74

REPORT ON DIPHTHERIA, WITH POST MORTEM AUTOPSIES.

Colonial Hospital,
New Plymouth, 3rd August, 1861.

Diphtheria has been more than sporadic in this town, for several months past, and the fatality therefrom in the proportion to the number attacked has been very considerable. Until to-day, when two cases in a wharre near the Hunui were brought under my notice, no cases among the Maories have occurred, consequently I have hitherto taken few cases under my own care, and indeed felt, until very recently, so bewildered, as to the nature of the disease, consequently so undecided as to the methodus medendi, that I rather willingly held back from having farther to do with it than to be merely an onlooker. Yet I was early led to believe that the pharynx was not the primary seat of the disease, and that the morbid action on that was not the cause of the fatality. Therefore I endeavoured, lately, to overcome that silly prejudice against post mortem autopsy, and within the last fortnight succeeded in examining the bodies of three patients who had succumbed to the disease, the particulars of which I append to this Report. On inquiry I learned almost invariably—the exceptions being very young children—that the gastric symptoms preceded the pharyngeal, hence infer that these were resultants of the former, and nothing more. The coatings of the pharynx, which has given the nonsensical names, "Diphtheria" and "Angina Membranacea," to the disease, should be regarded rather as a deposition intended by nature to protect the tender parts they cover from the acrimony of the eructations, or risings of noxious gas from the stomach. But be this speculation right or wrong, still the stomach, as is verified by dissection, is the organ which suffers most from the disease. My theory, therefore, is that, from some hitherto occult cause, a morbific ferment takes place in the stomach, which excites, first a functional disturbance of that viscus, but eventually an inflammation of the inner membrane thereof, which, as in the instance of the milder, yet often fatal grades of yellow fever, runs on, very generally, but in so far as my experience goes, somewhat insidiously, till towards the final stage, to the utter disorganising of the mucous tissue, or villous coat. The similarity of effect on this, to that which I have a hundred times witnessed in autopsies of fatal cases of yellow fever, was very remarkable in the appended cases Nos. 1 and 2, even to the deposition of dark patches of matter on the said coat, resembling the notorious Black Vomit. And, moreover, in the first of these, the vomiting in the last stage had distinctly the coffee ground expression of color.

Treatment, of course, is various. Hitherto I have failed in no cases treated as follows, but these have only been four in number, and to these I was called so early that the pharyngeal membrane was in patches, or just beginning to form. I commence my treatment by the exhibition of a brisk emetic of the sulphate of copper—say sixteen grains to an adult, in an ounce of rain or distilled water. After the action of this I mop over the entire pharynx with a strong solution of nitrate of silver (one ounce to six ounces of distilled or rain water). Next I give liberal doses of levigated charcoal, not simply as a deodoriser, but more as a corrector of gastric fermentation. I pay no regard to the highly nourishing, quinine-and-wine-giving plans; but confine my patients to the least fermenting species of food, such as rice, soaked sea biscuit; and for drink, rice water and linseed tea. I take care to have, in the first instance, the bowels well cleared out by a large dose of calomel, followed by a draught of castor oil; and during the whole of the disease, I am careful also that the constipating tendency of the charcoal is obviated by laxative doses of the same medicines. The emetic requires, generally, three repetitions, and on two occasions I exhibited it twice a day. Generally it has the effect of forcing off the adventitious pharyngeal membrane much more efficiently than the caustic appliance. But my opinion is that the benefit derived from these is in some peculiar subduing action on the no less peculiar inflammation—probably in some such way as cayenne pepper acts on the stomach in yellow fever, or on the pharynx in angina. I have hitherto found that where the charcoal is given in frequent and sufficiently large doses, the bad odour of the breath is completely obviated; and, in conclusion, I may remark that the convalescence to full or usual health has been always rapid.

Post Mortem Autopsies.

No. 1.

• • • Aged four years, died on the twelfth day of the disease, or rather from the date of the false membrane commencing to form on the tonsils and posterior pharynx. On laying open the neck, thorax and abdomen, the various viscera, viz., the larynx, trachea, and bronchii, the lungs, heart, spleen, pancreas, intestines and all investing membranes and tissues seemed in perfectly sound, or normal condition. But the stomach, œsophagus, pharynx, and tongue, on being removed