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 of deglutition. In a certain proportion of cases, we are at this time further warned, by increased difficulty of breathing, attended with a peculiar croupy sound, that the diphtheritic membrane has spread to the larynx and trachea, inducing a condition of things which may be regarded as almost inevitably fatal, so few have been the recoveries under such circumstances. In this case symptoms of asphyxia speedily show themselves; the countenance becomes livid and ghastly, the skin cold and covered with petechial spots; but yet the little sufferer struggles on for hours after the pulse has ceased at the wrist, fighting for breath, imploring, if old enough to express its wishes, to be left to die, and in its distress and restlessness, throwing itself about to almost the very moment of death.

The above description applies to the steady progress of diphtheria in the severest cases, and may be taken as typical of the disease in its most aggravated form; but there are many cases equally fatal in the end, in which the symptoms do not explode with such violence, or reach their acme with such rapidity. On the contrary, the throat-symptoms, never very pronounced, appear to be readily amenable to treatment, and the child in a few days might be thought to be exempt from danger. The amendment, however, turns out to be fallacious, and the child, to all appearance free from risk, is suddenly seized with croupy breathing, and in a few hours is beyond hope. These deceptive cases are well described by Mr. Brown, of Haverfordwest, who was one of the first to call attention to the presence of diphtheria in this country. He says, in alluding to these cases, "I have seen them die in four hours from such sudden invasions; they may linger five or six days, with intermissions of eight or