Diphtheria (continued). - In some cases, when the membrane spreads down to the larynx, tracheotomy, or opening into the windpipe, may save the patient's life. In past days a great many deaths occurred as a result of the operation, but nowadays three-quarters of the cases operated on recover, the best results being obtained when the operation is performed early. Any medicines must be ordered by the doctor. Domestic treatment consists in keeping the patient in bed, lying quite still and flat, because there is great danger from heart failure on any sudden movement. Plenty of fluid nourishment, with beef-tea and wine, are necessary to keep up the strength, so that the patient may have sufficient vitality to fight the disease. A great many cases of diphtheria occur in young children under ten years of age. It may follow one of the infectious fevers.

Diphtheria is very infectious, and spreads rapidly from one person to another. It hangs about the house unless careful disinfection after the illness is carried out. There is an idea that defective drainage in a house will cause diphtheria; it will certainly produce an infected throat condition, which makes a person very liable to diphtheria. The disease may be contracted from cats and other animals, or spread by means of infected handkerchiefs. Careful hygienic measures, early attention to any form of sore throat, and prompt isolation of every case of diphtheria prevent the spreading of this disease.

Dropsy. - Dropsy is a collection of fluid either in the tissues underneath the skin or in one of the large cavities of the body - the chest, or thorax, or the abdomen. Abdominal dropsy may occur in heart disease, in liver affections, or in disease of the kidney. Cardiac, or heart dropsy, is due to failure of the circulation from enfeeble-ment of the heart. The blood in such parts of the body as the feet and ankles becomes stagnant, and some of the blood serum oozes through the blood-vessels into the tissues. The dropsy is most apparent in those parts of the body which have been lowest; for example, in the feet and legs when walking about, and in the back if the patient is lying in bed. In certain forms of heart disease dropsy does not appear, and it is not necessarily a sign of heart disease at all. It may, for example, be due to anaemia.

Swelling of the ankles almost invariably appears in simple anaemia, due to the unhealthy condition of the blood. Dropsy of the abdomen is nearly always due to some affection of the liver, and it requires treatment by a medical man. When dropsy is. very general over the body, appearing even in the eyelids and producing puffiness of the face, it is probably due to kidney disease, and immediate medical skill is very necessary. Dropsy in one leg or arm is commonly caused by obstruction to the large vein of the limb, perhaps by a clot. As a rule, there is pain and tenderness, and perhaps a local swelling. In these cases raising the leg in a horizontal position is the proper treatment.

Dipsomania is that state in which there is a hereditary tendency to drink periodically. A craving for alcohol suddenly comes upon dipsomaniacs which they feel compelled to yield to; whilst at other times they are free from any desire to take alcohol in excess. The subject of alcoholism will be considered in a special article later.

Dyspepsia is the name given to "difficult digestion," generally associated with pain and discomfort. When the symptoms come on suddenly, the condition may be called acute dyspepsia, one. form of which, bilious attack, has already been described. The other is more correctly called acute gastritis, which is an inflammation of the gastric organ - i.e., the stomach. In most cases acute gastritis is really poisoning either by decomposed food - stale fish, meat, tinned foods, mushrooms, or shellfish - or such chemical poisons as arsenic, phosphorus, etc. The symptoms are pain, discomfort, and a sense of burning in the stomach with tenderness on pressure. There is vomiting, headache, and great prostration and diarrhoea may come on later, showing that the poison has passed along the intestinal tract. The intestinal pain lasts a few days. Of course, if a large dose of irritant poison has been taken the result may be fatal.

The treatment consists of giving an emetic if the poisoned food has recently been swallowed. If some time has elapsed, a dose of castor oil is required. The fact that several people suffer from acute gastritis or dyspepsia after eating the same dish is an indication of the cause. Hot fomentations over the stomach relieve the pain, and abstinence from food for twenty-four hours, followed by feeding with small quantities of milk and soda, is necessary.

Chronic Dyspepsia, or chronic indigestion, is one of the commonest ills of the flesh. The symptoms of pain and discomfort after eating generally come' on gradually. The digestive power is deranged, perhaps because there is too little acid in the gastric juice. On the other hand, some forms of chronic dyspepsia are due to excess of acid in the gastric juice. In the first form the pain comes on very soon after taking food. There may be definite pain, shooting up to the shoulders, or only a feeling of discomfort and distention. The appetite is often not affected by the condition. The tongue is flabby, and the patient is apt to suffer from depression. The second form of chronic dyspepsia (acid dyspepsia), where there is hypersecretion of hydrochloric acid, differs from the first in that the pain comes on an hour or two after taking food. It commonly occurs in young people, and is said by some to be an evidence of the nervous temperament. The cause in either case may be errors in diet, insufficient chewing of food, with perhaps overwork or worry or mental strain in association.

The treatment in both cases is to regulate the diet carefully, to ensure sufficient mental and physical rest with moderate exercise in the fresh air. The diet is the most important feature. Highly spiced and indigestible foods must be rigidly excluded. Three simple meals a day, chewed very thoroughly and eaten slowly and quietly, must be the rule. Drugs have to be administered by the physician, the type of drug ordered depending on whether the dyspepsia is due to too little acid or too much acid. It is folly for people to take stomach drugs without a doctor's orders, because there are these different forms of dyspepsia which require exactly the opposite type of drugs. Dyspepsia should never be allowed to go on for a month or two, as it tends to get worse, and after a time quite unfits people to do their work happily. They become veritable slaves to their stomachs, and the longer the treatment is postponed the greater difficulty there is in ensuring a cure.

Eczema is an inflammation of the skin characterised by the exudation of a watery fluid. In some cases it seems to arise spontaneously without any cause of irritation, and this is true eczema. " Artificial eczema ' can be produced by any skin irritant. The eczema which appears on a washerwoman's hands due to the irritation of the soda, the eczema on an infant's thighs produced by chafing, are common examples of artificial eczema produced by external irritants. Sometimes the condition is very acute and severe. At other times it may be very chronic, and appear and disappear for months or years. In the first stage there is simply redness of the skin. Then tiny blisters or vescicles appear, which burst, producing the watery fluid. In a later stage this fluid dries into crusts, which may form scaly dry patches over the skin. Itching, burning, and throbbing are generally present.