Dirin HKKIA. 



: punctured his anil, hi.- .md throat, with a 



1 with the in. -11 .--h he h;ul just i ino\ ! from ;i dipht heriticsorethroat. 



The attempt to inoculate himself was unsinves.sful, ami M. Trousseau suliered in no 



trom his devotion '. Tin- experiment was subsequently repeated by 



ian, with tin- >am- lie- ilt. 



' have diphth- an be no doubt that a person may 



sutler from it any number of times. Tin- fact of having had and sur\ivel the 

 tut that immunity against u second attack which i.s so markedly 

 a d tic of me, i latina, and MttU-pOOL 



Diphtheria usuallv begins, both in adults and chlldm, \\ith marked svmjitoms of 

 . there being an elevation of the temperature of the body by four or live degrees, 

 and an increase in the rate of the pulse which is often very marked. Sometim 



k begins with a little sensation of chilliness, but it is never u>hered in with that 

 marked .shi \ering which occurs in some other level's. The patient usually complains 



mi:, <>f pain in the head and neck or in the loins, of debility, weai 



in the limbs, and increased thirst. Sometimes he is re*tle*.s or inclined to be drowsy, 

 or he may IK- sick. Children, when first taken ill, are apt to sleep during the day 

 more than usual, and are restless or even light- headed at night. 



shortly the patient experiences a sensation of dry ness and burning in the 

 throat, as well as pain on swallowing. If the space under the jaw r be examined, some 

 little hard, tender lumps will be felt, which are the enlarged glands. If the throat 

 w carefully examined, it will be found to be of a dark-red livid colour, the uvula 

 which hangs down at the back being swollen to twice its size. In a few hours the, 

 d parts become covered with a false membrane, which is most marked on the 

 tonsils ami soft palate. This diphtheritic inflammation, with the formation of the mem- 

 brane, is very prone to spread, both upwards to the back of the nose and downwards into 

 the larynx and windpipe. At first the membrane is easily detached, and the tissues 

 beneath are apparently healthy, but as it grows thicker and tougher it may be torn 

 off in strips, and the subjacent structures will be seen to be raw and bleeding. As 

 the local mischief extends the temperature of the body usually rises, and the general 

 constitutional disturbance is increased. The diificultyin swallowing is in proportion 

 to the amount of inflammation, swelling, and exudation. "Wearisome and painful 

 efforts to clear the throat are often occasioned by the abundant secretion of a thick 

 tenacious mucus. In some cases the breath becomes extremely offensive. From the 

 tii-st there is usually a good deal of cough ; but should the windpi])e become affected 

 l>oth cough and voice assume a hoarse, husky, muffled tone, and a difficulty is experi- 

 enced in breathing. During the whole course of the disease the bowels are either 

 quite natural or they are confined, diarrhoea being very unusual. 



Several varieties of diphtheria are recognised by medical men ; in some the 

 symptoms are much milder than we have described, and in others they assume a more 

 malignant typ. 



The great danger of the slighter forms is that they may be entirely overlooked. 

 The patient is apparently so little indisposed that professional aid is not considered 

 necessary, and the true nature of the complaint remains undetected. It may so 

 happen that this is of very little moment to the patient himself, but it is a matter of 



