462 
J. F. WINCHESTER. 
be the same in all cases. In several cases the lesions of a mul¬ 
tiple degenerative neuritis have been found. The characters of 
the paralysis, particularly the usually rapid recovery, are in 
favor of the peripheral nature of the lesion in many cases. 
Pathology .—When a mucous membrane is injured in such 
a way that its epithelium dies without desquamation, while its 
blood vessels are damaged and pour out an abundant exudation, 
it sometimes happens that the dead epithelial cells become 
saturated with the exuded liquid and then pass into a peculiar 
condition of rigidity akin to coagulation. 
The seat of this change appears to the naked eye as a dull 
greyish raised patch surrounded by red and swollen mucous mem¬ 
brane. The exudation is rich in albumen, and the transformed 
cells take on the appearance of a kind of coarse mesh work, 
almost or altogether devoid of nuclei. 
The subepithelial areolar tissue is beset with filaments of 
fibrin and leucocytes. Haemorrhages are not uncommon. Inflam¬ 
mations of this kind, in which the tissue itself coagulates into a 
solid mass, are called diphtheritic. When the necrosis and co¬ 
agulation extend only to the epithelium we may speak of the 
process as superficial diphtheritis. It is not necessary that the 
whole of the epithelium ultimately affected should perish at 
the outset; some part of it at least may perish secondarily in 
consequence of the inflammation. 
Superficial diphtheritis occurs chiefly in the organs of the 
throat, but the conjunctivse and the epithelium of the urogenital 
organs are also occasionally attacked. The structure of the re¬ 
spiratory organs and the intestines seems not to favor this form 
of inflammation. When their epithelium perishes from any 
cause it is usually shed or dissolved away and a croupous false 
membrane is formed instead of the diphtheritic coagulation. 
Necrosis and lymph coagulation in the tissue are the distin¬ 
guishing features of the diptheritic inflammation ; whether it is 
superficial or deep its nature is the same—the new seat is of 
secondary importance. Deep or parenchymatous diphtheritis 
affects a greater extent of tissue than the superficial form. It is 
