DIl'lllHKUlA. 237 



U pr.ietically is this: that we should not apply blisters or intli.-t 0TOD the 

 trivial wound, during the prevalence of an epidemic of diphtheria. Kvt-n the 

 application of leeches .should be avoir 



hiphtheria ; B death simply mechanically by siilloration, but the exhaus- 



tion oecasioued by the intensity of the constitutional disturbance is usually an 

 important fat-tor. Tin- duration of the disease may \ ary from forty-eight hours to 

 been days. When death takes place within a week from the first appearance of 

 .symptoms of illness, it is always preceded by the extension of the inflammation to the 

 larynx. When death occurs as the consequence of the general disease, the fatal is-^ie 

 usually ensues during the second week of the disorder, unless, indeed, the patient has 

 .ivatlv weakened ny some previous ill. 



During the progress of the case the kidneys not unfrequently become affected, and 

 diphtheria, may cause Bright's disease, just as scarlet fever does. 



Affc'r recovery from an attack of diphtheria there is often paralysis of different 

 parts of the body. As the paralysis is developed only gradually and slowly, it is 

 seldom noticed until the second or third week from apparent recovery from the 

 disease. 



The soft palate is usually the first part affected, and difficulty is experienced 

 in talking, swallowing, and expectorating. The voice becomes nasal and the 

 sounds run into one another, so that it is no easy matter to understand the 

 nt. In eating or drinking the food is always going " the wrong way," that is, 

 it falls into the larynx, and is forcibly ejected during a violent fit of coughing. Very 

 frequently fluids, instead of being swallowed, run out through the nose. The patient is 

 almost unable to expectorate ; and should he get a cold on his chest his condition may 

 become critical. 



Sometimes the muscles of the eyes are affected and there is disturbance of vision. 

 A t first there is difficulty in reading fine print, the effort being attended with con- 

 siderable discomfort and even pain. At a later stage the patient is found to squint, 

 and he often sees everything double. After a time the paralysis may extend to the 

 limbs and other parts of the body, so as quickly to reduce him to a condition of the 

 most utter helplessness. The muscles of the neck may be involved, so that when the 

 head falls backwards or forwards the patient is unable to lift it again without help. 

 If the muscles of the trunk are considerably affected it becomes impossible for him 

 ise himself from the horizontal position, or to turn himself in bed from one side 

 to the other, and when placed in a sitting posture he simply collapses. When the 

 affection becomes so general as this, there is always a fear lest the paralysis should 

 extend to the heart or to the muscles by which respiration is carried on. When the 

 palate is the part affected, the food may enter the windpipe and cause sudden suf- 

 ion ; or it may pass into the lungs and set up inflammation. As a rule, how- 

 . a good recovery is made from ail these paralytic symptoms. 



What should be done when diphtheria breaks out in a family] In the first place, 

 send for the doctor. There is no disease in which the personal attendance of a medical 

 man is more imperatively demanded. He will take the entire charge of the treat- 1 

 ment, and you will not only have done the best for the sufferer but will have relieved 

 yourself from a fearful responsibility. 



