460 
J. F. WINCHESTER. 
and eight days, but it may be longer. The disease is often 
limited in its prevalence in particular sections to a circum¬ 
scribed area. It has been observed to be restricted to a few 
houses, a single house, or to a narrow strip of land on the banks 
of a stream. 
The special cause seems to require auxiliary causes, at pres¬ 
ent unknown, which are peculiar to certain localities. Epi¬ 
demics differ as regards certain features of the disease and the 
rate of fatality. In respect to variations at different times and 
places, diphtheria resembles other epidemic diseases. 
Clinical History .—Diphtheria presents in different cases 
such differences that some authors have described several varie¬ 
ties of the disease. The marked point of difference relates to 
the development of the disease. The attack is sometimes 
abrupt, beginning with a chill more or less pronounced, and 
followed with a marked elevation of the temperature. 
At other times the disease may begin with symptoms denot¬ 
ing great prostration. When the development is gradual and 
insidious and there are few or no local symptoms pointing to 
the existence of the malady, the characteristic affection of the 
throat reveals the disease. When the fauces alone are involved 
there is seldom any pain or soreness, and in some instances the 
sensibility is diminished. Incomplete paralysis of the muscles 
concerned in deglutition, which is sometimes a sequel, may be 
a concomitant of the disease, rendering swallowing of liquid 
more or less difficult, and regurgitation through the nose. The 
breath may be foetid. 
When the false membrane extends over the buccal mucous 
surface, it occasions more or less pain on the introduction of 
food or drink into the mouth, together with ptyalism and stiff¬ 
ness of the parts. When the nares are affected there is a dis¬ 
charge from the nostrils which may be limited to one nostril. 
The gravity of-the disease is commensurate with the extent of 
the local affection and the abundance of the exudation. 
However mild cases may be at the outset, there is always a 
liability to the occurrence of diphtheritic inflammations in new 
