fret ful, and seemed to be in great pain when handled, especially in the bath; comfortable only when lying across the nurse's shoulder. The left arm and leg became painful on the least motion, lost power and commenced to swell. The fontanelles were open as well as some of the cranial sutures. After the difficulty was recognized he was placed on pure milk diet without the addition of water, fruit juice, especially orange, and meat broth. Remedies were Calc. Phos. and Nux vom., as well as Lycopodium, overcoming the most distressing symptoms.

The fourth patient to whom I was called, by Dr. Dearborn, showed a swelling like an inverted saucer on the left side of the forehead which was about the size of a fifty-cent piece. In this case the right arm was enormously swollen, but the gums showed no evidence. It was found on inquiry however, that occasionally there was some blood in the passages from the bowels. This child also recovered soon on the above mentioned diet and especially Silicea reduced the swelling and tenderness rapidly.

Northrup justly remarks that the tendency against the use of patent prepared foods is justified. There seems no greater surviving fallacy current in medical practice than the retained feeding of tender infants upon the patent productions of commercial firms. Remedies appear hardly necessary according to those who have studied the disease from a nutritient standpoint. Nevertheless the intense suffering connected with the extravasation of the blood beneath and into the tissues can be greatly relieved by proper Homœopathic remedies, and the cure of the ricket complication made more rapidly. Therefore Phosphorus, Calc. phos., Cal. bromida, Silicea, etc., have been prescribed. One remedy however, may deserve our attention, which has not been recommended so far except in a passing note in Hale's New Remedies. I refer to Agave Americana, the American Aloe, the juice of which taken from the leaves has cured scurvy where simple diet and fruit juices have failed. The symptoms recorded as cured are the pale, dejected countenance, gums swollen and bleeding, legs covered with dark, purple blotches, legs swollen, painful, and of stony hardness; appetite poor; bowels constipated, and pulse small and feeble. This picture corresponds very well to the infantile form of scurvy.

There is in my mind no cause for creating a new disease name for a condition of scurvy which by the presence of rickets and espec

ially by the peculiarities of the development of the infantile organism is modified in its pathological features. We find that most all affections of childhood differ from those of the adult by these very same causes, and we would have to invent a special nomenclature for typhoid fever, malaria, rheumatism and many other affections when appearing in infants simply because they present differences as occurring during the growing age. I think if we simply content ourselves with considering and stating this affection as scurvy complicated with rickets in infants, there will be no necessity for the special name of Barlow's Disease.

THE PARALYSIS OF DIPHTHERIA.

BY O. EDWARD JANNEY, M.D., Baltimore, MD.

THE fact that diphtheria causes, usually as a sequel, a peculiar form of paralysis is now recognized. Attention has been called to this phenomenon at various times since Nicholas Lepois referred to it in 1580, but the medical mind has been loth to accept a fact so apparently strange.

About 12 per cent. of those who recover from an attack of diphtheria suffer from paralysis. It is observed after the false membrane begins to disappear, or more frequently after the active symptoms of the disease have entirely departed and the patient is in a state of convalescence. Instances have been observed also in which paralysis took place during the first days of the attack.

Both sensory and motor nerves are affected, and atrophy rapidly takes place if the paralysis continues sufficiently long.

LOSS OF TENDON REFLEXES.

The earliest paralytic phenomenon that occurs is the loss of tendon reflexes. What is known as "knee-jerk" is absent in about one-half of all cases of diphtheria, this symptom being observed often as early as the first day of the attack. It is apt to continue for a considerable period, and outlasts the other symptoms.

PALATAL PARALYSIS.

Paralysis of the velum palati and the muscles of the fauces is the most common form that is caused by diphtheria. In severe cases the palato-glossus and the pharyngeal constrictor muscles become paralyzed. Its presence is recognized by slowness of speech, nasal tone of voice, snoring during sleep and difficult deglutition, with a return of fluids through the nose. In severe cases, the muscles of deglutition being all paralyzed, swallowing can only be performed by throwing the head back and allowing fluids to descend

the oesophagus by gravity. Liquids flow outwards through the nose, because the passage-way to the nose is not closed by the soft palate, as is usual. Sometimes the epiglottis is affected, and the opening to the larynx not being closed, food enters, causing spasmodic coughing.

After a week or two this form of paralysis usually disappears, the muscles regaining their wonted power; but it continues longer in many cases, especially in those in which blood poisoning has been marked.

MULTIPLE PARALYSIS.

Multiple paralysis also occurs. This generally begins as palatal paralysis, but not always. In this variety the patient loses the use of many groups of muscles, although not all in the same degree. Thus, the use of the lower limbs may be lost, while that of the upper extremities is retained. Paralysis of all the muscles of the body never occurs, and the degree of power or sensibility lost in each group of muscles may vary from day to day. "The numbness, for example, which the patient has been experiencing in one leg will suddenly cease and become greater in the other leg. To-day the right hand will not give a dynamometric pressure of more than ten or twelve kilogrammes, and to-morrow its power will have augmented, while that of the left will have diminished; then the parts which were at first affected are a second time attacked and become more affected." (Trousseau.)

Impairment or loss of vision is often a part of this form of paralysis; the limbs also become weak and unable to support the body; objects cannot be picked up or even held in the hands, and this impairment of muscular power may continue until the patient becomes entirely helpless. In those muscles in which motion is interfered with sensibility is generally lost, with numbness.

Multiple paralysis may last for weeks or even months. Power usually soon returns to small muscles, but comes back more slowly to larger groups. In the course of time, however, full power gener ally returns.

PARALYSIS OF THE HEART.

In every case of diphtheria, there is danger of heart-failure. Usually, but not always, this occurs when palatal paralysis is already present. The attack is sudden in its onset. The skin be

comes pallid, perhaps cyanotic, respiration is embarrassed, the patient may show distress or pain by cries; vomiting may occur; the pulse is found to be very feeble and abnormally slow, soon increasing to great rapidity (160), and then disappearing. While death almost always follows these symptoms immediately, life is occasionally slightly prolonged. Active stimulation at the moment that slowing of the pulse occurs has saved life, but prompt action is required.

The cause of heart-failure in diphtheria is not easy to determine. In some cases the heart has become weakened by the fatty degeneration of its muscle fibres. "When the general disease lasts long and is very intense, and especially in cases in which death is caused suddenly by paralysis of the heart, the muscle appears pale, soft, friable, broken by extravasations of blood, and on microscopical examination most of its fibres are seen to be already in an advanced stage of fatty degeneration." (Oertel.)

Such a condition of the heart muscle, might in time, weaken the organ beyond recuperation, yet the heart failure is too sudden in the class of cases under consideration, to assign it to this cause alone. Again death has occurred from sudden stoppage of the heart, when the autopsy revealed the muscles to be in a normal condition.

Others have argued that death is caused by thrombosis; bloodclots being generally found in the heart cavities. It has been shown, however, that these clots do not differ from those found in the heart after death from other causes, and that they are probably formed post-mortem.

When the suddenness of heart failure in diphtheria is taken into account, together with the presence of paralysis of various other muscles of the body, we are led towards the belief that the phenomenon of heart-failure is caused by paralysis, due to some influence on the nerve centres which reaches the heart through the pneumogastric nerve. This would account also for the concomitant symptoms, i.e., vomiting, epigastric pain and dyspnoea, observed in cases of heart weakness, and offers the best explanation of the unfortunate accident.

What is the underlying cause of the paralysis, four forms of which have been described as occurring in diphtheria?

Investigations conducted with the aid of the microscope have ascertained that lesions of the peripheral nerves exist, and that congestion and degeneration of the gray matter in the spinal cord and