ACUTE INFECTIOUS DISEASES. 



lowed by paralysis. The not unfrequent occurrence of diphtheritic 

 paralyses after very mild cases, as well as the curious fact that they 

 never follow the disease immediately, but come on from two to four 

 weeks after its disappearance, sufficiently explains why the connection 

 between the paralyses and the diphtheritis so long escaped recogni- 

 tion. Paralysis of the soft palate and pharynx is the most frequent 

 form of diphtheritic paralysis, and generally precedes the other forms ; 

 when the soft palate is paralyzed, the patients have a nasal voice ; on at- 

 tempting to swallow fluids, they enter the nose. If the pharynx also be 

 palsied, the act of swallowing is greatly impaired, and we are some- 

 times obliged to nourish the patient through a stomach-tube. This 

 paralysis of the muscles near the seat of diphtheritic inflammation is 

 most frequently accompanied by that of the muscles of the eye, by 

 which the power of accommodation is lost, and the patients begin to 

 squint. The extremities also, especially the feet, are occasionally at- 

 tacked by more or less complete paralysis. In a very small epidemic 

 I saw two cases of total paralysis of all the extremities. The progno- 

 sis of diphtheritic paralysis is generally favorable ; almost all cases re- 

 cover sooner or later. The various attempted explanations of these 

 cases are unsatisfactory. We do not even certainly know whether 

 they are of peripheral or central origin. It has been suggested that 

 the paralyses after diphtheria are analogous to those occasionally ob- 

 served after other severe diseases, especially after severe typhus. But 

 this suggestion is opposed by the great frequency of diphtheritic paral- 

 ysis compared to that after other diseases, as well as by the marked 

 disproportion between the intensity of the malady and the consequent 

 paralyses, distinguishing diphtheritic paralyses from those remaining 

 after other diseases. 



TREATMENT. Prophylaxis requires that the physician should pro- 

 tect himself from contact with the false membrane and shreds of tissue 

 that are coughed up, and that he should warn the attendants on the 

 patient of the danger of this contact. When circumstances permit, 

 those who have nothing to do with the care of the patient should keep 

 out of the sick-room. 



The recommendations of the varied internal and external remedies 

 that are said to have proved efficacious against diphtheritis, have usu- 

 ally originated in the last stages of epidemics, at which time the cases 

 are usually milder, and recoveries more frequent, even without treal 

 ment. Almost all physicians, experienced in the treatment of diph 

 theria, agree that, in severe attacks, the most prized remedies are per- 

 fectly useless. In recent cases I deem it advisable to remove the false 

 membrane carefully, and touch the dried bases with nitrate of silver, 

 concentrated muriatic acid, or liquor ferri sesquichlorat., but not to re- 



