Zymotic and Germ Diseases. 259 



jacent sinuses, inflammation of the pharynx, eruptions over the surface of the body of a 

 dull, red color, and a peeling or desquamation over a greater or less extent of the body. 

 It is very rarely that the disease makes a second attack on the same victim. This disease 

 by itself is not usually dangerous, but it is often complicated with other diseases and be- 

 comes serious, the fatalities at times reaching five per cent, or more. 



Roseola or rose-rash is an eruptive disease which resembles scarlet 

 fever in some of its symptoms so as to be sometimes mistaken for it. It is in reality, how- 

 ever, a faint imitation of scarlet fever and is comparatively harmless. It is not followed 

 by desquamation and may come a second time. Yet, by some it is claimed to be conta- 

 gious. It is often epidemic. 



A disease called German Measles, or by the Germans, Rotheln, very closely resembles 

 a mild form of measles, and is said to be mistaken for it. This disease is epidemic, and 

 may attack the same person more than once. Both these diseases are supposed to de- 

 pend on a " special cause " or contagium. 



Another disease of the eruptive sort has occurred in the Southern 

 States and other warm parts of both America and the eastern hemisphere. It is called 

 Dengue* Its symptoms are extremely violent, but seldom fatal. In 1828 it is said that 

 10,000 people had this disease in the city of Charleston, S. C., at one time. There is gen- 

 erally fever and an eruption, sometimes hemorrhage from the nose, mouth or bowels, 

 sometimes discharges of serous matter from the mucous membrane of the nose. Some 

 claim it to be contagious and that it prevents its own return. It runs its regular course 

 in about eight days. No medical treatment has any other than a palliative effect. 



Diphtheria f is a disease that has been known from the most ancient 

 times. The name, which means skinny or membranous, and has been given to it during 

 this century, alludes to one of the peculiarly dangerous and characteristic symptoms of 

 the disease ; namely, the formation in various parts of a false membrane. This membrane 

 is formed by exudation of certain fibrinous matters through the mucous membranes, 

 which matters remain as coatings upon the mucous membranes and form thereon this 

 false layer. The fibrinous material forming this false membrane Flint says, " consists in 

 partt)f fibrillated fibrin and in part of epithelial cells, pus and connective tissue cells, 

 which have undergone the peculiar metamorphosis called coagulation-necrosis. 

 Bacteria, both rod shaped and in the form of micrococci, or according to Klebs, of Mon- 

 ads, are of ten found as colonies in the false membranes." It is not proven that these organ- 

 isms have any special agency in the production of the disease or the membrane. They 

 are similar in appearance to others found in decomposing substances. The false mem- 

 brane is the same in diphtheria that it is in membranous croup ("Laryngitis with fibrous 

 exudations ") including the presence of the bacteria, &c. In some cases the false mem- 

 brane rests loosely on the mucous membrane below, and may be stripped off more or less 

 easily ; in other cases it is connected by infiltration of fibrous matter with the mucous 

 membrane below which also contains fibrinous matter, so that the two are with diffculty 

 separated until after a period of three or four days, when the separation becomes easy. 

 The former or loose false membrane is called the croupous, while the latter is called the 

 diphtheritic. Both sorts of the false membranes are, however, apt to occur both in croup 

 and in diphtheria. 



In most cases of diphtheria the parts primarily affected and from which the fibrinous 

 exudations take place and upon which the false membrane is formed, are the pharynx 

 and parts communicating with it, as the tonsils, the soft palate, and the pillars of the 

 velum of the palate. But it often goes further, and the larynx, the trachea, and bronchi, 

 may become involved, or the disease may spread up the eustachian tubes into the ear 

 drums, or into the nasal cavities, or upon the mucous membrane of the gums, cheeks 

 and base of the tongue. But not only this, "the lips, the arms, the vulva, the vagina, and 

 the prepuce are sometimes effected." Flint 1076. The greatest danger from this disease, 

 as from croup, is the stopping up of the air passages by the growth of the false membrane, 

 although if the patient escapes this there are numerous other chances of the disease 

 making away with him. The disease does not often occur sporadically. It is epidemic 

 and it is contagious to the extent of being easily portable. There are many examples of 

 this disease starting under circumstances which seem to prove it to have originated 

 afresh ; that is, it was not communicated from any previous human patient. It is be- 

 lieved to have originated from the exhalations of the partly dried beds of ponds, from 

 offensive cess-pools, from the use of foul water, &c. It is true such places might possibly 

 be nurseries, in which germs are caught and bred, and at favorable moments sent forth 



* Pronounced Deng-ga. In the British West Indies it was called " Dandy " fever, 

 t Also called Cynanche, malignant sore-throat, &c. 



