Philadelphia Dec. 8, 1859.

A stated meeting of the Union was held this evening at the house of Dr. G. Wolf. The President, Dr. J. K. Lee, In the chair.

The minutes of the last meeting were read and approved.

After going through with the regular order of business, and no new provings of medicines being presented, the subject of “Diphtheria” was taken up for discussion.

Dr. J. R. COXE, Jr.. having recently lectured before the students, upon this disease, was called upon for a few opening remarks.

He said (hat he had carefully consulted “Aretaeus,” who describes Diphtheria as it now appears, In two different forms — light and severe — and with admirable correctness, under the name of “Ulcus Syriacum” and “Ulcus Egypticum” Forestus and Broncholi also correctly describe It — so does Fothergill of England, and Bard of New York. Our best modern authority Is Bretonneau of France.

He had had hut six cases. The first of these he lost, and, he was compelled to say that he lost it from his own neglect.

It was a boy about 6 years of age, croupy from his birth, and whom he had cured of not less than twelve attacks of spasmodic or non-membranous croup, and of three very severe attacks of Angina Membranacea.

When summoned at 3 A. M,, he was informed by the parents that the child had a very severe attack of croup. On his arrival he found it to all appearance labouring under that disease. He did not examine the case as closely as he should have done, and although he perceived patches of false membrane on the tonsils and palatine vault, he considered them as the exudations of croups nor did he discover his error until too late to save the child. About 8 A. M. he began to suspect the case was not croup, as the breath at that time became very offensive, and suspecting Diphtheria, he changed the medicines which had been Kali bichrom. and Bromium. Iodine both internally and by inhalation was then given, afterward Arsenicum and Muriatic acid — next carbo veg. and Mercurius iodatus rub; but all to no effect. The putridity increased with frightful rapidity, swallowing became impossible, and the child died at 10 P. M, asphyxiated.

The other five cases might or might not have been as severe as the first; but as the Doctor was now on his guard, he carefully examined the fauces and throat immediately on his arrival, and in all the cases discovered a whitish yellow exudation on the tonsils, which were swollen and hard. He could wipe off the exudation with a handkerchief, and the mucous membrane beneath appeared nearly natural, except rather deeper in color. There was no evidence of ulceration.

In four of these cases there was but little constitutional irritation. The children (all under 8 years of age) could eat and sleep, and did not appear to suffer.

The pulse was depressed, though not to any great extent. It was a typhoid pulse, quicker than natural but weak, depressed, and readily disappeared wader pressure.

The fifth case (a girl 7 years of age, large and well developed) had considerable constitutional irritation. She had severe ehills followed by flushes of heat, loss of appetite, great languor, restlessness and irritability and considerable prostration. Her natural temper was remarkably mild. In sixteen hours there was great pain on swallowing, the tonsils were greatly swollen, the uvula and whole fauces were scarlet red, and the false membrane was plainly perceptible on the tonsils, and afterward over two-thirds of the fauces. There was also a slight swelling of the parotid gland of the left side. In this case after giving Nitric acid and Merc. iod., with but little if any benefit, he gave Iodine, (1st decimal) and dropping 20 drops of the tincture in a saucer, directed inhalation every fifteen minutes. In an hour the symptoms were less severe, and under the same medicine at longer intervals, she recovered in about 3 days.

The other four cases were cured by Merc. iod. 3, and Nitric acid 4, (both decimals at first; afterward the centesimal dilutions).

He said the great difficulty is to prevent the disease from invading the larynx — since Dr. Abererombie says “all die when the larynx becomes affected.” He thought Nitric acid., with Merc. solub., or Merc. iod., the best preventives; but if these fail, he recommended Muriatic acid and Arsenicum, and Iodine by inhalation.

He further observed that great care was necessary in convalescence, with regard to taking cold — a draught of air not capable of injuring a babe will produce a relapse. The diet must be very liberal, with stimulants in small quantities.

Dr. S. S. Brooks remarked, that he had met with but two cases, which might be called Diphtheria. These were mild and terminated favorably.

The first was not recognized for two or three days, during which time it was viewed and treated as ordinary pharyngitis. The usual improvement not appearing, a more careful examination was instituted, which revealed an almost fiery bright redness of the whole pharynx, especially of the left side, with much enlargement of the tonsils and uvula, and the tonsil of that side was very hard to the touch. Numerous irregular-shaped patches of a greyish yellow color, were upon the tonsils and uvula, which appeared to be partly exudations and partly ulcers; they varied in size from that of a pin's head to a three cent piece. On the left side these patches extended forward upon the gum of the dens sapientia. There was great pain on swallowing, and considerable fever; but no prostration attended the case. The duration of the case was about two weeks.

Mercurius biniodatus, in about one grain doses of the first trituration every 3 hours, appeared more serviceable than any other remedy. Indeed, all others appeared of doubtful value. Dilute Nitric and Muriatic acids, and Chlorate of Potassa in solution, were each used; but their effects were so uncertain that he concluded not to use them in a future case. Other preparations of Mercury — as the Vivus and Solubilis were used for short periods, but they appeared to aggravate rather than relieve.

At that time Dr. Brooks had not seen, nor had he heard of Dr. Madden's remarks on this point — in the British Journal of Homoeopathy for April, 1859. He quoted from Dr. Henry R. Madden's article on the treatment of Diphtheria, as follows: — “Here I must take the opportunity of remarking that the Biniodide of Mercury has in my hands succeeded better in this complaint than any other Mercurial preparation. When I sent my notes to Dr. Black, I observed that in true Diphtheria I had found Mercury did decided harm. I had at that time tried Merc. sol., Merc. cor., Merc. oxyd. sub.; but I had not used Merc. biniodidus, and I must say that this last preparation has not disappointed me even in the fully developed disease.”

His second case Dr. Brooks immediately recognized. It was similar to the first, though milder — so as to permit the patient to visit his office. In its treatment, he had been so well pleased with the effects of the Biniodide of Mercury, that he used it almost exclusively in this case. Nitric acid was substituted for one day, on account of his being out of the Biniodide at the moment of prescribing, and during this interval, the case seemed to grow worse. Its duration was about. one week.

Dr. B. W. James related a case of Diphtheria, occurring in conjunction with Malignant Scarlatina, that had come under his care in the Northern Home for Friendless Children. It was a child about 10 years of age, which was seized with violent vomiting and general prostration. When called in, 7 hours had elapsed since this sudden attack came on, and the following symptoms were present: Skin hot and dry, pulse small, frequent and very easily compressed; the tongue was somewhat swelled and much coated, except at the tip, where it was very red; the breath was feverish and disagreeable; there was a constant thin watery discharge from the nose, and a flow of saliva from the mouth. His eyes were prominent, with a staring look. He appeared to be almost unconscious of what was said to him. There was also an involuntary tremor of the whole body. An examination of his throat revealed a very red, inflamed condition of the fauces, velum palati and tonsils, with a hard swelling of the latter. Two whitish yellow patches appeared on the left tonsil, and one on the right. This was in the evening.

The next morning the whole of both tonsils were covered with the diphtheritic exudation, and it was extending over the fauces. The pulse was very feeble; the hands and feet cold; the breath more fetid; the tongue thickly covered with a whitish coating, which could easily be wiped off; a dark incrustation was forming on the teeth and lips; the trembling of the body continued, and he was still more unconscious. Belladonna and Kali bichrom. were given through the night without any effect. Merc. iod. rub. was given in the morning, and by evening a slight improvement was perceptible. Nitric acid was then given in alternation, with the Merc. iod. By this time a rash began to make its appearance on the surface of the body.

On the third day consciousness returned; the diphtheritic exudation was thrown off; the scarlatinal eruption came out more fully, presenting a dark or purplish hue.

On the fourth day his condition was much improved, and likewise on the fifth day, except that the discharge from the nose (although somewhat diminished) had become acrid, and excoriated the adjacent parts, and an ulceration of the throat set in. The next day he was not so well — the pulse indicating greater debility. Up to this time Nitric add and Merc. iod. were continued; but were now discontinued and Arsenicum given, and a more nourishing diet ordered. The following day he was better, and the next day (Dr. James month of service having expired) the case passed into the care of the other attending physician.

Drs. R. Gardiner and J. G. HOUARD had attended in consultation two cases of the disease in a severe form — both children in one family The first case was held very much like one of croup, and received treatment for that disease, and it was not until the breath became excessively fetid, and the parotid and other glands of the neck swelled, that Diphtheria was suspected, and the remedies changed to those recommended for the latter affection. This case proved fatal.

The other commenced in the same way, followed with foul breath, prostration, great flow of secretions from the nose and mouth, and swelling of the parotid glands. The treatment however was different. Aconite and Merc. iod. were given at once, afterward Bell, and Merc. iod., and finally Nitric acid; under the use of which, the child rapidly improved and eventually recovered.

Dr. HOUARD remarked, that other cases in his practice had since proved Nitric acid a valuable remedy for this disease.

Dr. Lee had noticed a peculiar stretching out of the neck, and throwing back of the head; in cases of croup, which was not observable in diphtheria.

Dr. COXE observed, that in his first case, there was no difficulty of inspiration, but great difficulty of expiration.

On motion, adjourned. B. W. JAMES, M.D., Recording Sec'y.

---