Page:Diphtheria - a lecture delivered at the Norfolk and Norwich Hospital (IA b22345656).pdf/9

 hours from the first complaint. Such cases most justifiably excite the utmost apprehension, for in a brief period more a most serious increase takes place in all the symptoms. The system has now fairly taken the alarm, and there will be either a hot skin with quick pulse, or, as in the severest cases, a state approaching to collapse with a cold and livid surface. The swallowing, though it may, especially in adults, be in some cases not materially embarrassed, now, in young children, most generally becomes difficult and painful, so much so that the little patient obstinately refuses to make the attempt either with food or medicine. And this constitutes in itself one of the main difficulties in the treatment; if the patient, by force or persuasion, be induced to swallow under these circumstances, the scene is often a fearful one, and the child is seen struggling and fighting for breath, while the food is violently ejected by the mouth and nostrils.

The case has now assumed a most formidable aspect, the child is enfeebled by its inability to take food, and harassed by the attempts it cannot avoid to swallow the saliva and foul secretions of the mouth; the false membrane has invaded every visible portion of the pharynx which appears as if coated with dirty wash leather, and is discoloured with the blood and sanies which exude from the congested vessels beneath it. The breath has all along been offensive, but now it is horribly so, so that the most tender mother can scarcely nurse her child without feelings of repulsion; a bloody and fetid secretion excoriating the skin runs from the nostrils, and the glands and cellular tissue of the neck are tender and infiltrated, thus adding materially to the embarrassment