As already observed, diphtheria is primarily a local disease. This being the case, its local treatment becomes a matter of the greatest consequence. Indeed, this portion of the treatment should receive first attention. This fact has been long recognized by one class of physicians, those who have believed the disease to be essentially local in character; and a great variety of remedies have been employed. Prominent among these has been the application of caustics of various sorts to the throat. Nitrate of silver, nitric acid hydrochloric acid, iodine, caustic potash, pure carbolic acid, and va rious other caustics have been thus employed, but none so frequently or so extensively as the first named.

After dwelling at some length upon the evil results of cauterization, Oertel remarks as follows: "There can be no doubt, then, that the unfavorable results which have been obtained on all sides by cauterizations, more or less energetically practiced, must put a stop to this procedure, even if, in its stead, we should be obliged to resort to its opposite, the purely expectant and symptomatic treatment.

Another author, eminent both as a teacher and as a practitioner of medicine, says:"A large proportion, if not the great majority, of the practitioners of this country have been led to discontinue the causterizing and irritating topical applications which have been heretofore in vogue." "The use of a solution of nitrate of silver, and even of the solid stick, at one time met with considerable support, but it is being gradually abandoned by those who have had experience of recent epidemics. In fact, the profession has given up the use of caustics altogether, being convinced that they rather aggravate than check the local process."

Numerous other equally eminent names might be cited as opposed to the use of caustics in this malady, among whom are Profs. Jane way and Lusk, of Bellevue Hospital Medical College, New York. We have dwelt thus lengthily upon the subject of caustic treatment because this obsolete practice is still held to by physicians who have not had a large experience in the treatment of this disease, or who have become too thoroughly fossilized to be able to modify their ideas in accordance with the most advanced information on this subject.

There is no known means by which the growth and development of germs may be more efficiently checked than by the use of cold applications which should be made to the throat externally, and the patient should be allowed to hold small bits of ice in the mouth and to swallow them occasionally. The cold applications must be made thoroughly enough to reduce the temperature of the throat as near the freezing point as the patient can endure without suffering, as otherwise it will do almost nothing toward modifying the morbid process. The best mode of accomplishing this is to apply to the throat compresses composed of several folds of linen or cotton-flannel may be used when necessary-between the folds of which are placed numerous small bits of ice, or small quantities of snow. The intensity of the cold may be regulated by the quantity of ice or snow used When the patient cannot bear so great a degree of cold, compresses may be applied wrung out of cold or iced water. The compress must be large enough to cover the throat and extend well around the sides of the neck.

To guard against too prolonged lowering of the temperature and circulation of the part affected, and to relieve pain, once an hour or two the cold compress should be removed and the throat fomented for ten or fifteen minutes.

To alleviate the suffering, and the difficulty in breathing and swallowing, and to facilitate the removal of the false membrane, no single remedy is so efficient as the inhalation of hot vapor. It is not necessary that the vapor should be medicated, although chlorine, carbolic acid, or vinegar may be added with benefit The important thing is that the vapor should be as hot as can be borne by the patient without discomfort A temperature of 110 to 120 will be borne without difficulty by most patients. This remedy soon affords the patient so much relief that even little children manifest a very great appreciation of it The inhalation should be practiced once or twice an hour at first, and ten to fifteen minutes at a time. The warm vapor acta like a poultice in relieving the swelling, soreness, and spasm, and in facilitating the separation of the false membrane. In cases of croup ous diphtheria, especially when the larynx is involved, this remedy is almost the sole reliance for saving the patient's life.

Different modes of applying this remedy have been suggested. It is of the greatest importance that it be done thoroughly. A very good plan is to attach a rubber tube to the nose of the tea-kettle. A tin tube can be readily made by a tinner if rubber cannot be obtained. As the steam is generating, let the patient hold one end of the tube to his mouth and inhale the warm vapor as freely as he can.

Another very good plan is this: Place in an ordinary tea-pot a few good sized pieces of freshly burned lime. Pour on the lime a boiling hot mixture of vinegar and water. Close down the cover, and let the patient breathe the vapor through the nose. The lime and solution can be renewed as the quantity of vapor diminishes. This is a very good plan, if well carried out. The best of all arrangements for this object is an apparatus constructed for the purpose. Every family ought to have an apparatus of this sort ready for use.

No attempts should ever be made at the forcible removal of the membrane. If it is torn off, the mucous membrane is left sore and often raw, or bare. When removed thus, another membrane is sure to form.

The removal of the membranes may be effected by the inhalation of solutions of substances which have the power to dissolve them chemically. A moderately strong solution of lime-water, or of vinegar, answers well for the purpose. An atomizing apparatus is required. In cases of diphtheria of the larynx, this is a very important measure indeed, and must be used very thoroughly.

When the membrane has ceased to form, hot fomentations should be assiduously applied to the throat in addition to the inhalation of warm vapor, which should be continuous at least fifteen minutes in each half hour.

The administration of a light emetic is often advantageous in effecting the dislodgment and expectoration of the membranes in cases in which the larynx is affected. A copious draught of lukewarm water is usually sufficient for the purpose; but if emesis does not follow its repeated use, a small dose of sirup of ipecac or a teaspoonful of powdered alum or ground mustard, or some other simple emetic, followed by warm-water drinking, will be sure to induce vomiting.

When the nasal cavity is obstructed by false membranes, thorough syringing should be resorted to, the solution consisting either of equal parts of good vinegar and warm water, or a solution of lime, five grains of freshly burned lime to the ounce of water. The syringing should be continued fifteen or twenty minutes at a time, and renewed at brief intervals until the membrane is softened and comes away in pieces. The face of the patient can be protected during the syringing so that the skin will be in no way unpleasantly affected. Usually very great relief may be given the patient by this measure.

Deodorants, such as ozone, and other non-offensive agents, may be employed to great advantage with appropriate apparatus, for the purpose of purifying the air of the sick-room. Chloride of lime, carbolic acid, and sulphuric acid are too offensive and annoying to the patient to be used in this way with benefit Probably no agent is so useful for this purpose as ozone, one of the most powerful disinfectants known.