Page:Diphtheria - a lecture delivered at the Norfolk and Norwich Hospital (IA b22345656).pdf/13

 The duration of diphtheria is various. I have seen it fatal in forty-eight hours from the first overt seizure, and it has been known to terminate even sooner—the system being as it were knocked down at once, as is seen in exceptional cases of other forms of blood-poisoning. It may, on the other hand, continue for two or three weeks, and prove fatal either by pure exhaustion, as has been before said, or by the supervention of other lesions. Amongst these paralysis of the muscles of deglutition has been noticed, as well as a state approaching to more or less complete hemiplegia. In favorable cases an improvement may be looked for on the fourth or fifth day, and is indicated by the expectoration of membranous shreds, detached from the fauces, as well as a corresponding general amelioration of aspect, and increased facility of swallowing. Even when the exudation has invested the larynx and trachea, the false membrane has in some rare instances been expelled with immediate relief to the urgent difficulty of breathing.

We now proceed to the pathological appearances of this disease. Those which are essential are chiefly confined to the fauces and upper part of the respiratory tract, although the primary and even secondary bronchial tubes are sometimes involved. The soft palate, the back of the pharynx, the uvula, and the tonsils, will be found more or less invested with a fawn-coloured fetid membranous deposit, torn up in places, and more or less detached by the repeated cauterizations which have probably formed a part of the treatment. Below this adventitious deposit the mucous surface is deep red or livid, with papular elevations which correspond to indentations in the lower surface of the membrane. Be it