Page:Diphtheria - a lecture delivered at the Norfolk and Norwich Hospital (IA b22345656).pdf/19

 from the exudation in question, by the fact that they represent an absolute loss of substance, and not a something superadded to the surface, as is the diphtheritic false membrane. The gangrenous eschars of malignant scarlatina and putrid sore throat as it is called, can only be mistaken for the diphtheritic membrane by those who make an inefficient ocidar examination, and are satisfied with the olfactory evidence of the existence of putrescent matter in the throat. In the one case the careful observer will detect deep and extensive sloughing; in the other, the adhesion of a putrescent film, but no loss of substance. The fact, also, that in the former cases the patient dies from exhaustion, while in diphtheria they generally die asphyxiated from the laryngeal exudation, adds materially to the correctness of the opinion which separates the two forms of disease.

There is one question connected with diphtheria for the reply to which the public will always look with anxiety—viz. Is it infectious? On this point medical opinion is much divided, the majority of observers, however, pronouncing very decidedly in the affirmative. My own conviction is that it is undoubtedly infectious to a limited degree; by which I mean, that when patients are accumulated in small ill-ventilated apartments, which is too often the case in the cottages of the poor, the disease is likely to be communicated, but I do not think that, like scarlatina or erysipelas, it is prone to be communicated in spite of all sanitary precautions, or that the infection can be conveyed by the clothes or persons of those who superintend the patients. That it commonly spreads in