Page:Diphtheria - a lecture delivered at the Norfolk and Norwich Hospital (IA b22345656).pdf/8

 the disease that he may have to arm himself for a conflict which the inexperienced would scarcely anticipate. This apparently insignificant patch or patches is, in fact, the diagnostic sign of the malady, and unless speedily checked by appropriate treatment, is destined to spread over the whole soft palate, and too often to invade with fatal effect the trachea and larger bronchial tubes. In speaking of this peculiar appearance, the small patch of diphtheritic exudation, it is necessary to call attention to the possibility of mistaking for it either pieces of inspissated mucus, or those masses of caseous looking matter which exude in strumous subjects, from the surface of the tonsils. I have reason to believe that this mistake is not uncommonly made, and that cases are dignified with the name of diphtheria which have no pretension to so formidable a cognomen, as is moreover shown by the facility with which they are remedied. Such an instance has presented itself to me within the last few days.

In those cases in which the disease has made its assault with greater violence, and which are characterised from the commencement by rigors, vomiting, and more intense general distress, the throat will likewise be found tumid and vascular, but the vascularity will be of a dusky mulberry hue, like that of erysipelas, and the diphtheritic membrane will, even at this early period, be found to have invaded the greater part of the surface of the tonsils and soft palate. I have in one or two instances, in fact, seen the entire fauces, as far as the eye could reach, invested with this membrane in twelve