236 THE TREATMENT OF DISEASES. 



the very gravest importance to all who have the misfortune to be brought in contact 

 with him. This slight attack is capable of communicating to other people the disease in 

 its most malignant form. It is difficult to over-estimate the serious consequences 

 that might ensue from a case of this description being allowed to run loose in a 

 school. 



These slight attacks usually begin without any symptoms which might give 

 warning to the patient or his friends of the approaching danger. There is a little 

 fever or none at all ; there is c, trifling sensation of malaise, a little uneasiness in 

 the throat, and a feeling of dryness or a slight pricking pain in swallowing. In. adults 

 these symptoms are very easily overlooked, and in children they cannot be ascertained. 

 The glands of the jaw and neck swell moderately, and are somewhat tender or 

 painful on gentle pressure, only in rare cases does this light form of the disease give rise 

 to more marked symptoms. The fever is then more intense, the temperature of the 

 body stands three or four degrees higher than normal, the skin feels dry and hot, 

 the pulse is frequent and full, and the face slightly congested. The patient com- 

 plains of heaviness about the head or of a sense of stupidity, of lassitude, increased 

 thirst, and of an annoying or painful sensation on swallowing. Sometimes even there 

 may be a little stomach disturbance and the patient may be sick ; still, after a short 

 time usually in the course of from twelve to twenty-four hours these symptoms- 

 disappear as quickly as they came, and the patient soon forgets all about what he 

 characterises as his little temporary indisposition. 



If, however, we could have examined his throat, we should have found that it was 

 in places swollen and of a vivid red colour. A few hours later a number of greyish- 

 white or whitish-yellow spots would have been seen, perhaps confined to one tonsil 

 and a little of the adjacent tissues, and we should then have entertained no doubt as 

 to the true nature of the disease. The diphtheritic membrane gradually clears off, 

 and in a few days the attack may be over; or, on the other hand, the termination may 

 be less favourable. 



It should always be remembered that in these cases the absence of fever and 

 general constitutional disturbance is no guarantee that mischief is not going on in 

 the throat. The temperature may be scarcely elevated above the normal, the pulse 

 may be but slightly accelerated, the difficulty in swallowing may be nearly gone, and the 

 general condition apparently quite satisfactory, and yet the formation of the diphtheritic 

 membrane may be gradually extending. On the fourth, or perhaps the sixth, day the 

 temperature may suddenly rise to 103 or 104, and the pulse to 120 or 130 beats in 

 the minute. The head is hot and painful, and the patient pays he feels very ill. 



He complains of a feeling of dryness and burning in the throat and pain on swallow- 

 ing, and there is now no difficulty in recognising the fact that he is in for a bad attack, 

 and is suffering from the more serious form of the disease, which we have already 

 described. 



If there be any wound or abrasion of the skin during an attack of diphtheria it 

 is apt to become covered with a pellicle of membrane similar to that which forms in 

 the throat. Even in people not suffering from the disease, but who are exposed to 

 an atmosphere charged with the diphtheritic poison, sores or abrasions will undergo 

 this change, and it is said that in this way an attack sometimes commences. What 



