England in the beginning of the year 1857, since which time it has never totally left our shores.
The symptoms.—The little patient, before the disease really shows itself, feels poorly, and is "out of sorts." A shivering fit, though not severe, may generally be noticed. There is heaviness, and slight headache, principally over the eyes. Sometimes, but not always, there is a mild attack of delirium at night. The next day he complains of slight difficulty of swallowing. If old enough, he will complain of constriction about the swallow. On examining the throat the tonsils will be found to be swollen and redder—more darkly red than usual. Slight specks will be noticed on the tonsils. In a day or two an exudation will cover them, the back of the swallow, the palate, the tongue, and sometimes the inside of the cheeks and the nostrils. The exudation of lymph gradually increases until it becomes a regular membrane, which puts on the appearance of leather; hence its name diphtheria. This membrane peels off in pieces; and if the child be old and strong enough he will sometimes spit it up in quantities, the membrane again and again rapidly forming as before. The discharges from the throat are occasionally, but not always offensive. There is danger of croup from the extension of the membrane into the windpipe. The glands about the neck and under the jaw are generally much swollen; the skin is rather cold and clammy; the urine is scanty and usually pale; the bowels at first are frequently relaxed. This diarrhœa may or may not cease as the disease advances.
The child is now in a perilous condition, and it becomes a battle between his constitution and the disease. If, unfortunately, as is too often the case—diphtheria being more likely to attack the weakly—the child be very delicate, there is but slight hope of recovery. The danger of the disease is not always to be measured by the state
