, the unbiased  observer  must be
forced to the conclusion  that diphtheria is a dis-
ease of low action—ataxic—and that the imflam-
mation attending it is, certainly, not idiopathic
and active. This is further shown by the greater
success following this  mode  of treatment than 
           ALCOHOL AND DIPHTHERIA.        II

any other; and by the significant fact that ma-
lignant  cases  thus usually escape the dissolved
state of the blood, and that paralytic accidents
are less  frequent.

   "The cause of diphtheria is an interesting theme
for speculation.  There  need not be a material
agency, a septic poison,  in  the atmosphere, as is
the  general  opinion,  which, received into the
blood, multiplies  itself like a ferment, and thus
contaminates the  entire  circulating mass; for a
change in the normal constituents of  the air, or
a variation  in  its electric condition, would ren-
der it less adapted to fulfil its part in the trans-
formations constantly going on in the  lungs, and
would thus  give  rise to a defect in the vital
elaborations of the blood.   A  faulty state of the
atmosphere—one  that imperfectly supplied the
blood  with the influence necessary to its con-
stant renewal—would  be  scarcely felt  by the
strong and robust, but would tell with the most
effect on those  debilitated by depressing  causes,
and those endowed with  little vital power.   In
my experience, the subjects of diphtheria  are, al-
most universally,  children ; and  when it  attacks
adults, those of little  stamina are singled out,
who at the time are suffering  from unusual ex-
haustion. Of the former, those inheriting  a scro-
fulous constitution, or other vicious state of the
system, are the ones, as a rule, that are  seized. 
12
ANTAGONISM  OF
The child has not only to maintain the body in
statu quo, like the adult, by the constant renewal
of the worn-out  materials, but also to provide
for growth and increase.
  " That the cause of diphtheria is not an animal
or vegetable  poison, but a state of the air that
impairs the vitality of the blood, is further shown
by the following considerations:  diphtheria pre-
vails in all seasons and climates, in primitive and
miasmatic regions, in well-cleaned streets, among
the better classes, and in courts and alleys, among
the victims of want and  vice ;  indeed, filth, pov-
erty, vegetable and animal effluvia do not increase
its virulence or cause its dissemination.  It is not
self-limited, has no fixed  stages of increment and
decline, may recur several times, does not attack
indiscriminately, but, as a rule, singles  out scro-
fulous children,  or  at  least  individuals whose
constitutions are reduced and whose  blood is
impoverished,
  "[Thepathology of diphtheria is neither elucidated
by autopsies, nor by  chemical or microscopical
examinations.  No special structures are invad-
ed, or characteristic lesions discovered;  only
everywhere is found a dark, grumous blood, fill-
ing equally the veins and arteries, and stagnated
in various organs.   MM. Millard and Peter first
pointed out that the blood was of a dirty brown
color, resembling liquorice juice, or water con-
taining a mixture of soot. 
            ALCOHOL AND  DIPHTHERIA.         13

   " During life, there  are conclusive proofs, in
 the malignant cases, of a  poisoned, disorganized
 condition of the circulating fluid ;  the dark, gru-
 mous blood oozing from the tonsils when rough-
 ly touched, the spontaneous  haemorrhages,  the
 muscular weakness, the prostrated nerve-power,
 the clammy perspiration, the rapid, soft, and shaky
 pulse, the sphacelation in the fauces, the sequelae
 —anaemia, paralysis,  etc.—the gradual  sinking
 of the patient, and the extinction of life without
 an  effort at reaction  or  the slightest  tokens
 of constitutional resistance.  The evidences of a
 blood-contamination, equal to those seen in ty-
 phus, are infinitely greater than those presented
 in other  diseases, now  universally conceded to
 arise from this cause.   Chemistry detects  neither
 specific poison in the air, nor foreign element in
 the blood or material change in its constituents,
 when patients have died  of  this disease.  The
 changes, and the agencies producing them, what-
 ever they may be, are inappreciable by this means
 of investigation.
   " The enlarged vision afforded by the  micro-
 scope, likewise,  reveals  no sensible alteration in
 the blood; and the naked  eye, which recognizes
 the  fact  of  the transudation  of the liquor san-
guinis, and its concretion  into a pseudo-mem-
 brane, gives us equal information with the most
 powerful  glasses.   The fibrillae, granules,  pus-
cells, etc., that  are found, are not distinctive; 
14
ANTAGONISM  OF
and the much-talked-of alga are frequently seen
on mucous  surfaces  when  covered by  morbid
secretions. Their ova exist in the atmosphere at
all times, but are not developed unless a favora-
ble nidus is presented.

  " The  stimulating  treatment,  with a singular
uniformity, whether  in  the  acute  or chronic
stage—that of  excitement, fever, and inflamma-
tion, or of prostration, rheumatism, or dropsy—
had the same happy effect; and it was in all con-
ditions  that had a diphtheritic origin uninter-
ruptedly followed, since I  only  regarded the
causation, not its manifestations—the root of the
evil,  not its offshoots—and directed my efforts to
the removal of a special state of the blood. This
state of the blood, which is  prone to occur in
scrofulous children, or adults reduced by disease
or of feeble constitutions, in a certain endemic
condition of the atmosphere, is marked by a di-
minished  vital  power, which being exalted  by
stimulants, the  symptoms are checked,  the  in-
flammation subdued,  the membrane removed, a
rapid recovery effected, and  relapses  prevented.
In other words, this plan of medication is radi-
cal, strikes at the heart of the trouble ; whereas,
most others that have been proposed are but an
ineffectual warfare   against  symptoms.  The
blood, which  is similarly affected  in the mild or
severe cases, in the first or later stages, only 
           ALCOHOL AND DIPHTHERIA.        15

 differing  in  the  degree of its dissolution, alone
 claims  our attention.   Against  this condition,
 before  the disintegration is irreparable, I bring
 to bear the most powerful means at command
 to buoy up the constitutional powers, and sus-
 tain the activity and energy  of each  function.
 The first link in this  morbid chain being this re-
 trograde movement in the vitality of the blood,
 when this is checked, fever, inflammation, hae-
 morrhage, exudation, collapse, paralysis, dropsy,
 etc., disappear almost magically, from  the sim-
 ple fact that the cause has been  rendered null
 and inoperative, and the prime pathological
 change removed.
  " Of the remedies that have been employed in
 diphtheria, two only  have proved themselves in
 my hands worthy of  confidence, with the excep-
 tion, in the chronic stage, in  favor of the salts of
 iron. These two remedies—alcohol, and cinchona
 in one  of its forms—are administered in such
 doses and at such intervals as  to  secure one
 effect—the fullest  stimulation of the  nervous
 and  vascular  systems.    Either,  singly, may
 suffice when the vital force needs but slight aid
 to maintain the integrity of the blood ; but the
 two  united have more than a double power, and
 call  out the  greatest possible amount of resist-
 ance, since the nerve-centres  and blood-vessels—
 the great life-factors—are exalted to the highest
point.   Alcoholic liquors, when given in such 
i6
ANTAGONISM  OF
quantities and at such intervals as to occasion
and keep up a steady  but not excessive  excita-
tion, not only quicken the functional offices of
each organ, but act more especially on the ner-
vous and vascular systems.  They bring out the
latent powers, arousing them when dormant, and
freeing  them when oppressed by a load of mor-
bific influences; and thus give, for the time
being, the greatest energy to the entire organism.
Herein, according to the views of many therapeu-
tists, alone  consists the  value  of this class of
stimulants in any disease. The patient lives over
the crisis, or the poison is  spent  or eliminated ;
and thus recovery becomes possible.
  " This is but a partial estimate of the remedial
action of alcohol, which not only produces the ef-
fects just mentioned, but others of much greater
importance  in the present disease—the increased
vitality of the blood itself.  It is well known that
the habitual use of spiritous beverages augments
the  blood-making process,  renders the  blood
richer in all of its important constituents—the red
globules, albumen, and fibrim—and of a greater
crasis;  by which means  there arises an excess of
organizable material, that often occasions inflam-
matory diseases in bon vivants.  This condition is
the opposite to that  existing in the diphtheritic
subject, whose  blood has invariably been ren-
dered  poor by  exhausting disease, or impover-
ished by the demands of increase and growth, as 
           ALCOHOL  AND DIPHTHERIA.         I 7

in the instance of children.  Tiiese causes are in-
tensified and rendered operative by a scrofulous
or syphilitic taint.
  " Therefore,  from  clinical  observations  and
therapeutical deductions, I arrive at the practical
conclusion  that alcohol is not only a stimulant
to  the  system at large, but  also to the blood
itself, quickening  its vital  elaborations, and in-
creasing its vital status, through  which a  direct
barrier is thrown  in the way  of the disease.  In
other words, the results produced by the disease,
and by the alcohol  in the blood, being directly
opposite, neutralize each  other;  and  thus the
stimulant assumes in my eyes the position  of a
true remedy, a trustworthy antidote.  Hence its
medicinal  power  being not  only remedial but
prophylactic,  it will prevent the extension of
diphtheria in the other members of the family, as
well as cure the one affected.  This conclusion is
a necessary sequence, if the pathology of diphthe-
ria and  the modus operandi of alcohol have been
correctly appreciated.
  " In malignant cases of diphtheria, it is advisa-
ble to invoke  the aid of  a co-operating  reme-
dy—of one, like quinia, that particularly excites
the great  ganglionic  nerve-centres; by  which
means a  maximum of power is attained,  and
stimulation carried  to the highest possible de-
gree.   The  various preparations of the  cinchona
bark fulfil this  indication ;  and, when pushed to 
18             ANTAGONISM  OF
the extent of causing tinnitus aurium, are the most
potent nerve-stimulants.  Their efficacy is shown
in all diseases when the innervation is weakened,
disordered, or perverted;  in fevers from malaria,
in fevers from a blood-poison, and in  a variety of
morbid conditions, attended with an exhausted or
defective nervous energy.  As a tenderness of the
gums is a mark of the saturation of the system
with a mercurial, so the ringing in the ears indi-
cates  that the brain is fully under the influence
of cinchona.  Both it  and the alcoholic  stimu-
lant, whether used  singly or jointly, should  be
given with regularity, and in sufficient  doses  to
obtain their full effects; and then the latter, in a
lessened quantity, continued for  two  or  more
weeks after the  disappearance of the disease and
its  sequelae.   From the  outset to a  permanent
restoration  to health, one or  perhaps both  of
these  remedies are to be  continuously adminis-
tered.
  " In the more tedious cases that retain a  haem-
orrhagic tendency, the  substitution ofasesqui-
salt of iron for the cinchona might, for a time, be
advisable, when the peculiar effect  of the  latter
on the brain had been  attained.  These salts  of
iron, like the alcohol, increase the crasis and co-
agulability of the blood, as I have experienced in
several  instances of internal  haemorrhage; but
they affect the body of the blood too slowly to  be
a trustworthy reliance in acute cases.   Their ac- 
ALCOHOL AND  DIPHTHERIA.        19
tion would be slight, short of two or three days;
whereas the progress of diphtheria brooks  no
delay.  Indeed, one of my cases was  attacked
with the disease, although  the  persulphate  of
iron, in  free doses, had  been in  use for haemop-
tysis for more than forty-eight hours.  At least
fifteen  drops of the muriated tincture,  or five
drops of the solution of the chloride or  persul-
phate of iron, should be administered every third
or fourth hour whenever the physician  wishes
to produce this peculiar change in the  blood;
but  in chronic cases, with more  time at his dis-
posal, the dose may be  less, since usually the
main object is now to remedy the anaemia.
  '•' Most writers  insist  strongly on the import-
ance of giving large quantities of animal  broths
to sustain the strength of the patient, and thus
enable him to ride out the violence of the  disor-
der.  This, as a medicinal means, cannot  but  be
erroneous in the  early stages, since  most of the
patients are taken while eating heartily of ani-
mal  food, and enjoying their usual health.  It
is improbable that nourishment, however con-
centrated, which did not prevent  the accession of
a disease whilst  the digestion   was  vigorous,
would cure  it when digestion, assimilation, and
nutrition were completely destroyed. The change
of food  into the  living structures is something
more than its ingestion into  the stomach, or  its
absorption into the  blood-vessels; and  nutri- 
20
ANTAGONISM  OF
ment, unappropriated, can  be only  an incum-
brance—a foreign element—which will be carried
off by the kidneys with the effete matters.  Most
of my patients took little or no nourishment be-
fore convalescing, when it  was ordered for the
same reasons that we order it  in other ailments.
  " It is important to avoid close, hot, and badly-
ventilated  rooms, and secure  a free circulation
of air.   As soon as practicable, the patient should
be taken out of doors, and no fear need be enter-
tained of catching  cold;  the disease  having no
analogy with tonsilitis, pharyngitis, or any other
mucous inflammation whatsoever."

  Since writing the  above, I  have come to rely
more and  more  confidently on alcohol in some
one of its many forms, as the  remedy par excel-
lence, not only for diphtheria, but also for all dis-
eases with  which it is complicated ; for example,
croup, scarlatina, pneumonia, and albuminuria,
and  I might say, perhaps, gastritis and menin-
gitis.  In fact, diphtheria  so  contaminates  the
circulation  that recovery is scarcely possible in
slighter ailments than these, unless this, the ma-
jor disease, which  overrides all else,  is promptly
attacked by the only agent that will neutralize
its venom and effectually check blood-degenera-
tion.  This being done, the  case is usually so
simplified  as speedily to terminate  in recovery
with little farther aid from art.  Often, indeed, 
ALCOHOL AND  DIPHTHERIA.
21
these several  complications are simply varied
expressions of the diphtheritic poison—signs of a
general infection of the system, that demand even
more urgently the use of stimulants and tonics
in full doses.
  Still more, diphtheria makes a decided impress,
when generally prevalent in a community, on all
other diseases, by imparting a low type that for-
bids depressing medication  and demands early
stimulation.  Antimony, ipecacuanha, and hot
baths should in croup soon give place to brandy,
quinine, and  good  food ;  immediately, if the
fauces  appear  at all suspicious, and shortly,  if
the  reducing plan fails to  subdue  the  rough,
rasping cough. Thus the formation of the croup-
ous  membrane, which,  doubtless,  in a  certain
epidemic state of the air  is always of a diphtheri-
tic nature, may be forestalled.  So,  also, in cases
of mucous, follicular, and glandular inflamma-
tion of the tonsils, the alcoholic treatment heads
off the enemy, should it lie in ambush, and more
certainly than any other ensures a prompt and
satisfactory recovery.
  The exudation fully declaring itself, whatever
may precede or attend it, the alcohol is to be im-
plicitly relied upon to the exclusion of all else,
unless the sulphate of quinia be an exception, and
given with the same precision as is requisite to
the proper administration of any other important
medicine.  The conditions  of  success must  be 
22
ANTAGONISM  OF
observed scrupulously, as otherwise the alcohol
may be robbed of its specific virtues, and the con-
tamination of the blood go on unchecked.  What-
ever makes a call on the nerves, and lessens their
tone like  cathartics, emetics, and foul  air; and
whatever deteriorates the blood, and  impairs its
crasis like mercurials, alkalies, and poor food, is
to be carefully avoided.
  Consequently, the patient should  be in  bed,
the room  cool and well ventilated, evacuants
interdicted, the secretions undisturbed, and the
fever, local symptoms, or other accessory condi-
tions  disregarded.   The one indication alone
obtains—to wit, the introduction,  as  promptly
as practicable, of a sufficient quantity of alcohol
into the circulation  to counteract the effects  of
the poison, and prevent  morbid changes in the
blood.   The  more speedy the  resort to the anti-
dote, the more speedy the cure,  a day or  two
being often sufficient to restore  the  patient  to
his usual health; but, if the alcohol  be held  in
reserve until  the fever is  allayed and the system
prepared for stimulants, it will be shorn of its
potency, as now the damage has been done and
there  is no vitality left  to  respond, though the
stomach were flooded  with  alcohol and stuffed
with food.
  The administration of alcohol, therefore, at the
inception of the disease, and in a  sufficient quan-
tity to prevent the peculiar fermentation in the 
ALCOHOL AND DIPHTHERIA.        23
blood induced by the diphtheritic poison, is neces-
sary to the full play of the specific virtues of the
remedy ; but, on the contrary, that of quinia at a
later stage and in a moderate dose to sustain the
nerve-centres and arouse the latent energies of the
system.  Nevertheless, to intensify the  power of
alcohol by imparting through the nerves more
vitality to  the blood, it  is safer in bad cases to
inaugurate the treatment with both, and, in this
way, anticipate the depression that soon follows
the appearance of the membrane.
  The office of iron  is much inferior to that of
quinia.   It is not to fight the battle, but to com-
plete the victory; not to defend the citadel, but to
rebuild its shattered walls ; and yet, in order to
remove every evidence of the terrible  struggle,
and restore the vital forces to their wonted su-
premacy, the aid of alcohol is  needed more or
less constantly. 
24             ANTAGONISM  OF
               CHAPTER  II.

PAPER READ BEFORE  KINGS COUNTY MEDICAL SO-
              CIETY, OCTOBER, '77.

  The re-appearance of diphtheria, the Winter of
'73 and '74, in an  epidemic form and with its old-
time fatality, excited great apprehension in the
community and  much  discussion in the profes-
sion.  Eventually,  as the disease  extended  in
area and increased in severity, a meeting of this
Society was called to consider  the subject, and
interchange views as to the means the best fitted
to meet and repulse the  enemy.  At that meet-
ing, I had the honor  to open the debate  on the
treatment.  My  opinions, markedly  divergent
from those  expressed by others—opinions  pub-
lished as early as '63 in the Boston Medical and
Surgical Journal—failed of acceptance, met with
adverse criticism, and fell to the level of all clin-
ical facts in the face of rational medicine.   How
preposterous for one man to pit a few empirical
observations  of  his against  doctrines settled as
long ago as the days of Cullen !  What! is the con-
test to be fought over again  with a modern John
 Brown?   Is  the caution to  avoid stimulants in
 fever and inflammation to be cast to the winds?
 It is contrary to reason and common sense.  Such
 a practice, surely,  would but  add  fuel to  the
 flames.   Moreover, the claim of nineteen recov- 
           ALCOHOL  AND DIPHTHERIA.         25

eries in twenty consecutive cases, as reported in
the Boston Journal, is easily explained: a physi-
cian often has a run of mild cases—a fact notably
observable in scarlatina.
  The object of this paper is to present addition-
al and more decisive clinical data,  such as it will
be  difficult  to explain away,  or  otherwise ac-
count for than  by conceding a direct and posi-
tive antagonism between alcohol and diphtheria.
I am now prepared not only to repeat the asser-
tion, formerly made  to  this Society—that a phy-
sician, when called early, ought not to lose more
than one in  twenty cases—but also to  announce
the still more startling fact, that double,  yea!
quadruple, that number has since then been, con-
secutively,  brought  to a  successful issue.   In
fact, diphtheria is, when attacked  boldly at the
outset, more amenable  to treatment than many
common diseases; and yet the fatality under pre-
valent modes of practice is as great, almost, as
that of unmodified small-pox.
  I propose calling your attention to the subject
before us this evening under the following heads :

  1 st. The pathology and treatment.
  2d. The histories of typical cases.
  3d.  The  reports of cases, and the certificates
of deaths.
  4th.  The preventive measures.
3 
26
ANTAGONISM  OF
      I. THE PATHOLOGY AND TREATMENT.

   My views on  the pathology and treatment  of
diphtheria, inasmuch as they have hitherto been
presented to the Society, I will  simply recapitu-
late in an  abstract  form : Diphtheria first ap-
peared  in  this  country in the  year 1858.  Its
essential features are totally distinct  from  those
characterizing all  previous  throat-distempers.
The remote cause of the disease may be the mul-
tiplication of germs, animal or vegetable, on an
abraded  point in  the  fauces, and their transit
thence through the lymphatics and blood-vessels
to every part of the body.  Its clinical history,
however, better accords with the action  of  some
subtle agency, which, pervading  the  air univer-
sally, impairs the vital  status of the  circulation
through the lungs.  In an epidemic, all are affect-
ed by the morbific agent, but a few only yield to
it.   Mature, vigorous persons have  vitality
enough to resist the disease.  Children and weak-
ly adults are its usual subjects.
   To this general and predisposing cause,  there
is, almost always, superadded a local and direct
exciting  cause,  such  as defective  exercise, im-
proper diet, dark rooms, damp houses, imperfect
ventilation, and poisonous emanations  from de-
composing filth in privies, cesspools, sewer-pipes,
etc.  To such agencies, the strongest constitution
will soon succumb. 
ALCOHOL AND  DIPHTHERIA.
27
  The blood being deteriorated, its crasis  is im-
paired and its vitality lowered;  and then the
sympathetic nerves, failing to receive due stimu-
lus, waver in their efforts to carry on the animal
functions.  Thus the mainspring of life loses the
tension that keeps the whole mechanism  in mo-
tion.
  The exudation is a symptom only—a  sign of
the degeneration of the blood and the semi-paral-
ysis of the sympathetic nerves.  The exudation
may be slight, or even absent altogether, and yet
ttie most serious sequelae supervene.
  All local treatment is  worse than  useless.  It
exhausts the nerve-force and induces greater in-
jection of the blood-vessels, thus favoring the
exudation.
  Alcohol neutralizes  the diphtheritic   poison,
sets free  the nerves  of animal life, subdues the
fever and inflammation, destroys the pabulum
that  sustains the  membrane, cuts short the dis-
ease, conquers its sequelae, and shields other
members of the family from an  attack.   Upon
the subsidence of the fever, as is usually the case
in from twenty-four to thirty-six  hours, a puru-
lent  secretion begins to loosen the membrane,
and  soon thereafter to detach it in flaky, ragged
fragments.  This process may take place, and re-
covery be possible, even  when the  larynx and
trachea are implicated.  The membrane is seldom
renewed, when this secretion is maintained by a 
28
ANTAGONISM  OF
steady use of the remedy.  Alcohol is as antago-
nistic to diphtheria as belladonna to opium, or
quinia to malaria.  Like any other  antidote, it
must be given promptly at the outset, as other-
wise its  potency will be  lessened, perhaps lost
altogether.
  Alcohol does not  act as  a stimulant, nor in-
duce any of  its ordinary  effects.  Enough  may
be given to cause profound intoxication in health,
and  yet  there exist  no signs of excitement  or
odor in the breath.  Hence, at a  late stage of the
disease, it is of little avail.
  Should the administration of alcohol anticipate
grave symptoms by thirty-six hours, recovery is
assured; should the epiglottis be implicated, a
croupy cough  present,  or the blood much con-
taminated, recovery is possible; but  should the
larynx be involved so as to  impede the aeration
of the blood, recovery is improbable,  though,
even then, the  secretion of  pus  may detach, dis-
integrate, and supplant  the membrane.
  All cases of croup, on the failure of the  usual
remedies to  subdue the  harsh, rasping cough,
should have alcohol added to the treatment;  all
cases of  scarlatina, on the appearance of a mem-
branous patch in the fauces,  should be considered
as diphtheria; all diseases associated witli  diph-
theria, inasmuch as its presence casts a baleful
shadow  over  every  other  morbid condition,
should be  disregarded, or,  at least, receive sec- 
ALCOHOL AND  DIPHTHERIA.        29
ondary attention only ; all the sequelae of diph-
theria—paralysis, albuminuria, haemorrhage, anae-
mia, etc., etc.—should, whatever else might be
demanded, be subjected to this all-potent remedy.
  Quinia is an efficient ally to alcohol.  It ener-
gizes the ganglionic nervous system—a  member
of the vital  forces not  less  important  than the
vascular—and thus enables the organism to right
itself and resume its functions.
  Iron plays an  unimportant part  at first; but
later, when  the  diphtheritic poison  has been
neutralized, it restores color to the  blood, im-
parts force to the nerves, and awakens active nu-
trition—matters of no  light moment in  most
cases.  At an  early day, even  food and other
means to  support nature are of slender advan-
tage ; but  when alcohol  and quinine have tem-
pered the violence of the symptoms, they are im-
peratively  demanded.
  The power of alcohol  and quinine to prevent
blood-degeneration  and  nerve-exhaustion, de-
pends on fresh air, bodily rest, mental quietude,
and disuse of lowering  medicines.   So, also, the
power of iron and food to restore the fluids and
solids  to their normal  standard, is only opera-
tive by observing  the same general caution as to
impure air, active  exertion, and heroic treatment
of individual conditions.
  Alcohol  and quinine have no greater power to
cure than  to prevent diphtheria, provided  they 
3°
ANTAGONISM  OF
are given  promptly  and continuously.   With
thorough  ventilation, they are all that is needed
to purify a room or a house, unless  there exist
some extraneous source of infection demanding
special attention.

      II. THE HISTORIES OF TYPICAL CASES.

  Alcohol inefficient as a stimulant—efficient as a preventive.
  C. B., nearly six years of  age, had been ailing
a week with what the parents supposed to be the
mumps, when I was  called. The child met me
in the hall, and presented no indications of se-
rious illness.  On inspection, the entire pharynx
was found  covered  with a  thin layer of mem-
brane.   The  fetor was slight, the inflammation
trivial, and the dysphagia  scarcely  noticeable.
Externally, the appearance  simulated parotitis,
only the swelling was lower and  broader, and
had greater hardness  and less sensibility.   The
child was put into bed, and a teaspoonful of whis-
key, with  a third  of  a grain of quinine, given
every hour.  As  the symptoms became  more
grave,  the  dose  was  gradually   increased to
double this quantity.   The treatment  did not
seem to have the slightest effect.   The child died
on the seventh day from blood-poisoning.   The
parents and  five  other children, one of  whom
had Pott's disease of the spine, took whiskey and
quinine four times a day, in  doses  varying from 
           ALCOHOL AND DIPHTHERIA.        31

 one to six drachms.  All escaped  except  the
 eldest daughter, who had on one tonsil a small,
 membranous  patch that fell  off in two days'
 time.

 Abortive action of alcohol—Diphtheria without exudation—
               Danger of sewer-gas.
   A little girl, three years of age, recovered from
 a severe attack of diphtheria in twelve days, by
 the use, almost exclusively, of whiskey.  Having
 been much  petted, it was  impossible to  induce
 her  to take the  quinine very frequently.  The
 parents, another child, and two  servants escaped
 by the virtues of the antidote.   The aunt, a per-
 son of strong temperance proclivities, who was in
 constant attendance on  the  child, refused to  fol-
 low my prescription.  When the child was con-
 valescent, she began to experience throat-symp-
 toms, to loathe food, and to suffer from weak-
 ness.  Her pulse was feeble, and her  extremities
 were cold.   Her system seemed laboring under
 some  powerfully-depressing agent, and yet  the
 local  signs  of  diphtheria were absent.  The
 fauces had a diffuse, deep-colored  redness, and
 the tonsils secreted a tenacious, muco-purulent
 matter, that was  readily  washed  away by a
 gargle.
  A few days after the termination of my atten-
 dance  on the child,  I  was sent for  to  see  the
aunt.  The local symptoms had subsided, but the 
32             ANTAGONISM  OF
general had become more pronounced.  There
were  present  the  most  dangerous sequelae  of
blood-poisoning—feebleness  of the heart's im-
pulse, and sluggishness of the ganglionic nerves.
She was directed to take whiskey and quinine, to
use nourishing food, and to keep her room.  As
soon as the appetite returned, the nutrition im-
proved, the blood gained volume, and the nerves
sent force to the organs, iron  was prescribed and
exercise in the open air enforced.  It was  three
months or more  before this patient regained her
usual health.
  The sickness in this family  began in March of
last year, and was  traced to sewer-gas as the ex-
citing cause.   This being prevented from enter-
ing the house  by running a ventilator from the
main trap in the water-closet to the kitchen flue
of the adjoining house, the recurrence of  diph-
theria  has been  obviated,  though  other pre-
caution, save the use of alcohol and quinine, was
not taken.  The health of the family  has  since
been excellent.

Clinical observations, similar to  those just detailed, made
                in another family.
  This family  consisted of the grandmother, the
mother, two children—a girl of eleven and  a boy
of six  years  of age—and two servants.   The
mother and the  two children slept in the room
adjacent to the bath-room, where the  odor was 
           ALCOHOL AND DIPHTHERIA.        33

 so offensive  as  to lead to the constant emplov-
 ment of disinfectants.
   The girl was attacked with diphtheria the 24th
 of January, and the boy the  nth of February, of
 last year.
   The girl had a very severe attack ;  primarily,
 from the poisoning of the blood, and, secondarily,
 from the swelling and elongation  of  the uvula.
 The membrane was slow in falling; and then, as
 she began to sit up, a paralytic affection of the
 pharyngeal muscles showed itself.  Nevertheless,
 in ten weeks, she regained her usual health.
   The  boy's symptoms were light  compared
 with those of his sister, and soon subsided. From
 some cause—perhaps neglect to continue his med-
 icine a sufficient length  of time, or fault in not
 attending to the ventilation of the soil-pipe im-
 mediately—the  boy  was attacked  again the 23d
 of February.  This attack was  much less severe
 than the first.   His recovery was  subsequently
 prompt and  complete.
   As the boy improved, the  grandmother began
 to show signs  of the secondary effects of diph-
 theria, although at no time had there been the
 slightest deposit  in  the fauces.   The  mucous
 membrane had been  merely dry, glazed, and in-
jected.   The prostration  had come on so grad-
 ually, that  I  was surprised,  when  my attention
 was called  to her, to  find the extremities cold,
and the pulse small and feeble.  Forgetting her- 
34
ANTAGONISM  OF
self in her anxiety for the children, she had neg-
lected to take the preventive medicine, except at
rare intervals.  Her daughter, however, had  ob-
served proper precaution, and escaped.
  The treatment of this case consisted, at first, of
rest in bed, and the use of whiskey and quinine
as medicine, and of lime-water and milk as food ;
and then, as her strength returned, of gentle ex-
ercise in the open air, and the addition of iron,
meat, and vegetables to the programme.  My at-
tendance on the grandmother extended from the
27th of March to the 1st of May, when the  family
left for the  country.  In  each  case, the recovery
was perfect.  Meanwhile, the joints of the  soil-
pipe had been  examined, and a ventilator  four
inches in diameter carried from the two  water-
closets to the roof of the  house.   Since this was
done, no odor has been perceptible, or any form
of filth-disease present.

    Secondary results of diphtheria without exudation.
  A gentleman, seventy years of age, was seized
with creeping chills and flying rheumatic pains.
He thought he had taken cold, and treated  him-
self, as had been  his wont for similar attacts, on
the starving plan.  Having on a previous occa-
sion examined his urine, and found it heavily
laden with phosphates, I was  also  led  to the
same conclusion, and  induced to prescribe Ro-
chelle salt, and to direct an unstimulating diet. 
ALCOHOL AND DIPHTHERIA.
To my surprise, he  rapidly  grew  worse.   He
was indifferent to food, had cold hands  and
a purple color under the nails, and manifested no
inclination to leave the lounge, except to change,
as  his posture became irksome, for a few min-
utes to an arm-chair.   This  prostration, coupled
with his years, gave me serious apprehensions as
to the final  issue.   There was no disease of the
heart or of the fauces to be  detected.  As to  the
kidneys, they were excluded by a recent exam-
ination of the urine.
  In a day or two, a gouty joint of his right foot
began to be painful; and, directly, all the toes of
the left foot,  which had never  before been  affect-
ed, became red and swollen.  Whilst this  gouty
inflammation was showing itself in the feet, an
ulcer with deep-red, elevated  margins appeared
on  the right tonsil.  The rest  of the gland  was
intact.
  At  the first indications of increasing  debility,
whiskey and quinine were given cautiously as a
stimulant and tonic ; and then, when it was found
that the feet gradually improved under this treat-
ment, the amount and frequency of the dose were
systematically carried up to the diphtheria-level.
Meanwhile, nourishment was not neglected.
  What was singular—a fact  that gave me  the
clue to the real nature of the disease—the trouble
in the feet left almost as quickly as it appeared,
although little or no impression had been made 
36
ANTAGONISM  OF
on the symptoms of nerve-exhaustion.  Besides,
the ulcer soon lost its red, prominent boundaries,
and appeared not unlike those so often seen on
the mucous membranes.  At this stage, the muri-
ated tincture of iron was added to  the whiskey
and quinine.
  Notwithstanding the serious aspect of  this
case, convalescence was so far established at the
end of three weeks, that the patient was permitted
to leave the city for his farm in Fairfield, Conn.
Here, his medicine being  materially aided by
country air  and exercise in the garden, he im-
proved steadily, and in two months  regained his
usual vigor.  At present, his health  is better than
it was before his illness.
  If this was not a case of diphtheria—one of
great gravity—I  am  at  a loss what name to
apply to his disease.  One  other strongly con-
firmatory symptom I should have mentioned : at
an  early period of the attack,  the patient had a
fit of strangulation on taking  the  first swallow
of a glass of milk.  Subsequently, he was obliged
to be cautious and methodical whenever he drank
fluids.
            Diphtheria with pneumonia.
  A  gentleman who had  for  many years been
superintendent of  a  large  brass  manufactory,
where his  nerves had at length become so shat-
tered by the roar of machinery  and  the reverber-
ation of metal that he was about  retiring to a 
ALCOHOL AND  DIPHTHERIA.
37
farm in Connecticut, was taken down with pneu-
monia and diphtheria simultaneously.  Brandy
and  quinine  carried  him  quickly  and  safely
through these diseases;  whereupon, the country
air, imparting  tone to the nervous system, re-
stored the full vigor of former years.

  The membrane extending to larynx, trachea,and bronchi.
  A  child seventeen months  old, badly nour-
ished, and subjected to the adverse conditions of
the back  basement of a  tenement house, came
under my care the third day of its illness.   The
exudation covered the fauces and filled  the  nos-
trils.   The voice was extinct, the head thrown
back, and the inspiration laborious and whistling.
I held  out no hopes to the parents of recovery,
but told them that their only chance was to give,
as long as the child could  swallow, the following
prescription:

       IJ,  Quiniae sulp.  .   .  .   gr. vi.
          Acid sulp. aromat..  . qtt. xx.
          Sp. frumenti. ...      5 i.
          Aq. fontanae   ...    5 ij.  M.
S. A- teaspoonful every hour and a half in water.

  This was given  singly and  uninterruptedly
until  convalescence was  established, when the
whiskey alone was  relied upon.
  On  the third  day of my attendance, as  the
membranous secretion gave place to a  purulent 
38             ANTAGONISM  OF
one  and the respiration improved, the ears be-
came filled with the same deposit, and the cervi-
cal glands enlarged by a low form of inflamma-
tion.  Two of these glands quickly suppurated,
and were lanced.   In  the  meantime the  exuda-
tion  having disappeared, the medicine was given
at longer  intervals, and  lime-water and con-
densed  milk substituted for the mother's milk,
which was watery and  insufficient.
  In a  day or  two, the child began to struggle
for breath as in membranous  croup, when the
quinine and whiskey were re-ordered as  at first.
The  effect  was a copious purulent secretion, a
disintegration of the membrane, and the relaxa-
tion  of the spasm.  As soon, however, as this
danger  was past, a graver one, if possible, pre-
sented itself—the extension of  the exudation to
the bronchial tubes.  The  child did not  expand
its chest, had a livid, bronzed look, was bathed
in a clammy, profuse  perspiration, and  felt as
cold as a piece of marble.
  I directed an  emetic of ipecacuanha, sinapisms
to the chest, dry warmth to the extremities, and
a continuance of the prescription.  The emesis,
bringing up a  large amount of muco-purulent
matter, gave instant relief.   Afterwards, the child
vomited once or twice a day spontaneously.  My
attendance  extended   from  February 19th  to
March 1 ith; but, ten days before the last date, the
recovery was assured.   This was not retarded or
marred by any secondary trouble whatever. 
          ALCOHOL AND  DIPHTHERIA.         39

          Croup, scarlatina, and diphtheria.
  A boy three years old was taken in the even-
ing with croup. At first emetic, and then nauseat-
ing doses of ipecacuanha  were given, but in the
morning, to head off any  lurking tendency there
might be to  the membranous form, fifteen drops
of whiskey every two hours.  The third day, the
mother  had  a small diphtheritic  patch on  one
tonsil.  Two  teaspoonfuls of whiskey and  one
grain each of quinoidine and sulphate of cincho-
nia were directed every two hours.  The whiskey
ordered for the boy was  now  given to his bro-
ther, two years younger, in ten-drop doses.  On
the fourth day, the first, and on the eleventh the
second  son, were attacked with scarlatina in a
mild  form.   The  alcoholic  treatment  was fol-
lowed without addition until convalescence  was
established.   On the twelfth day, the daughter,
twenty-one  years  of age, the only  remaining
member of the family, was attacked with a raging
fever, intense headache, and membranous inflam-
mation  of both tonsils.   In her case, the same
medicines were prescribed as those taken by the
mother.   All recovered  promptly and suffered
from no  secondary disorder, except the mother,
who had, some ten days after the fall of the mem-
brane, a dimness of vision that forbade  reading,
sewing, or other continuous application of the
eyes.  This  symptom necessitated a return to the
original treatment for a couple of weeks. 
4°
ANTAGONISM  OF
      Diphtheria and scarlatina in the same subject.
  A boy, six years of age, was taken with diph-
theritic  sore throat; and, though the local  dis-
ease remained much the same, he rapidly grew
worse.  His blood  seemed  saturated  with the
poison—as shown by the stomach rejecting all
food and drink, by  the heart acting feebly and
irregularly, by the  extremities being  cold  and
shrivelled,  and the skin having a dusky, sodden
look.  At first one, and then two teaspoonfuls of
brandy were given every two hours ;  but, soon,
the larger dose every hour.  Food,  in any form,
would not remain on the stomach, and  quinine,
promptly rejected, induced a retching  that  was
slow to  subside.   The brandy, only tolerated in
divided  doses, had to be often repeated to make
good the loss.  On the third day, there  was a ty-
phus-like  fever,  lividity of the surface, oppres-
sion of the brain,  muttering  delirium, and  a
quick, feeble pulse.  On the fourth day, scarlatina
made  its appearance.  The  eruption, save mot-
tled blotches on the face, was confined to the
trunk, and  had a deep  raspberry hue.  As the
symptoms  assumed greater  gravity, the brandy
was given in three-drachm doses every hour, and
aided, as far as  the  stomach  would permit, by
quinine, and lime-water  and milk.   At the ad-
vent of the eruption,  the membrane began to
spread over the fauces and to extend up the pos-
terior nares, and, at  its decline, to be detached in 
           ALCOHOL AND DIPHTHERIA.        41

putrid flakes and discharged in  purulent sputa.
The active treatment extended over two  weeks,
and resulted, without accident, in a speedy and
perfect recovery.

      Diphtheria and scarlatina in the same house.
  A girl, nine and a half years old, deficient  in
constitutional force,  weakened   by too  rapid
growth, and afflicted with lateral  curvature of
the spine, was taken with diphtheria.  The exu-
dation on the third day covered the fauces, filled
the nostrils, and extended along  the roof of the
mouth.   The symptoms became more and more
typhoid, and the putrescence more  and more
pronounced. Food and drink were not tolerated,
quinia induced violent retching, and brandy was
vomited unless given in small quantities.  The
case  seemed desperate,  as  it presented all  the
signs  of malignancy.  Beginning  at first with
smaller  doses, the brandy was soon. increased to
four drachms the hour, and  when  rejected was
made  good.  As the stomach became more tract-
able, lime-water and milk, scalded  in a thin de-
coction  of farina, was given for nourishment; as
the disease began to  yield, quinia was adminis-
tered  in suppositories ; and, as  the membrane
lost its hold and was supplanted by a purulent
secretion, the tincture of iron, in  small and fre-
quent doses, was conjoined with the brandy.  In
two weeks, convalescence was fully inaugurated ;
                       4 
42
ANTAGONISM  OF
and in  three, when the local disease  was com-
pletely  subdued, a semi-paralytic  state  of the
heart showed itself, and necessitated the removal
of pillows  and a rigid  enforcement of the hori-
zontal posture.   Eventually she was restored to
her usual health without a drawback,  excepting
a discharge from the right ear.
  On the fifth day of this patient's illness, two of
her younger sisters were attacked with scarlatina.
The whiskey which they, together with the other
members of the family, had been taking  as a
prophylactic, was now continued as a  medicine.
The only  addition was a diaphoretic mixture.
They passed through the fever in the most satis-
factory  manner, it being  neither aggravated by
complications nor prolonged by secondary dis-
orders.  The others in the house, some twelve in
number, exclusive of the servants, escaped by
the virtues of the antidote, though the  scraping
of walls, the burning of clothes, the tearing up
of carpets,  etc., were omitted.
             Abortive power of alcohol.
  I  was called  on a  Sunday  evening by my
friend, Dr.-----, to see a lady whose  child had
died the morning previous of diphtheria.  She
had held the child most of the time of its illness,
and  kissed it repeatedly and frantically on the
lips  as putrescent matter flowed from them  in
its last moments.  Friday and Saturday she had 
ALCOHOL AND  DIPHTHERIA.
43
had  an  exudation of moderate extent  in  the
fauces; but now she had, in addition, a diffused,
intumescence and induration of the neck.  See-
ing  that  the patient  had   inhaled  the  child's
breath for six days,  had had patches on  both
tonsils for two, and had applied her mouth to the
poison many times, I  mentioned to the  doctor
that  we had  all the conditions present foreshad-
owing a  malignant case;  and that,  regarding
alcohol as a true antidote, I would advise its ad-
ministration  in full doses, the same as when the
disease was  at  its height.   Besides the quinine
previously prescribed, the  patient  took a table-
spoonful of whiskey every hour with this  result:
she attended the child's funeral on Tuesday, and
in a  day  or two regained her usual health.   In
this  case, the abortive power of alcohol was fully
manifested—a power it rarely fails to assert.

III.   THE  REPORT OF  CASES AND THE CERTIFI-
               CATES OF DEATH.

  To further substantiate the virtues of alcohol
in the treatment of diphtheria, I will appeal to
the  records  of the Health  Board  of this  city.
From the figures furnished me by two persons
connected with this department, it appears :
  In '74,  there were reported 1,651 cases of diph-
theria ;  in '75,  2,669  cases; and in  '76, 2,329
cases ; making in all 6,649. 
44
ANTAGONISM OF
  During  the same  years,  respectively,  there
were reported 580,  965,  and  812 deaths from
diphtheria, and 318,  451, and  412  deaths from
croup, making the  total  mortality from diph-
theria, 2,357, from croup, 1,181, and from diph-
theria and croup, 3,538.
  Now,  if it be  assumed  that all the cases re-
ported as  diphtheria were genuine, and that the
majority of deaths from croup had a diphtheritic
origin, as  doubtless  is true, * then  there will
be slight grounds for congratulation over  the
progress made by therapeutics. The mortality is
truly appalling.   Even were diphtheria and true
croup regarded as identical in nature—different
names for the same  morbid condition—the ex-
hibit would still  be far from flattering.
  From Jan. 10th, '74, when I lost the young girl
whose history is the first presented in this paper,
to this date, I have reported 78 cases of diphthe-
ria, and lost one  only.  This even does not right-
fully belong to the list, as the child had been un-
  * The above statement is substantiated by the elaborate
report of Dr. Pilcher on Croup and Tracheotomy to the So-
ciety, April 17th, '77. He shows by the records for the past
seven years—'70 to '77 inclusive—that in sixty-two different
instances, have two or more fatal cases of croup occurred
in the same house, either upon the same day or within a
few days ot each other ; and also, that the deaths reported as
from  diptheritic croup were in '74, 71 ;  in '75,  164, and in
'76, 128. 
ALCOHOL AND  DIPHTHERIA.        45
der the care  of  a homoeopathic  physician for
several  days.  A younger child lay dead in the
house  when I was called.  Besides, the patient
refused all food and medicine, and died in thirty-
six hours.  An older child promptly recovered.
  To these 78 cases should be added some  eight
cases or more, which, from the  slight local  trou-
ble or other cause, were not reported, but which,
from the course of the  disease, I am convinced
were really diphtheritic.  Three of these cases—
two  of which are related above—from the  delay
in resorting to brandy and quinine at the outset,
required  much longer treatment  than  usual.
Thus it appears that, in a  period of three and a
half years, 85 cases of diphtheria have been  treat-
ed, successively, without a  failure.   What is
more, not  a  death appears  under  the head of
croup, or other disease—the sequel of the  diph-
theritic poison.
  The  following report was also furnished me
as to the number of deaths and their causes for
the same period:
  Old age, G. B., 81, and E. M. D., 84 ;  heart dis-
ease, A. G.  G.,  58, and  J. H., 70; softening of
brain, D. S. G., 76; cancer, C.  K., 46; apoplexy,
A. H. C, 47 ;  phthisis, J. X., 45, and E. H. P., 59;
pneumonia, N. L., 61 ; congestion of lungs, L. M.,
2; jaundice, L. E. B., 64;  typhoid fever, I. W. E.
B., 40 ;  cerebro-spinal meningitis, B. K., 45  ; cys-
titis, E. G., 75; Bright's  disease, G. P. W., 50; 
46
ANTAGONISM  OF
puerperal fever, S. W. T., 33 ; diphtheria, M. E.
M., 7; scarlatina, R.  M., 5; chronic eczema, J.
S., 3; cholera infantum, H. C, 16 mos.,  E. DeF.,
16 mos., N. L. P., 15 mos., J. J. D., 18 mos., and
A. B., 6 mos.; marasmus, A. S. L., 3 mos., and
B. W. D., 1 mo.; convulsions, D. W. O., 6  mos.,
and B. B., 7 mos.; whooping cough, A. A. Q., 4
mos.; dentition, W. D.,  12  mos., and D. P., 15
mos.
  In this connection, it may be well to  examine
the claims of tracheotomy as a forlorn hope. The
point is, will it increase or lessen the chances of
recovery ?  Dr. Pilchers tables of operations in
this city lead to the conclusion  that twenty  per
cent, has been saved after the failure of medicine.
If this be so, then surely no case should be given
up- until  the aid of surgery has been  invoked.
Such aid  having  rarely,  or   never, appeared
proper  in  my practice, I thought the grouping
of diphtheria, croup, oedema glottidis, and laryn-
gitis  under one head  might involve a fallacy.
The results of my investigations are presented
in the table following : 
	Opera-tions.	For Diph-theria.	Recov-ery.	Death.	For Croup.	Recov-ery.	Death.
A., G. H.	2	2	I	I			
B., J	2	I		I	I	I	....
B.,1. H..	3	....		....	3		3
B.,E. S..	3	2		2	1		1
C, G....	5	....		....	5	2	3
C, J	7			....	7		7
C, A. B..	i	I		I	....		....
D., D. A.	2	2		2			
E., G. A..	2	I		I	1		1
F., M....	2	2		2			....
F., G. R..	II	7		6	4		3
G, H. J..	I	1		1			
G., A. G.	I	1		1	....		
G, C. H.	3	3		3	....		....
G.,W....	15	10		9	5		5
H., R....	3	1		i	2		2
H..J.C.	25	15		15	10	2	8
H., N.G.	i	1		1	....		....
J..C.....	2	1		1	1		I
J., J- G..	6	....			6		6
K.. D. E.	2	2		2			....
K.,J.....	12	8	2	6	4	2	2
L., H....	I	1	I		....		....
M., J. M.	5	3	I	2	2		1
0., W. C.	I	....	....	....	I		1
P., L. S..	8	6	3	3	2		2
P., O. S..	i	....		....	I		1
R., J. C.	IO	6		6	4	2	2
R, H. N.	4	3		3	I		....
R., H....	I	1		1	....		....
R., F. W.	8	4		3	4		3
S., W. F..	I	I		1	....		---
S., S, . . .	4	I		1	3		2
S., G. K..	2	2		2			....
S., F. H..	I			....	1	....	
W.,G....	I	I		1	....	....	....
W., W...	I	....		....	1	I	....
W.,J....	I	I		1	....	....	....
W., W. T.	I	I	1	....		....	....
W.,J. S..	I			....	1	....	
W., R. M.	I	---		---	1	---	
	164	92	12	80	72	15	57
 
48             ANTAGONISM  OF
  Of these 164 operations, 92 were for diphtheria,
of which 12 recovered and  80 died—13 percent.;
72 were for croup, of which  15 recovered and 57
died—20  per cent.   Before  the appearance of
diphtheria in this city, Dr.  John Cochran, a bold
and skillful  surgeon, had  seven operations for
croup, all of which died ;   and, during  the same
period, seven operations for strangulated hernia,
all  of which recovered.  Dr.  I. H. Barber relates
a similar experience.  Dr. R. Hesse had three fa-
tal  cases  in  succession.  Since then he has met
with two cases of croup, in which the call to op-
erate was, apparently, imperative.  The parents
hesitated and begged for time. This was allowed,
and small doses of calomel  were given.  Eventu-
ally, when the doctor went prepared to operate,
the breathing had become so much easier that he
declined to interfere.  Both children recovered.
  In the years '74, '75, and '76,  there  were 6,649
cases of diphtheria reported to  the Health De-
partment, and, in the  same interval, 2,355 certifi-
cates were presented—a ratio of mortality great-
er than one to three.  If, as is persistently stated,
many physicians report every simple affection of
the pharynx, follicular tonsillitis particularly, as
diphtheria, how  humiliating stands  the record !
The plague of olden times was not more destruct-
ive.  No  wonder, with an  ill-success  such as
this, the physician, in his  extremity, flies to the
surgeon  for  succor.   Should  this be?  Need 
ALCOHOL AND DIPHTHERIA.
49
medicine be so helpless as to  be content with
thirteen  per cent, of recoveries ?   I make bold to
say that, had these 92 cases been treated  early,
freely, steadily, and persistently, with alcohol, the
majority would have been saved ; and that, had
this remedy failed,  there would  have been  no
chance for tracheotomy.

         IV.  THE PREVENTIVE MEASURES.

   During the prevalence of diphtheria in a fam-
ily, those exposed directly or indirectly to infec-
tion should be protected by having a free  circu-
lation of air through the house, and by taking a
certain amount of alcohol  each  day   until the
patient has recovered.  My usual prescription is
here given :

IJ   Quinoidine.
     Cinchoniae sulp.,      aa, gr. xii.-xxiv.
     Acid. sulp. aromat.      -     -     3 ij.
     Sp. frumenti.   -    -    -       1 viii.  M.
   S. Fifteen drops  to  a tablespoonful, four or
five times a day, according to the age of the sub-
ject.
   To all young children and to  many adults,
I am in the habit of directing brandy or whiskey
alone, in the above proportions.  For the patient,
quinia is substituted  for the quinoidine, and the
interval between the doses shortened  to one  or 
5°
ANTAGONISM  OF
two hours.  Six drachms an hour is the maxi-
mum quantity for an adult.
  Most cases  of diphtheria have, in addition to
the common epidemic influence,  a direct excit-
ing cause.   This will be found, when contagion
is excluded, to be poisonous emanations of some
kind in the house, or on the premises.  The fons
et origo mali with my patients, I  have traced, in
most instances, to sewer-gas.  To hit upon some
plan that would effectually shut  out  this deadly
agent from the dwellings of  my patients, I read
many scientific articles on the subject, and con-
versed with many  practical plumbers  on the
methods they adopted ; but to no purpose, until
it so happened, two years since, that a family of
mine, the subjects of ever-recurring sore throats,
gastric disorders, diphtheritic attacks, was hap-
pily rid of the poison.   The  plumber carried an
iron  ventilator, four inches  in  diameter, from
each soil-pipe where it makes the outer bend of
the closet-trap  to the roof of the house.  This
ventilator replaced a lead one of small calibre,
that had proven itself quite useless.   Since  this
work was  done, all  forms of filth-disease have
disappeared.   The smaller pipe only gave egress
to the gas under  strong pressure; whereas the
larger one acted on  the principle  of a flue, a
draught being excited by the warmth of the gas.
The larger pipe, also, permits a return-current.
  In building  a new house, the extension of the 
ALCOHOL AND  DIPHTHERIA.        51
soil-pipe  to  the  roof would  serve the purpose
fully;  only in this case, were there  more  than
one water-closet, it would  be necessary to carry
a ventilating pipe from the outer bends of the
lower traps to a point above the upper trap, and
there join it to the common soil-pipe.  This is to
give air to the traps ; for, should a flow of water
take place at the  top floor, it  would,  if of suffi-
cient volume to fill the  soil-pipe, siphon out all
the traps below.   In  other  words,  the  water,
entangling and carrying down bubbles of air as
it passes the outer branch of the traps, creates a
vacuum and sucks the traps dry.   For the same
reason, the leaders from the roof are poor ventil-
ators, as every heavy rain will, almost certainly,
empty all the traps in the house.  When the soil-
pipe, furnished with the   air-pipes  mentioned
above, terminates in the kitchen flue, a perfect,
or nearly a perfect, immunity from  the presence
of sewer-gas is attained, however much it  may
be forced upward by the accumulation of water
and filth in the sewers.
  When  all  this has been done, and a fancied
safety attained, there may still be, from the  lack
of proper care—to use  no  harsher  expression—
on the part of the plumber, a free ingress of gas
into the  house, by  secret passages more direct
than to the roof by the ventilator.  The soil-pipe,
when of  lead, may be fissured or corroded;  and,
when of iron, loosened or separated at the joints. 
52
ANTAGONISM OF
It may make angular turns, run on a  level, have
a trap, valve, or other contrivance to prevent the
gas of the sewer from entering the soil-pipe, and
may, by thus checking the flow of the filth to the
street, retain it, more or less,  on the premises.
  Of course, any device or obstruction that  pre-
vents a free circulation from the  outer wall to
the roof, will  stop the draught, and  render the
ventilator useless.  A  flue closed at the  bottom
cannot have an ascending column of air.  Under
such circumstances, as the decomposition of ani-
mal matter and the generation of gas  are contin-
uous, the pressure will soon become excessive—
too great  to  be resisted by the  small body of
water in the traps.
  A waste-pipe from  a basin  or  sink may dis-
charge  into the  soil-pipe.  The  leader from a
piazza-roof, or a  drain for  surface-water,  may
connect with the sewer.  In either case, traps are
of little use, as, in the one, they will be siphoned
out by the flow from the water-closets above,
and, in the other, emptied by evaporation in dry
weather;  and thus in both, the gas will enter the
house, either directly or indirectly.
  Therefore, to avoid  these and like sources of
danger, a lead soil-pipe should be discarded, and
one  of  iron   substituted.   This  should  make
curved turns,  incline at an angle sufficient to en-
sure  the  prompt  discharge of its contents, have
an open channel to the sewer, and be impervious 
ALCOHOL AND DIPHTHERIA.        53
to gas at its joints
                     The traps  in the laundry,
                       kitchen,  and   pantry
                       should,  equally  with
                       those in the water-closets,
                       have air-pipes  connect-
                       ing with either  the main
                       ventilator, or a smaller
                       one that  extends to the
                       roof. In other words, all
                       waste-pipes terminating
                       in  the  soil-pipe  must
                       have   communication
                       with the  air at the outer
                       bend of their traps.  The
                       piazza - leader  and  the
                       water-drain should  dis-
                       charge  into the traps of
                       the kitchen water-closet.
                       The waste-pipes  of the
                       basins should run  into
                       the trap  of the  water-
                       closets ;   and   then,  to
                       make the bed-rooms dou-
                       bly safe, a trap should
                       be placed  under  each
                       basin, and furnished with
                       an air-pipe,  as  in  other
                       instances.  If a room is
                       rarely used, the precau-
tion must  be observed, in order to keep  the
 
54
ANTAGONISM  OF
trap of the basin full, of turning on  the water
every few days.
  The capacity of the sewers being inadequate,
and  their descent insufficient to secure a ready
flow, their contents, during rainy weather, surge
to and fro, and by suction, like that of a piston,
empty the traps.  The same result may be pro-
duced during a violent  wind-storm, by the sud-
den  rarefaction of  the  air, causing upward and
downward currents in the ventilators.
  Against  this danger, there is the  poor safe-
guard of letting the water run so as to refill the
traps.  A better plan is to have a small air-pipe
extending to the roof, instead of connecting with
the ventilator, as is  the practice of the  plumbers
who loaned me the electrotype  from  which the
cut was  taken. By  its adoption there  seems
little doubt that the siphoning  out of the traps,
or, in other words, the  creation of  a vacuum
in the outer arm of  the traps, will be prevented,
whether by the flow of water, the suction  from
the sewer, or the rarefaction  of the atmosphere. 
ALCOHOL AND DIPHTHERIA.        55
                CHAPTER  III.

   OBSERVATIONS MADE DURING THE  EPIDEMIC OF
                  '77 AND '78.

   In continuation of my paper on diphtheria,
 read before the Kings County Medical Society,
 and presented  in the last chapter, I will now
 bring my report down to the  present writing—
 May 15th, ''78.   By this addition to the time cov-.
 ered by my cases, it is hoped that the virtues of
 alcohol as an antidote will  be satisfactorily dem-
 onstrated to all; even to those, if any such there
 be, who are as yet not wholly convinced.
   Thus far, the epidemic has, in my practice, been
 more severe the present than the two preceding
 seasons; in  the fact, more  especially, that diph-
 theria and scarlatina have re-asserted their kin-
 ship, one either following close upon the heels of
 the  other, or both  announcing themselves to-
 gether.   In most  cases, the bloodless veins and
 nerveless muscles, though  the membrane fell in
 a day or two, were very marked.   Nevertheless,
 now as heretofore, the effect of alcohol, whether
 aided or not by quinine and iron, in restoring the
 health, was prompt and complete.   Save the fatal
case, none suffered serious interruption to con-
 valescence, or  permanent deterioration of vital
energy.
  In the interval  between February 7th, '77, the 
56
ANTAGONISM  OF
date of the last case in my previous report, and
November 23d, '77, the date of my first case  in
this, I  did not meet  with a case of diphtheria.
Since then I have treated forty cases of diphthe-
ria, of which three were complicated with scarla-
tina, and perhaps one other that died.  If to these
be added the  eighty-five previously given, thus
extending the  period of observation to more than
four years, the grand  result of  only one death  in
one hundred and twenty-five cases is presented—
a result so astounding as almost to stagger be-
lief.
  Surely  the  action  of alcohol must  be direct,
positive, specific, when, by its use in a series  of
epidemics, attended with  great fatality under ac-
cepted modes  of treatment, such unheard-of suc-
cess is attainable.

      TREATMENT ILLUSTRATED BY  CASES.
Typical cases treated with  whiskey,  or with whiskey, quinia,
  and cinchonia—Diphtheria-poisoning, but no exudation.
  J. D. C, aged 3 years and n months, was taken
with  diphtheria the  2d  of  February, '78.   The
fever was high, tonsillitis severe, and the exuda-
tion extensive, but thin and creamy.  The second
day the general and  local condition  was  much
the  same, only the  exudation, which  had con-
creted in distinct layers, was separating at several
points and hanging in ragged flakes.  The  third,
the fever had  abated,  the  tonsils receded, and the 
           ALCOHOL AND DIPHTHERIA.        57

membrane fallen.  The fourth, there was a gen-
eral  coolness of the surface, much greater than
normal.
  The only treatment enforced was comprised in
the administration  ot two drachms of whiskey
every hour and a half, together with varying pro-
portions of quinia and cinchonia.  The medicine
was  given regularly for three  days and nights,
but,  thereafter, irregularly at night.  Convales-
cence progressing, the dose was lessened and the
interval lengthened.  In ten days, the boy, though
still  weak, resumed his usual activity.
  While he was recovering, his brother, two years
younger, came  down  with the disease, and had
similar but more urgent symptoms. As the baby
only took  a  bitter  mixture under compulsion,
whiskey alone was used—ninety  minims every
hour and a half for  three days.   Now, the child,
which had previously refused  all  nourishment,
began to  take sparingly of milk.  The  fourth
day,  the coolness of the surface of the body was
more decided than  in  the first case.  In a week,
by a reduced dose of the alcohol,  convalescence
was fully established.
  The only remaining child, a boy  nearly six
years of age, who had been taking whiskey and
quinine as a preventive, was attacked just as his
brothers were fairly out of the woods.  The gen-
eral  symptoms of diphtheria were present; but
the local  absent, excepting a slight injection of
                       5 
58
ANTAGONISM OF
the pharyngeal  capillaries, and  a small white
point on the posterior palatine arch at the root
of the tongue.   The breath was very foul, more
so than with the  others.   For fear the membrane
would, sooner or later, declare itself, the alcohol-
ic treatment was employed in this, as in the other
cases.  The fever lasted three days, was attended
with  excessive weakness, and terminated in a
decided lack of animal heat.  Thereupon, the sys-
tem, seemingly freed from a morbific element—
doubtless   the  poison of  diphtheria—speedily
righted itself.
  The mother of these children, cet. 35, being at-
tacked, March 9th, '78, with a violent influenza,
took  two  teaspoonfuls  of  whiskey every two
hours the 10th, nth, and 12th, from an early hour
in the morning to a late one in the evening.  On
the 13th, feeling  relieved  of the load on the chest
and the other symptoms peculiar to the disease,
by the secretion of mucus, she discontinued the
treatment.  On  the  14th, she seemed, except a
slight  huskiness of the  voice, restored to  her
usual health.  In the evening, however, she be-
came languid and drowsy, and, in the night, had
fever, muscular  pains, headache, and tenderness
of the throat, internally and externally.   On the
15th, the mucous membrane of the  fauces pre-
sented a bright-red  color, and  an  oedematous,
glistening  appearance, as though the inflamma-
tion was of a grade high  enough to  cause the 
ALCOHOL AND  DIPHTHERIA.
59
effusion  of  serum  under the epithelium.   The
tonsils were studded with diphtheritic patches.
  One-half ounce of whiskey was given every
hour, and a pill, containing one  grain  each of
quinia, cinchonia, and quinoidine, four  times a
day.
  The first six hours the general and local symp-
toms continued to increase in  severity, particu-
larly the neuralgic pains in  the head; but soon
thereafter to decrease, so much so  that in the
evening  there was  less dryness of the skin, less
irritation of the throat, and less discomfort gen-
erally. Early in the night, the skin was bedewed
with a gentle perspiration, and later, the pulse
became soft, equable, and regular,  and the whole
surface of the body decidedly cool to the touch.
On  the  16th, the oedema had  disappeared, and
the  inflammation receded from the fauces; but
the  patches  on  the tonsils were  larger  and
thicker.  The symptoms of excitement were now
succeeded by those of prostration.  This change
was still  more marked in the  evening, when diz-
ziness  and faintness  were occasioned by sitting
up in bed, and  still more in the night, when the
pulse became indistinct,  the impulse of the heart
feeble, and its first sound inaudible.
  On the 17th, the patches  had  fallen, and the
mucous  membrane resumed its   natural color,
except a  deep-red surface—the site of the exuda-
tion.  The patient has, the past two  days, taken 
6o
ANTAGONISM  OF
twenty-four ounces  of whiskey; and  that,  too,
without experiencing at  any time the slightest
feeling  of stimulation.  On the  contrary, the
effect of the alcohol was, apparently, like that of
some powerful vascular and nervous depressant—
aconite, or veratrum viride, for example.  As the
semi-paralytic state of the heart was  still pro-
nounced, almost as much as the night previous,
the recumbent posture was rigidly maintained.
The whiskey was  given  every hour  and a half,
and the pills every three hours.
  The circulation had gained so much in volume
and force  on the 18th, that she was allowed to sit
up ; on the  19th, to go down stairs ;  and on the
20th, to take a short walk.  All this while, except
the night of the 20th, the medicine had  been
given regularly.
  Thus it appears, that a grave case  of diphthe-
ria, complicated  with one of the gravest of com-
plications, is so  promptly  mastered by alcohol
and quinine, that the patient, within the  week,
takes a short walk, and, thereafter, continuously
improves  without a drawback.
  What short of an antidote would produce such
a result ?—a result incredible  to one who has
never been an eye-witness to this mode of treat-
ment.
  J. D. C, the boy who  had the  diphtheria in
February, was again taken down  the  day after
his  mother.  This attack was less severe than the 
          ALCOHOL AND DIPHTHERIA.        61

first, and  resulted in  a more  prompt  recovery.
There was nothing in his symptoms,  or in the
treatment, worthy of  note.

          Nursing mothers with diphtheria.
  Mrs. D., nursing a baby three months old, was
taken with  diphtheria simultaneously with her
sister,  December  31st, '77.  Her daughter, six
years of age, had been attacked with the disease
a week  previous.  Her son, ten years of age, fol-
lowed the mother.  He had the general, without
the local  symptoms, of blood-infection.  By the
same means—alcohol and quinine—and in the
same period, he regained his health. The mother
was ordered two  teaspoonfuls of  whiskey with
quinine, and the baby ten drops of whiskey, every
hour and  a  half.   The breast-milk became very
scanty, and was supplemented by condensed milk
with lime-water.   At the end of a week, neither
mother  nor  baby required further care.
  Mrs.  T.,  nursing a baby  six  weeks old,  was
taken with diphtheria, January 2d, '78.  She was
ordered two teaspoonfuls of whiskey every hour,
and the baby six drops of Jamaica rum every
two hours.  The mother's milk having dried up,
it  was,  after the falling of the membrane, re-
stored  by the steady application of the child to
the breasts; and yet the child suffered no detri-
ment, save indigestion and colic.  On the  third
day, the mother  was attacked with a profuse me- 
62
ANTAGONISM  OF
trorrhagia, which continued thirty-six hours, and
then abruptly terminated.   In two weeks, with-
out addition to  the treatment, every vestige of
the disease was obliterated.
  Mrs. B., nursing a baby four months  old, was
taken with diphtheria, February  24th, '78.  The
mother's milk became very scanty; and yet, as the
child refused other nourishment, it had  of neces-
sity to suffice.   The treatment was the same  as
in the other two cases.   My attendance was for
six days only.

         Scarlatina—Scarlatina and diphtheria.
  C. D., ozt. 9, was attacked  with  scarlatina in a
severe form, December 5th,  '77. On the eruption
fully declaring itself, he took continuously the
following :

B       Liq. ammoniae acetat.
         Sp. frumenti,   . .  . aa §  ij.      M.
  S.  Two teaspoonfuls every hour and a half in
water.

  The sequels of blood-poisoning did not show
themselves.

  M. D., cet. 12, the sister of the above, was  at-
tacked with scarlatina and diphtheria, December
12th, '77.   The prostration was extreme, and the
pulse uncertain, small, and rapid.  The breath
had a sickening,  disgusting odor, and  the  face, 
          ALCOHOL AND DIPHTHERIA.         63

hands, and feet a dusky, shrunken look.  The
tonsils,  though engorged and  bronzed,  offered
little impediment to deglutition. The membrane
seemed, as soon as formed, to break down into
putrescent matter,  that loaded the breath and
tilled the room.   The eruption  appeared on the
chest in raspberry-colored spots, which  neither
ran together in a general blush, nor invaded the
rest of the trunk, or the arms and legs.   On the
fourth day, the eruption, of a bright, natural hue,
appeared on the hands and feet.
  The treatment was the same  as the  brothers';
only the dose was increased to three teaspoonfuls,
and repeated every hour.  After three  days, the
acetate  of ammonia was replaced by the sulphate
of quinine.   As the alcohol began  to evince its
power in about thirty-six hours by a copious  se-
cretion of pus, the breath became less fetid, the
pulse less shaky, the capillaries less sluggish,
and the oppression less profound.  Directly, the
two  poisons  were under control, and, being
robbed of their venom, offered no further resist-
ance to the vital forces, as they strove to restore
harmony  in the system and power  to each func-
tion.   In twelve days, convalescence  was estab-
lished.
  The baby, at. 12 months, was, whilst the second
case was in progress, attacked with scarlatina in
the  mildest  form.  The eruption ran  over  the
surface of the body without  materially  disturb- 
64
ANTAGONISM OF
ing his wonted activity and playfulness.  This
result was thought to be due to the preliminary
treatment, as the baby had, from the time when
the sister came down, taken fifteen drops of whis-
key every three hours.  On the appearance of
the rash, no change  was made in the treatment,
except the shortening of the interval between the
doses to two hours.
  A. P. D., at. 40, the father of these children,
was attacked with scarlatina and diphtheria New
Year's eve.   His condition  resembled his daugh-
ter's very closely in most  particulars, only the
signs of blood-poisoning were more pronounced.
The eruption  had the  same character, and fol-
lowed the same course.  The pulse was irregular
and  intermittent,  and  the surface  dusky and
shrunken.  Restlessness, jactitation, and insom-
nia persisted  for forty-eight hours,  when  they
were overcome.  The throat was somewhat swol-
len internally, and  indurated  externally.   On
one tonsil there was a diphtheritic patch that was
shed and  renewed for two weeks.  There was
left an excavation that  was  filled up by gran-
ulation.
  Mr. D. took a tablespoonful of whiskey every
hour, combined at first with the acetate of ammo-
nia, but subsequently with  the sulphate  of qui-
nine.
  The father and the two  children were fed al-
most exclusively on  lime-water and  milk, until 
ALCOHOL AND DIPHTHERIA.
65
their convalescence was  far advanced.  To this,
lemons and  oranges were the chief exceptions.
As a result  of this diet,  the digestion was easy
and natural, the urine clear and abundant, and
the recovery prompt and  complete.

        Diphtheria—Diphtheria and scarlatina.
   L. B. and  E. J. B., aged respectively 9 and 3^
years, had an attack of diphtheria the first week
in December, '77, and  made a rapid recovery.
   January 24th, '78, I was  again called to see
L. B., who had then been ill for six days.  From
the dullness of the mind,  the sluggishness of the
circulation, the induration  of  the  glands, the
blueness of the fauces, and the putrescence of the
breath, it  seemed as though the delay had  been
so long as  to give the alcohol but  little chance
to exercise its antidotal power.  Nevertheless, in
five days,  three drachms  of whiskey every hour,
together with eight grains  of quinine daily, re-
moved the torpor, energized the heart,  softened
the induration, lessened the fetor, and detached
the membrane.  When, in a few days, convales-
cence was fairly inaugurated, the heart's action
became so feeble as to necessitate a strict enforce-
ment of the  horizontal posture.  To the alcohol
and quinine in  less frequent doses, the muriated
tincture of iron  was  now  added.   His usual
health was not fully regained before the  comple-
tion of the sixth week. 
66             ANTAGONISM  OF
  January 27th and 28th, E. B., at. 13 ; A. M. B.,
at. 16; Lillian B., at. 7; and E. J. B., at. z\, came
down with the disease.  They presented the same
symptoms of  putridity and  malignancy  as the
brother, and Lillian  had, in addition, scarlatina.
Under the treatment  above detailed,  they all
speedily recovered, except the youngest, that died
on the eighth day.  Whether or not  scarlatina
contributed to this event could not be accurately
determined, as an efflorescence that appeared on
the chest the first day soon  vanished.  That there
was  neglect the first two nights is certain, as the
attendant thought it better to let the child sleep
than to disturb her with medicine.  The result
was, whatever the cause, the death of the patient
that  seemed at first the least ill of the five at-
tacked.
           The true diphtheritic membrane.
  W. A. B., at. 29, had fever, sore throat, and gen-
eral malaise the 10th of February, '78, particular-
ly during the night.    The  next morning when I
saw him, each tonsil  was covered with the wet-
chamois-leather exudation.  Otherwise, the fauces
were not involved.   I prescribed a tablespoonful
of whiskey every hour and a half, and nine grains
of quinine a day.  The  second morning, the fe-
brile excitement had  subsided, and portions of
the membrane fallen.  The third, the tonsils pre-
sented a red, jagged surface, free from membrane.
The pulse was slow and measured, and the skin 
           ALCOHOL  AND DIPHTHERIA.        67

as cool as though it had just been bathed with an
evaporating lotion.  The fourth, he came down
stairs; the fifth, he walked out; the sixth, he gave
up his medicine, went  to  his  business, and re-
turned to his evening  amusements, contrary to
advice.   For this  rashness  he had, the first of
March, an attack of acute  rheumatism,  which
soon yielded to free doses of salicin.

              Typo-malarial diphtheria.
   F. W., at. 6, was taken, the night of March 17th,
'78, with a croupy cough and febrile symptoms.
In the morning, when I  was called, the fever was
high, the fauces inflamed, and the tonsils dotted
over with diphtheritic points—the mouths  of the
follicles.   The second morning, these points had
coalesced into a thick, continuous, leathery mem-
brane. She took two drachms  of whiskey every
hour the  first day, and three the three following
days—making in all one quart by the graduated
glass.  The fifth, sixth, and  seventh days, the in-
terval between the doses was increased to an hour
and a half, and at night  more time was allowed
for sleep.  The reason  for  the change was the
lowering of the pulse, the calling for food, and
the falling of the membrane, excepting that fill-
ing the follicles.  The  evening  of the seventh
day, the surface of the  body was cool.  During
these  three days, she took  nineteen ounces of
whiskey. 
68
ANTAGONISM OF
  On the eighth day, convalescence seemed to be
established.  On the ninth, there was no mem-
brane; but a diffused redness, and a return of the
croupy  cough.   The  tongue,  which  had been
much coated, became  dry and  crusted.  The se-
cretion of bile was partially suppressed, and the
desire for food lost.  On the tenth day, the whis-
key was decreased to one and a half drachms
every two hours,  and the quinine changed for
ammonia.  On  the  fourteenth day, a free secre-
tion  had restored the voice and resolved  the
croupy cough;  but  three small patches had ap-
peared on  the tonsils,  a slight epistaxis and
haemoptysis had occurred several  times, and the
exudation had  showed  itself  in  the  vulva.  It
being thought that the ammonia had, by render-
ing the blood alkaline, counteracted the effect of
the antidote, and thus caused  the  unfavorable
symptoms, the whiskey and quinine mixture was
resumed ( 3 ij every two hours), and the muriated
tincture of iron was  given  in eight-drop doses
three times a day.   In from forty-eight to seven-
ty-two hours the patches fell, the mucous inflam-
mation disappeared, the haemorrhage ceased, the
tongue cleaned, and the strength returned.  On
the twentieth day, there  being  no further call for
my visits, they were discontinued.   The girl's
health has since been  fully regained. 
ALCOHOL AND DIPHTHERIA.        69
Five physicians of this city, whilst attending malignant cases
   of diphtheria, have contracted the disease.  Of these,
     two icere treated by accepted modes, and died, and
         three by the alcoholic, and recovered.

  Dr. Geo. G. Hopkins, of this city,  performed
tracheotomy  on a child in extremis from diphthe-
ritic croup the past Winter, and was in constant
attendance to the time of its  death—ten days
thereafter.   The same  night, he  discovered a
membranous patch on  each of his  tonsils.  Im-
mediately, he began the use of brandy in full
doses—two tablespoonfuls every hour.  This large
quantity, repeated on time, caused no stimulation
until the  end of three days.  As  the modern
tablespoon holds six drachms, more  or less, he
must have taken in seventy-two  hours  about
three quarts of brandy—and that,  too, without
experiencing  the slightest  excitement.  On  the
fourth day, he reduced the amount of brandy and
commenced the use of  quinine.   The  only other
remedy was the chlorate of potash as  a gargle.
  On the second day, the membrane was loosened,
and, on the  third,  detached.   Experiencing no
secondary disorder except weakness, he very im-
prudently resumed his business, including night-
calls, in a week's time.   The cost of this  impru-
dence was confinement  in the house for  several
weeks with acute rheumatism, to  which he is
subject. 
7°
ANTAGONISM  OF
  I present the cases of Drs. Catlin and Watt in
their own words :

                 Brooklyn, Feb. 26th, 1878.
Dear Doctor:
  I send you briefly my personal experience with
the grim disease diphtheria; and I  do so with
more  than ordinary satisfaction, because I feel
that the treatment  used in  my  case proves the
truth  of all  you have said so many times at our
Society in regard to the beneficial results of sat-
urating the system with alcohol.
  I was called, December 6th, '77, to assist in the
operation of tracheotomy for a case of diphthe-
ria where the membrane had invaded the larynx
and trachea, and was  subsequently detailed, as
one of several  physicians,  to  watch  the case.
Two  days  after first exposure, the disease de-
clared itself in my own system, and announced
itself  by a prostration so absolute that only those
who have made  personal acquaintance with this
modern plague can comprehend it.  Within six
hours after the membrane first  appeared on the
tonsils, my strength was so entirely gone as to
leave  me almost absolutely helpless.  Under the
guidance of my faithful friends,  Drs. Hallett and
Campbell,  the whiskey  and quinine  treatment
was pushed, and from the first dose of the stim-
ulant I was conscious of benefit.  The membrane
began to disappear in  thirty-six hours; but the 
ALCOHOL AND  DIPHTHERIA.
71
convalescence was  slow, and  the  constitutional
depression continued for over a month after the
attack.
  It may be  said truly that the local manifesta-
tions were slight;  but  the  prostration came so
suddenly, was so absolute, and continued so long,
that the presence of some virulent blood-poison
was apparent.  The alcohol was exhibited every
hour at first, in tablespoonful doses, but was only
felt in a general warming sensation  through the
system without any exhilaration until the third
day, when, for this reason, it was given in  dimin-
ished doses.  From  the first,  I was conscious that
it  not only held the  disease in check, but gave
me the power so much needed to fight it success-
fully; and now I am more  earnest than ever in
urging the same course upon  my patients, while
I feel personally under a debt of gratitude to you
for the constant, persistent, and emphatic  way in
which you have called our attention for the last
few  years to this  way  of using alcohol  in this
most treacherous and alarming disease.
  The stimulating  plan of treatment has long
been followed by all of us; but we, as a profes-
sion, owe you  a lasting debt  for insisting upon
early alcoholic saturation of the  system as the true
way to exhibit  the  stimulant, if we  would gain
its antidotal  effect  and  throttle the disease early
in  its history.       Yours, sincerely,
                              A. W. Catlin. 
72
ANTAGONISM  OF
           Office of James Watt, M.D.,   )
    276 Carroll st., Brooklyn, April 23, '78. j
E. N. Chapman, M.D. :
  Dear Sir—During a period of twelve years, I
have constantly kept in view, in the treatment of
diphtheria, the laws laid down in the article pub-
lished by you during the year 1863.  I have good
reasons for believing  that  many of my cases of
diphtheria were cut short, and the severity of the
attack  lessened, by the use of alcoholic stimu-
lants.  I find  that it  reduces the pulse, lowers
the temperature, induces  sleep, and  stimulates
the sympathetic nerves.   I  believe that it has, in
several instances under my observation, prevent-
ed cardiac paralysis.  I have  been  surprised at
the quantity which the patient, at any given age,
may use during  the attack.  So far as my experi-
ence goes, I have frequently given half an  ounce
every hour to a child of from five to eight years,
without any of its toxical effects being exhibited.
  During the year 1876, I suffered with a severe
attack  of diphtheritic poison, from  the constant
attendance upon a family  of five  persons who
were affected with the disease.  I was taken with
severe rigors, muscular pains, headache, and sore
throat.   The only kind of liquor I had at home
was Jamaica  rum, of which  I took about  two
ounces every three hours, with ten grains of qui-
nine every six hours.   In  less than twenty-four
hours I  was free from pain, had no exudation on 
ALCOHOL AND  DIPHTHERIA.
73
my throat, and was  able to attend to my office
duties in two or three days.
  While I am  willing to give all due  credit to
the alcohol taken, I must confess  that quinine
must, and always will, play an important part in
the treatment of this disease; but I am satisfied
that any one who will give the alcoholic treatment
a fair trial in cases of diphtheria will never have
cause to regret it.
                    Yours, truly,
                               James Watt.

  That alcohol has a specific power over the
poison of diphtheria—the same as over the poison
of the rattlesnake — is to  my mind more fully
demonstrated (if this were necessary) by  every
fresh case coming  under observation.   The freer
the dose, and the earlier the treatment, the more
prompt the effect, and the more  complete the
cure.  Thus, blood-changes are  anticipated, and
the fell destroyer is met face to face as he breaks
his way into the citadel of life.   The quantity of
alcohol given should be regulated by the volume
of the circulation and the malignancy of the dis-
ease, and  not by rules applicable  to ordinary
cases.  An excess would be  safer than a defi-
ciency, as the one would do no harm, and the
other might fall short of the  full specific  effect.
Dr. Hopkins wisely administered to himself two
tablespoonfuls of brandy every hour, seeing that
                       6 
74
ANTAGONISM  OF
for ten  days his blood had been continuously
taking in the poison.   The fear of stimulation is
not to be entertained, whatever the complications
present that, under ordinary conditions, forbid
the use of alcohol, as  it will now, as in simple
diphtheria, be the  most powerful  antiphlogistic
to reduce the pulse, lower the  temperature, and
subdue the inflammation.
  In further proof of this  direct and  positive
action of alcohol, I find by trial that its  immedi-
ate presence in the blood is  needed to neutralize
the poison, and attain full  specific effects—that,
taken some days before or after the  infection  of
the blood, it is of little efficacy.  Hence, a person
exposed to  contagion ought, on  the second  or
third day, to begin the prophylactic treatment,
and, thereafter, to continue it a week or  more.
  What establishes the alcohol on a still broader,
firmer foundation is  the fact, that, having been
tried the past  six months by many physicians of
this city, it has yielded results emphatically con-
firmatory of mine.   Several  have not lost a case;
and all, though now and then unfortunate, have
met with a success to them unknown before.  As
far as my inquiries  have extended, I am warranted
in the statement, that, with those  using  the alco-
holic treatment, pure and simple,  the ratio of re-
coveries has reached  95 per centum.   This good
report passing from mouth to mouth has raised
alcohol into high favor—so  high  that it is now 
ALCOHOL AND  DIPHTHERIA.
75
 considered by many here, whatever else they may
 think  proper to unite with it, the remedy par
 excellence.  This change of practice is  beginning
 to tell on the statistics of the disease, as appears
 by comparing the cases and deaths of the last six
 months with those of corresponding months of
 preceding years.

     CASES OF AND DEATHS FROM DIPHTHERIA.
            1875.            1876.
         r--------*-    ^           >
         Nov. Dec.: Jan. Feb. Mar. Apr.
 Cases,  .  348 353   345  305  271  214=1838
 Deaths,  . 98  106    90  112   89   84=  579
   Less than one death in three, or 31.5 to 100.
            1876.            1877.
         ----*----*  ,--------•--------N
         Nov. Dec: Jan. Feb. Mar. Apr.
 Cases,  .  173  229   208  181  210 229=1230
 Deaths,  , 61    71    77   57    94    68= 428
  More than one death in three, or 34.79 to 100.
            1877.            1878.
         ,____*____N   ,________»________
         Nov. Dec: Jan. Feb. Mar. Apr.
 Cases, . 242  252    242   173  180  135 = 1224
 Deaths,  . 72    50    56   32    43    37= 290
  Less than one death in four, or 23.69 to 100.

  The figures above presented show that  there
has been a remarkable improvement in the ratio 
76
ANTAGONISM  OF
of recoveries the past six months, especially when
it is considered that, of the great bulk  of those
practising medicine in this city, but few compar-
tively have  employed the alcoholic  treatment.
This one fact, at least, ought to arrest attention.
In the last  epidemic, there were in the months
named 1230 cases of, and 428 deaths from, diph-
theria; and, in the present epidemic,  1224 cases
and 290 deaths—the saving of 138 lives.  Surely,
the hope is not premature that the dawn of a
better day is at hand—one in which this great
scourge of the young in very many parts  of this
country shall be met fearlessly, and  conquered
promptly.
           THE SPHERE OF ALCOHOL.

  Alcohol is adapted to a much wider  range of
application than is thought  advisable, or safe
even, by the majority of the  profession.  In  the
earlier years of my practice, in accordance with
the doctrines I had  been taught, I never resorted
to  stimulation,  however  moderate, when there
was the slightest  arterial  excitement, without
much hesitancy and many misgivings.  Safety
lay, according to  the  general  opinion,  in  the
direction of reducing  measures  as long  as  the
fever and inflammation persisted.  These being
subdued, it was  deemed  imperative  to feel  the
way cautiously, lest the heart might  be  excited
and the disease renewed.  Hence, a resort to 
ALCOHOL AND DIPHTHERIA.         77
stimulants might be too soon, but rarely too late.
  As, however, many cases of ship-fever fell to
my lot, I soon found that the more I disregarded
the skin and pulse, and  gave support to the
struggling  vital forces  by such mild means as
wine and broth, the better fared my patients.  At
length, as  I  ventured  to  give  small doses of
brandy  early, the improvement was  still more
prompt.  Consequently, when, by my ill-success
in diphtheria, I had come to the conclusion that
it, equally with typhus and typhoid fevers, was a
blood-disease, I  was not  wholly unprepared to
adopt a  supporting, stimulating  treatment.   I
soon  found,  as  my cases multiplied, that the
earlier the use and the freer the  dose of alcohol,
the milder the disease and the quicker the recov-
ery.  The  fever subsided,  the inflammation  re-
ceded, the membrane fell, and  convalescence be-
gan, as though some magic influence had blight-
ed  the germs of disease.   Here, certainly, was
not the effect of a stimulant, but of an antidote.
  At first, when diphtheria appeared in company
with scarlatina, croup, pneumonia, or other dis-
ease that forbade, according to the views I then
held, the use of  stimulants, I was  in  great per-
plexity, inasmuch as what was indicated in one
was contraindicated in the  other.  It  seemed as
though, by  the intervention of a purely inflamma-
tory disease,  I was debarred the use of my rem-
edy.  Proceeding with  much  caution, I discov- 
78
ANTAGONISM  OF
ered, by tentative  trials, that the accessory dis-
order,  however high  the  fever  and  rapid  the
pulse,  yielded  to  the  alcoholic  treatment pari
passu with the primary, but went from  bad to
worse, whatever else was done, when the alcohol
was insufficient  to neutralize the diphtheritic
poison. Hence, I was ultimately led to disregard
all complications, and  push my remedy in heroic
doses,  so as to destroy as quickly as possible this
poison which imparts its quality to every morbid
process arising in its course.
   In the  same way,  I  became  satisfied, when
haemorrhage from mucous cavities, congestion of
the kidneys,  feebleness of the heart's action, loss
of muscular  power, or other condition—the se-
quel of diphtheria—showed itself, that the anti-
dotal treatment was still the main  reliance.
   Thus, eventually, experience fully  convinced
me that the alcohol was not only the remedy for
the diphtheria-poison, but also for  its  effects.
These  are, almost always, varied expressions of
functional torpor of the sympathetic system—the
one common pathological state, I am thoroughly
convinced, of every disorder attendant upon, or
following after diphtheria.  At the outset, there
is a semi-paralysis of  the  vaso-motor nerves of
the fauces, resulting in engorgement (not inflam-
mation), the  transudation of the  liquor sanguinis,
and the formation of the membrane.  A like con-
 dition  of  the  vaso-motor nerves,  distributed to 
ALCOHOL AND DIPHTHERIA.        79
the mucous tissue, induces haemorrhage, to the
lungs pneumonia, to the  kidneys albuminuria,
to the  heart  and voluntary muscles  paralysis.
Hence,  with the  blood freighted  with a poison
which acts on  the nerves of organic life with such
deadly  energy that the various  functions—the
sum of which is vitality  itself—are either sud-
denly  suppressed,  or continuously obstructed,
what can the physician accomplish unless he first
remove the cause?  This done,  the effects are
under command.
  I  conclude, therefore,  that alcohol  in  large
doses is, at an early stage, both an antidote and
an  antiphlogistic ;  but that alcohol in  small
doses is, at a  later stage, together with quinine,
a stimulant and tonic to the sympathetic nerves,
by  and  through which the circulation  of the
blood and the nutrition of the tissues are accom-
plished.
  In  scarlatina,  rubeola,  influenza,  sewer-gas-
poisoning, and most low types of fever, there is a
like contaminated state of the blood, and a like
impression upon  the sympathetic nerves.  At
least, alcohol  is  more  efficient  than any other
article in modifying  these diseases, and aiding
nature in its recuperative efforts.   In fact,  most
inflammatory  diseases, even  though sporadic,
originate from morbid materials in the blood—
the effete matters generated in the system—and
not  from  external  causes.   These  retrograde 
8o
ANTAGONISM  OF
 products  depress  the sympathetic  nerves, and
 weaken the animal functions.  In practice, I find
 that, speedily after the violence of the disease at
 the onset has spent itself, the alcohol and qui-
 nine are far superior to all  other articles of the
 Materia Medica.
   The  stimulation of the sympathetic nerves is
 markedly  efficacious in most chronic diseases  in
 which  the restoration  to  health is dependent
 mainly on a more active interstitial  nutrition.
 This is evinced in bronchitis by the  secretion  of
 mucus, in pneumonia by the resolution  of the
 hepitization, in tuberculosis by the limitation  of
 the deposit, in scrofula by the  reduction  of the
 glands, and in suppuration by diminution of the
 discharge.  The  same  remark  is  applicable in
 most disorders that depress the  nervous energy,
 and impair functional activity.
   In stomach and bowel  affections, alcohol  sus-
 tains its reputation by the  improvement  in the
 digestive processes; in debility, by the return of
 muscular power; and in  anaemia, by the deeper
 color of the blood.  In a word,  when the organ-
 ism has for a time  been  thrown into  disorder,
 and obstructed in its movements, the stimulation
 of the motor force that  keeps each and  every
 part in  operation is of the  first moment.  The
 reduction of this force robs nature of the power
 of resistance: the increase of it sustains her in
the contest, and not infrequently renders victory
possible. 
           ALCOHOL AND DIPHTHERIA.         81

   If alcohol act as an antidote in diphtheria and
 its congeners, it will be of  the first importance,
 in order to secure definite results, to employ fer-
 mented liquors of the standard proof.  It would
 be better, should there be a doubt of their qual-
 ity and strength, to use alcohol alone, the effect
 of which can be definitely estimated and exactly
 regulated.  This course might, perhaps, be advis-
 able under all  circumstances, inasmuch as the
 remedy would then be placed among drugs, and
 the scruples of many  persons  be relieved.  At
 least, the change would not imperil the welfare
 of the patient.   The following formula, which I
 have used, answers every purpose:
 $     Quiniae sulp.
       Cinchoniae sulp., .  aa gr. viii-xvi.
       Acid. sulp. aromat.,  .  .  .   3 jss.
       Fr. cinchonae comp.,  ...   3 iv.
       Sp. rectificati,.....3 ivss.
       Aq. fontanae,.......1 iij.   M.
   For an  adult,  from four  to  six drachms  is
 the proper dose, which in severe cases is to be
 repeated every hour.

       DIETARY OF LIME-WATER AND MILK.

  There is a point in the treatment of diphtheria,
only casually alluded to heretofore, that demands
close attention when the disease persists, compli-
cations arise, or  sequelae follow.  This point—the 
82
ANTAGONISM  OF
diet—may at first be a matter of little  concern ;
and yet, in a day or two, one of the highest mo-
ment, inasmuch as the repair and waste of the
system  are dependent, almost  wholly, on  the
vitality ot the  blood and  the  tonicity  of  the
nerves.   Nutrition, secretion, and excretion fail-
ing, medicine loses its efficacy and meets with no
response.
  As  the diet  enjoined  has, in  my later cases,
consisted chiefly, if not exclusively, of lime-water
and milk, it seems incumbent upon me, in order
to render the details of treatment complete, to
explain the action of lime on milk, and give the
reasons why the product, thus formed, is claimed
to be superior to any other article of food.
  The importance of diet, either in health or dis-
ease, can scarcely be overestimated.  In the sick-
room, the use of broths, extracts of beef, tea and
toast,  and the many farinaceous  preparations
that, until the last four or five years, held  undis-
puted sway, has now given place, more or less,
to that  composed  largely or  wholly of milk.
This change  was  mainly due  to the fact, that
milk contains all the elements of nutrition in the
exact proportions  needed by the  several tissues
of the body;  but other articles, separate princi-
ples only—the proteinaceous,  the amylaceous,
the  oleaginous, the saline, etc.—that might or
might not be so adjusted as to supply the demands
of nature.  A deficiency, or  a disproportion, in 
ALCOHOL AND DIPHTHERIA.
83
 the animal, vegetable, and  mineral constituents
 of one's food seriously impairs digestion, impov-
 erishes the blood, and  perverts assimilation—
 matters of no light import, when the welfare of
 the patient depends upon the integrity of the
 nutritive functions.
  To plain milk, which is gradually supplanting
 everything else in the dietary of infants, and even
 those of riper years, there exists the serious ob-
jection that it is, from  the large,  solid curds
 formed in the stomach by the action of the gastric
juice, quite indigestible—a condition  of things
 the same as when pieces  of meat are  swallowed
 entire.  As these masses of curd are  to be lique-
 fied from  circumference to centre  by a slow,
 laborious  process of disintegration, such  a  diet
 can but be more faulty than  the  old, with all its
 shortcomings.   In health, it oppresses the stom-
ach, excites dyspeptic symptoms, and occasions,
oftentimes, a smart febrile attack.   How, then,
can its  steady and exclusive use, if thus prejudi-
cial to  the well, be salutary to the  sick, whose
gastro-intestinal  secretions are disturbed  and
vital forces depressed ?  For one, I  am fully con-
vinced  that plain  cow's milk is  unfit to be the
main article of diet in any case,  whether that of
children or adults, and especially when the char-
acter of the solvents of the food is much impaired
by disease.
  To remedy these objections to plain milk, the 
84
ANTAGONISM  OF
addition of an alkali has been advised, particu-
larly in the case of infants.  Lime, potassa, soda,
or ammonia is selected indifferently, as the action
of each is thought to be the same—the removal
of acidity, and the promotion of digestion. Now,
an  ounce and a half of lime-water,  containing
less than a grain of the alkali, will, when added
to a glass of  milk, obviate its  bad qualities, and
render it the  most friendly substance that can be
given,  even to those who never drink  it plain
without a sense of uneasiness  and weight at the
epigastrium,  and that, too, though employed as
the sole diet  in typhoid cases.
  Will potassa, soda, or ammonia, in grain doses,
produce the like effect ?
  Having, the last five years, fed babies to the com-
pletion of the  first dentition on  Kme-water and
milk, the earlier months exclusively, and the later
with the addition of farinaceous preparations only,
I have attained certain striking results—results to
which, hitherto, I had been a stranger. It is sur-
prising how  vigorous is the digestion, how  com-
pact the frame, how hard the flesh, how clear the
skin, how bright the  face, and how rich the
blood; and,  besides, how  rare are common ail-
ments,  and  how  prompt  the re-action against
grave diseases.  In physique, they are not unlike
the uncared-for little brats one  may see—dirty,
ragged, unkempt, playing by  the roadside in  re-
mote country-places, where modern progress has 
ALCOHOL AND  DIPHTHERIA.        85
not stamped the life-blood  out of the  coming
generation.
  Will  potassa, soda, or ammonia, given  one,
two, or three years uninterruptedly, be thus con-
ducive to health ?
  Lime develops remarkable nutritive qualities
in milk by virtue, not of its alkalinity, but of an
undetermined chemical property, which has the
singular effect to render the  milk acceptable to
the stomach, easy of digestion, and ready for as-
similation.   Thus  the phosphate of lime, the
prime factor in tissue changes, is, in the  ratio of
2.31 to 1,000 parts of milk, presented to the blood
and distributed to the growing cells.  That cow's
milk  has highly nutritive  properties is  demon-
strated practically, on a large scale, by the rapid
growth of calves the  first few  weeks after birth.
Here  the  milk and  the stomach  are  exactly
adapted; not by art, but by nature, the one to
the other.
   Lime has a peculiar action on oil and on milk,
as  is  shown by very simple experiments.  An
ounce  of  lime-water, representing  six-tenths
of a grain of lime, and an ounce of olive, or lin-
seed oil, when shaken  together, become a thick,
honey-like mass that  does not change by keep-
ing ;  but an equivalent proportion  of the  other
alkalies dissolved in  water  and  mixed with the
oil, form a thin, yellowish fluid that soon  sepa-
rates into its original constituents.  In the first ex- 
86
ANTAGONISM OF
periment, there is formed a permanent emulsion ;
but, in the second, a temporary admixture only.
There is, as I claim, a like re-action between the
lime and the oil-globules of the milk, that inten-
sifies the emulsion already existing, and renders
the normal, but weak bond of union, closer and
more intimate.
  Four grains of pepsin will precipitate the ca-
sein of an ounce of plain milk almost  immedi-
ately ;  but, if lime-water  be first added, not for
three or four hours.   The first experiment yields
dense, adherent  masses;  but the second,  fleecy,
broken curds, that are so soft and fine as on agi-
tation to blend again with the whey, and restore
the original white, opaque color.   The emulsion
formed by the re-action between the  cream and
lime is neither disturbed by  citric, or hydro-
chloric acid, nor is  a black  precipitate thrown
down by calomel.
  My inference, therefore, from  observation and
experiment, is that milk, by the addition of lime,
is enabled to resist the prompt action of the gas-
tric juice; that the precipitate formed eventually
is fine and flocculent, and, consequently, is easily
digested; that all the constituents of the milk,
properly elaborated, are presented to the lacteals
for absorption;  that the blood receives each ele-
ment of  nutrition in the proportion required for
perfect assimilation ;  that the hydrocloric acid of
the gastric  juice—an agent in the  solution  of 
           ALCOHOL AND DIPHTHERIA.        87

 protein-compounds second to pepsin alone—does
 not affect the emulsion ;  that the casein is beyond
 the reach of the vegetable acids; that the affinity
 of calomel and other  chemicals for lime is less
 than that of cream, whereby the special effect of
 medicine is not impaired; and, finally, that lime
 in  the proportion of a grain  or  less to eight
 ounces of milk  renders it a perfect  food—one
 answering all the demands of the  digestive or-
 gans, and all the  requirements of the nutritive
 functions.
  Not only does milk represent all other foods,
 but certain medicines as well—cod-liver oil, the
 phosphates, the salts of iron, the vegetable acids,
 etc., etc.—which are in common use by physicians
 to remedy the defects of an ordinary diet.  Here
 is a natural product, within  the  reach  of all,
 which offers the oil,  the phosphorus, the lime,
 the iron, and every other principle necessary to
 normal nutrition, in a state of chemical combi-
 nation far better adapted to the wants of the  sys-
 tem than in the rude  substitutes of the Materia
 Medica.
  At an early period of infancy, condensed milk
 is preferable to plain, inasmuch as the more inti-
 mate union of  its constituents  by heat aids the
 lime in preserving the division of the casein.  So,
 also, at a later age, and even  at any period of
 life, there may be the same  reasons to influence
 the choice, when the gastro-intestinal secretions
are excessive and very acrid. 
88
ANTAGONISM OF
  As, however, its mawkish taste when diluted
with water forbids its general direction to those
old enough to insist on their likes and dislikes,
it  is desirable to have a preparation of similar
qualities.  Such a one can be readily improvised
by first making a gruel of farina or ground bar-
ley with water, and then adding five or six parts
of milk a few minutes before the  skillet  is re-
moved from  the fire.  This gruel  should, from
the labor  thrown on a weak stomach by starchy
compounds, be very  thin—only just  enough in
substance to form a thickened mixture with the
milk.
  In preparing the baby food, take  of condensed
milk  two, of warm  water  twenty-four,  and of
lime-water four teaspoonfuls.  To  this, add half
of a  teaspoonful  of powdered sugar — about
twenty-five grains—and of salt, a  pinch—about
two grains.  If the infant be more than  a year
old, the water may be diminished to twenty  tea-
spoonfuls.  By the same scale of dilution, plain
milk, when of good  quality, should be reduced
by  one or two parts of water, according to the
age of the child, and then the other ingredients
added, as in the first instance.  The ratio of lime-
water to cow's milk  is, for  ordinary use,  as  one
to seven, or two tablespoonfuls to  a tumbler of
milk, and three to a goblet.  This proportion of
lime-water, however, may be  increased with ad-
vantage by a  quarter or third part,  whenever the 
           ALCOHOL AND DIPHTHERIA.        89

gastric secretions are much in excess. As, at the
outset of any serious illness, the digestion is in
abeyance and the assimilation at a stand-still, it
is often advisable to give the milk scalded in a
gruel of farina or barley.  In a day or two, how-
ever, the lime-water and milk—diluted or not, as
the case may be—will constitute the most accept-
able and nutritious diet,  even  when continued
for weeks together.  For an adult, three pints of
milk in the twenty-four hours, given in larger or
smaller quantities at a time, are  sufficient to sus-
tain the system, and afford all  the nourishment
attainable by other kinds of food.

     ORIGIN OF THE ANTIDOTAL TREATMENT,

   If alcohol be, as  has been abundantly shown
in the  preceding pages, a  true antidote to  the
diphtheria-poison, it will be not inexpedient, at
the close of this work, to  give the  facts  upon
which  my claims to the discovery are based.   I
lost a  little girl  five and a half years old—the
victim of diphtheria—December  23d, '60.  The
treatment was conducted  on the plan  then  in
vogue.   My first trial  of alcohol in full  doses
and at the inception of diphtheria, as detailed in
the Boston Journal, February 3d, '63,  is here
given:

  " A few days after the death of this girl,  I was
called  to see another about the same age, who
                       7 
9o
ANTAGONISM  OF
was scrofulous, fleshy, a hearty eater, and delicate
from confinement within doors.  The child had
great irritability, a high fever, a hot,  dry skin,
and  a rapid, full  pulse.   Great difficulty was
experienced in swallowing, from  the  inflamed
and swollen tonsils, on one of which a membran-
ous patch was seen.   A teaspoonful of brandy
and a quarter of a grain of quinine were directed
to be given every hour, and the nitrate of silver
was applied every morning. This treatment was
continued uninterruptedly for  four days ;  when,
on the disappearance of the membrane, the qui-
nine and caustic were  omitted, and  the brandy
given singly.  This was to prevent a relapse, in
which it was successful, and to correct the altered
state of the blood.  On the morning of the second
day of the disease, the fever was lessened, the skin
disposed to perspiration, and the  swallowing
easier; though the  membrane had extended, and
the tonsils were darker colored, and bled when
roughly touched.
  "On the third day, there  was a great  improve-
ment in the  symptoms—diminished vascular ex-
citement, the membrane stationary, and looking
thicker, more raised, and of a yellowish color,
  " On the fifth day, the engorgement of the ton-
sils had subsided, and the membrane had  disap-
peared."
  As early as the  Spring  of  '61,  the  action of  .
alcohol in diphtheria was explained  to the stu- 
ALCOHOL AND DIPHTHERIA.
91
 dents in the Long Island College Hospital, and
 its marked efficacy illustrated  by cases.   The
 following case is an example :

   "During the session  of '61,  a little girl, u
 years of age,  presented herself at the College
 Clinique, brought there by her  mother.   Four
 weeks previous, she had had the  diphtheria—si-
 multaneously with three other children in the
 same house. All, except this one, died; and she
 escaped as by a miracle.  The mother stated that
 at first her  throat was  in a frightful condition,
 that there was  bleeding from the nose, and that,
 in two weeks, these symptoms  abated, when
 her weakness was very  great, and she was both
 blind and deaf.  After a time, the power of the
 arms was lost, when sight and hearing began to
 return.  In a few days more, the legs began to
 be affected, at which period she was presented to
 my notice.  The  power  in all of her extremities
 was nearly equal, though very imperfect and un-
 certain ; hearing and sight  apparently good; the
 countenance stupid and  idiotic; and great dull-
 ness of the mind,  which  seemed to partake of the
 general lethargy.  This case was treated  with
 brandy and good  food.  In a few days, there was
 a general  improvement in all of the upper  por-
 tions of the body ; but walking was much more
 difficult, and well-nigh  impossible.  The child,
from this time, was not brought back for twelve 
92
ANTAGONISM OF
days:  the mother, who came  to renew the pre-
scription,  stated as a  reason, that, from the loss
of power  in her legs, it was impracticable, al-
though there was now less weakness in the arms,
and her intelligence was improving.   After her
return, it was nearly three weeks before she re-
gained  the  perfect  use  of her lower  limbs.
Eventually,  however,  she  was  completely re-
stored in every respect, both in mind and body ;
as, several months subsequently, I had the oppor-
tunity of observing.   The manner of this creep-
ing paralysis was not a little remarkable; and,
still more, the torpor of the brain, which resulted,
for the time being, in  an abolition of two of the
special senses, and probably, though  the stupid-
ity of the  girl was too  great to determine this
point, of the others also."
   During the above college  term, I had a severe
case in private  practice.  The resort to alcohol
was not as prompt as  is now my custom.  It will
be observed, however, that the dose of brandy
used is the same as  that employed  in my later
cases:
   " Master C, aged 6 years, scrofulous, small in
stature, and  of defective vital power, was at-
tacked  with the most  intense congestion and
inflammation of the tonsils, and had a bounding,
rapid pulse  of 120  pulsations per minute, and a
high  fever.  On the second day, the symptoms 
ALCOHOL AND  DIPHTHERIA.         93
were aggravated; especially the condition of the
throat, which was now hard and swollen in the
parotid region.  The mucous follicles of the ton-
sils were distended with a white matter, giving
them the appearance  they present in follicular
inflammation;  which disease it was supposed to
be, and treated accordingly with diaphoretics,
etc.   On  the third  morning, these white points
had united, covering the tonsils uniformly.  The
entire fauces were more inflamed, had a darker
hue, and were disposed to bleed on examination.
There had  been nose-bleed the previous night.
The fever was high, the  restlessness and irrita-
bility very great, and the pulse 150 per minute.
   " The  boy was  now put  upon brandy and
quinine:  the former, at first, in teaspoonful doses
every second hour, then  every hour, but event-
ually every  half hour ; the latter, in quantities
of six grains in the twenty-four hours the first
three days, when, on the supervention of tinnitus
aurium, the  dose  was lessened.  A  portion of
quinine was given for five days; but, after this
period, only stimulants  and  nourishment.  At
the outset, beef-tea  was ordered; but, from the
difficulty of swallowing, little  was taken during
the height of the disease.  The parents were en-
joined to  be  particular in  administering  the
amount of  stimulant   directed,  whatever  else
might be neglected.  During a part of the treat-
ment, the patient took  a weak  solution of chlor- 
94
ANTAGONISM OF
ate of potash; given  more for the purpose of
bathing the  throat as it was  swallowed, than
from any reliance on its systemic effects.
  " The second day after commencing the use of
brandy and quinine, there was the following con-
dition :  the fauces uniformly covered with mem-
brane, the fever and heat of skin gone, the sur-
face  bathed  with perspiration, and  the  pulse
equally rapid as at first.
  " On  the third day, there was a  profuse per-
spiration, an oozing of blood from the  tonsils,
epistaxis, and greater evidences of prostration,
as shown by restlessness  and jactitation. Though
the quantity of brandy now given was large,  the
effects of a stimulant were not observable.
  " On  the fourth day,  the membrane was  de-
tached at several points,  was raised, thicker, yel-
lowish,  and appeared  as though it would soon
fall off.  The inflammation had subsided so  much
that  the act  of swallowing  was  more  easily
effected; yet the pulse was still soft and  rapid,
the weakness  extreme,  and the sweating pro-
fuse and exhaustive.
  " From this date, the  improvement was rapid
—the membrane hanging  in shreds, and finally
dropping off, and the engorgement of the throat
subsiding, so that the parts resumed their nat-
ural appearance.
   " On  the ninth day, the membrane disappeared,
and did not subsequently return.  On account of 
ALCOHOL AND  DIPHTHERIA.         95
the debility of the patient, the brandy was con-
tinued for some time after my attendance ceased.
Under its use, the child recovered  from the de-
bility so characteristic  of this disease,  and  re-
gained his wonted health."

  To show my treatment  still  further at that
early day, I will add one more case :
  - Mr. B., Fulton avenue, 35 years of age, a
baker by trade, working in a close, under-ground
room, of a pale look, emaciated appearance, and
of a  weak, delicate constitution, was taken with a
sore throat,November ist/62, and had fever, thirst,
and  inflamed tonsils—in other words, was seem-
ingly attacked with tonsillitis.   On the second
day, the mucous cryptae were filled  with a white
secretion, giving the parts the appearance of fol-
licular inflammation. On the third day, many of
these white spots had coalesced ; and the uvula,
becoming inflamed, had  a small patch of exuda-
tion on its  surface.  There  had been epistaxis
during  the night;  and the tonsils, disposed to
bleed, were  now covered with drops  of  blood,
which exuded on forcibly depressing the tongue.
The patient experienced an aggravation of symp-
toms from  a gargle  of the sulphate of zinc
which he had been using.   Both this and a dia-
phoretic mixture  were discontinued, and brandy
and  quinine substituted.  He took  continuously
half an ounce of  brandy  and half a grain of 
96             ANTAGONISM OF
quinine every second hour, until there was ring-
ing in his ears, when the latter was omitted, and
the stimulant alone administered.  The brandy
was continued in  a gradually diminished dose,
until  convalescence  was  established, and then
iron was given  to improve  the quality of his
blood.
  " Directly  after  commencing  this course  of
medication,  the disposition   to  spontaneous
haemorrhage  was overcome,  the congestion  of
the fauces abated, and the membrane, becoming
thick and yellow,  fell off, and was not renewed.
At this time the uvula, being  implicated, turned
of a black color  at its extremity, and sloughed
off.   Counting from the first appearance of the
membrane, it was  ten days  before  the fauces
were free of it; and the patient, though using
such bracing and sustaining remedies, was daily
getting weaker and more  debilitated.  Now he
was scarcely  able to maintain the erect posture,
his  legs  giving  way  from under him; and he
sweat profusely, drenching the clothes whenever
he  slept;  yet, in  two  weeks  more, his usual
health was regained."

  In the transaction of the Medical Society  of
the County of Kings,* I am thus reported :
  '' Dr. Chapman made some  remarks respecting
diphtheria.   He  thinks  it  a  blood disease, the
*April, '6i, vol. i, p. 199. 
ALCOHOL AND  DIPHTHERIA.
97
 poison of which may be eliminated in health—
 the throat trouble being but a symptom of gen-
 eral constitutional disturbance.
   " He commenced the treatment  of the disease
 [on  its appearance in '58] with mercurials, and,
 locally, with caustic; but his experience had
 convinced him that these remedies are injurious,
 and he now  relied  entirely upon  brandy and
 quinine, and upon simple gargles.
   " Brandy, he thinks, acts not only to strength-
 en the system, so that the poison may  be elimin-
 ated ; but the alcohol increases  the  plasticity of
 the blood, while the tendency of the disease is to
 disorganize the blood, and allow the albumen to
 form the membrane.
   " Dr. Chapman thinks the condition of the
 throat is not that of inflammation, but is merely
 congestion—a stasis in the capillaries."

   The above extracts fix the date of the first use
 of alcohol by me in free doses at the inception of
 an attack of diphtheria.  If it so be that any one
 followed this treatment at an earlier day, it will
 be just and proper in him to present document-
 ary proof of the fact, and take possession  of his
 rights.  In concluding this  little work—which
 will, doubtless, be assailed by reasoning a priori,
by arguments ad captandum vulgus, by the keen,
incisive sarcasm  of that  host  of  critics whose
bounden duty seems  to be  to  protect inviolate 
98
ANTAGONISM OF
the domain  of rational medicine,  so-called—I
ask one favor, and one  only: that the  state-
ments herein made shall be tested empirically,
by the actual treatment of a series of cases Under
the conditions  laid down, before  judgment is
passed,  and the court  adjourned.   In  other
words, that the defendant shall  have a fair trial
before he is condemned.  With this preliminary
to criticism—a formality rarely observed—I am
certain that the critics will become advocates,
even enthusiastic  advocates, of the  new  doc-
trine—the Antagonism of  Alcohol and Diph-
theria.