theritic ones? When we see this secretion run over and cause the mucous membrane to take on inflammatory action, we also can witness a secondary secretion from this inflamed mucous membrane unite with the original one, and become so intimately organized with it, and attached to the mucous membrane itself, that even the microscope cannot recognize in a section of it the point where the false membrane ends and the mucous membrane begins. An effort to remove the false membrane requires force, and always leaves a raw, bleeding surface, showing the close and perfect adhesion which has taken place. An examination of the attached side of this false membrane after removal will show it rough and uneven, with portions of blood vessels, nerves and cells attached thereto. All these evidences of diphtheritic inflammation favor the tendency to arterial obstruction, and consequent gangrenous destruction with blood poisoning, of which so many die.

The tendency for patients to suffer from paralysis after diphtheria is a marked characteristic, which has never been fully explained. Histologists explain it as a degeneration in the peripheral nerves of the parts affected. They have found granular deposit under the neurilema in place of the nerve tissue, or lying upon said nerve tissue.

PRACTICAL RESULTS IN RESTRICTING DIPHTHERIA.

Bearing on the communicability of diphtheria, and the practicability of its restriction, Dr. Baker presented a table and a diagram based on a compilation of reports by local health officers in Michigan for the year 1886. They exhibit the results of isolation and disinfection in outbreaks of diphtheria.

In the 102 outbreaks where isolation or disinfection, or both, were neglected, the average cases per outbreak were a little over 16, and the average deaths were 3.23; while in the 116 outbreaks in which isolation and disinfection were both enforced, the average cases per outbreak were 2.86, and the average deaths were .66, indicating a saving of over 13 cases and 2.57 deaths per

outbreak, or 1,545 cases and 298 deaths during the year, by isolation and disinfection in the 116 outbreaks, compared with those in which nothing was done.

TABLE.-Diphtheria in Michigan in 1886: Exhibiting the average numbers of cases and deaths per outbreak-(1) in all the 461 outbreaks reported; (2) in the 243 outbreaks in which it is doubtful whether or not disinfection and isolation were secured; (3) in the 102 outbreaks in which isolation or disinfec tion, or both, were neglected; and (4) in the 116 outbreaks in which isolation and disinfection were both enforced. Compiled in the office of the Secretary of the State Board of Health, from reports made by local health officers:

Isolation or Disin- Isolation or Disin-Isolation and Disin

(1)

ALL OUTBREAKS.*

fection not men

* These do not include the cases in Detroit and Grand Rapids. + It is possible that in giving the public the benefit of the doubt, cases are sometimes reported diphtheria which ultimately prove otherwise. Many of these being limited to one or two cases, may bring the averages in these columns, concerning which least is known, below what they really should be. All cases and deaths, concerning which positive statements were made by health officers, are included in the four columns to the right of this.

TABLE-Diphtheria in Michigan in 1886: Exhibiting the Average Numbers of Cases and Deaths per outbreak: (1) in all the 461 outbreaks reported; (2) in the 243 outbreaks in which it is doubtful whether or not Disinfection and Isolation were secured; (3) in the 102 outbreaks in which Isolation or Disinfection or both were neglected; and (4) in the 116 outbreaks in which Isolation and Disinfection were both enforced. (Compiled in the office of the Secretary of the State Board of Health, from reports made by local health officers.)

ICHTHYOL IN THE TREATMENT OF ECZEMA.

J. A. WESSINGER, M. D.,

Howell.

a

In treating this subject, it is proper to state, as briefly as possible, the chemical constitution of the agent to which we desire to direct your attention in the treatment of a very common skin disease. Two varieties of ichthyol are found in the market, differing from each other in respect to their base-one is the sulpho-ichthyolate of sodium, the other is the sulpho-ichthyolate of ammonium, which latter is the remedy most frequently used by dermatologists at present. Ichthyol is prepared from bituminous deposit, discovered by Dr. K. Schroeter near Seefeld, in Tyrol. This deposit appears to consist of immense layers of petrified antediluvian fishes and marine animals, found 5,000 feet above the present level of the sea. The species found had their abiding place there some time during the geologic ages. This agent is an oily product obtained by subjecting the bituminous rock to dry distillation in iron retorts; the fluid product which results soon separates spontaneously into a thick, tarry substance, and a fluid, dark-colored, strong-smelling oil. The latter is subjected to the action of concentrated sulphuric acid and other chemical processes, by means of which it is clarified and refined, when a neutral, or slightly alkaline, product results, having a peculiar odor. This product-ichthyol—is regarded as an extract from the original oil. Its chief ingredient is said to be a sulphur acid. In appearance it is of a somewhat tarry character, but resembles none of the ordinary tars, either in odor or chemical composition. Its consistency is about the same as that of vaseline. Ichthyol forms an emulsion with water, and is miscible,

in any proportions, with oils or vaseline. It is partly soluble in alcohol and partly in ether, wholly so in a mixture of both.* Dr. P. G. Nuna, Director of the Institute for Skin Diseases in Hamburg, was not only the first to try this remedy, but he was also the first to direct the attention of the scientific world to its effects. Nuna classes ichthyol as synergistic with resorsin, pyrogallol and chrysarobin-that is, it is a reducing agent, drawing oxygen from the tissues. The physiological action of ichthyol, as far as I have been able to study it from the writings of Nuna and Lorenz, and from observations made in my own practice, depends on the strength in which it is used, and, also, whether it is applied to sound or denuded skin. When ichthyol is applied to the healthy skin in weak strengths, we very soon notice that the parts to which the agent has been applied become covered with a moisture-little drops of water stand out, like dew-drops, upon the skin. Lorenz interpreted this condition as hyperidrosis, he thinking that this effect is brought about by a stimulating action of the agent upon the sudoriferous follicles. But the true explanation for these weeping surfaces is in the fact of the great affinity that ichthyol has for the watery constituents of the tis sues. If ichthyol be applied to the skin in the proportion of eighty grains to the ounce, the skin becomes thicker, denser and more solid, and rows of new cells seem to be added to the otherwise normal stratum corneum. If the remedy be long continued in this proportion, there seems to take place a division of the corneal layer into two parts-an upper dark-colored part and a lower light-colored part. Another effect from the protracted use of weak strengths is pustulation, resulting from abnormal closure of the mouths of the follicles by the hypertrophied stratum corneum, and peri-folliculitis is a result.

If the remedy in increased strength, can be made to penetrate the deeper layers of the skin, then permanent narrowing of the blood-vessels takes place, the skin becomes cooler, less swollen,

* American Cyclopædia.