Page:Diphtheria - a lecture delivered at the Norfolk and Norwich Hospital (IA b22345656).pdf/18

 of alternating heats and chilliness, or in the more acute cases, of slight chills followed by heat of skin, flushed countenance, &c. &hellip; Upon examining the pharynx and mouth, no trace of inflammation can he detected in this form of the disease; but the tongue is white and loaded at its base &hellip; After the above symptoms

have existed a longer or shorter time, hoarseness, if it have not previously existed; sometimes a peculiar shrillness of the voice; difficult, sibilous, sonorous respiration, and an unusual dry, loud, clanging cough, as if passing through a brass tube, are observed." Let this, the precursory and early stage of true croup, be contrasted with descriptions already given of the invasion of diphtheria, and no doubt will, I think, be entertained of the difference of the two diseases. The epidemic croup spoken of by Dr. Copland is no more or less than "diphtheria," but as all his references to it are from continental or American writers, it does not invalidate the assertions already made, that the disease is practically new to this country.

From ordinary tonsillitis, as well as from the throat-complications of scarlatina, the distinction is in my opinion equally patent. There may be the same redness, and in malignant cases, as they are called, the same livid and oedematous condition of the pharyngeal mucous membrane, as is seen in diphtheria, but there is no secretion of the remarkable membrane to which I have alluded. What has been mistaken for this has either been an accumulation of mucus soluble in water, the white rice-looking secretions of the tonsillar follicles, or the ash-coloured sloughs which frequently attend these forms of "sore throat," but which may be distinguished