In these cases one or two applications of the twentygrain solution of nitrate of silver, or of the undilute tincture of iron, or a gargle of the same, with fomentations of the neck, rest in bed, and nourishing diet, will be sufficient to effect a cure; but in the least severe cases great watchfulness is required, and medical visits to the patient should be frequent until a positive check to the progress of the disease is apparent.
Before taking leave of the subject, I must advert to one other point which may be a matter of question in the severest form of the disease, in which the patient is dying of croup, viz., the propriety of tracheotomy. This subject may be dismissed in a few words. Sanguine as are some French physicians, and more particularly Guersant and Trousseau, as to the results of tracheotomy in true croup, they shun the operation whenever there is a diphtheritic complication, or, in other words, when the croup is the result of the extension of the diphtheritic exudation to the larynx, and the patient is not dying merely from asphyxia, but is sinking likewise from a blood infection which has reached the limits compatible with life. It is obvious that were the membrane limited to the larynx and trachea, instead of invading also the primary bronchial tubes, which it generally does, still no hope can be entertained of the beneficial results of an operation while there is present a degree of typhoid prostration in itself sufficient to destroy the patient.
It must not be supposed in any case, but more particularly in severe examples of diphtheria, that all cause of anxiety ceases with the disappearance of the essential characteristics of the disease. Even when the
