DIPHTHERIA. 



degeneration of the kidneys in diphtheritis is not due to excessive in 

 crease of the bodily temperature, but is a direct result of the infection 

 with diphtheritic poison. 



If the disease has begun violently, if a chill and repeated vomit- 

 ing have been the first symptoms, the subsequent course of the dis- 

 ease also is usually more severe. It is true, the difficulty of swallow r- 

 ing generally remains moderate, and the fever does not become very 

 high, but the patient grows pale, the eyes become dull, the pulse 

 small, and usually frequent, rarely retarded; the patients are very 

 sluggish and apathetic. In many cases the putrefaction of the false 

 membrane causes a penetrating, foul breath. If the nasal mucous 

 membrane participate in the disease, a discolored, fetid fluid flows 

 from the reddened and eroded nostrils. The swelling of the cervical 

 glands becomes more marked ; the enlarged glands are very hard and 

 resistant, but have no tendency to suppurate. In about half the cases, 

 examination of the urine shows the presence of a considerable amount 

 of albumen. Even, after a few days, death may occur from general 

 paralysis, while the intellect remains clear. Some patients, whose 

 state had not excited any anxiety, and whose general condition was 

 previously very satisfactory even, die unexpectedly with the symptoms 

 of general collapse, without our being able to find any explanation for 

 the occurrence. Sometimes also attacks of deep syncope occur, and 

 pass over, till finally a new attack ends in death. Even the last- 

 mentioned severe cases may terminate favorably. Then the false 

 membranes are detached, and no new ones are formed ; the remaining 

 ulcers clean up and cicatrize. At the same time the difficulty of 

 swallowing disappears, the glandular enlargement subsides, the de- 

 pression of the patient disappears, and, if there be no sequelae, perfect 

 convalescence follows in two or three weeks ; but it is usually a long 

 time before the patients recover entirely. 



The disease, as above described, is greatly modified when the 

 diphtheritic inflammation of the fauces is accompanied by croupous in- 

 flammation of the larynx and trachea ; for then the above symptoms 

 are complicated with hoarseness, aphonia, excessive dyspnoea, and 

 other symptoms described when speaking of genuine croupous laryn- 

 gitis. This complication occurs in the mild, as well as in the severe 

 eases. Frequently, examination of the fauces and the epidemic occur- 

 rence of diphtheria alone enable us to decide to which form of croup- 

 ous laryngitis the case belongs. Even such cases may end in re- 

 covery ; but most of the patients die, some with the symptoms of col- 

 lapse, some with those of insufficient respiration, and poisoning of the 

 olood with carbonic acid. 



Even when the disease apparently ends in recovery, it is often fol 



