Issue 10, pp. 753-832, October 1861, SMSJ

788 Dvphtlima. [October,to confound it, are angina maligna and croup. In the firstof these affections, the medical man has the general symptomsof scarlatina to guide him, and especially the eruptionwhichis absent in diphtheria. In scarlatina, the tonsils areof a bright red, resembling the juice of the strawberry, andthe membrane which covers them is simply inflammatory ;while in diphtheria the hue is deeper. The exudation inscarlatina is white, opaque, cheesy and easily furrowed ;while in diptheria it is yellowish, tenacious and not easilyimpressed by the action of a hard body. The inflammatoryaction in scarlatina is observed at the beginning in allthe soft parts of the throat; while in diphtheria it almost invariablyshows itself at the commencement upon the tonsils.As the disease progresses, diphtheria manifests a tendencyto invade the air passages, which is not one of thecharacteristics of scarlatina.The main distinction between croup and diphtheria is tobe found in the part affected. In croup the trachea is primarilythe seat of diseased action ; in diphtheria it is onlyreached after the disease has made considerable progress.In croup the earliest symptom is stridulous breathing; whilein diphtheria the primary symptoms are chiefly observed inIn croup the false membrane onthe organs of deglutition.the tonsils is not present; in diphtheria, it is an invariablesymptom.Complications.—Diphtheria may manifest a dispositiontothe formation of a false membrane in other parts than thoseprimarily affected, as the skin, the mucous membrane of thenose, the ears, the lungs, and the anus ; or it may prevailcoincident with other affections, as influenza, bronchitis,measles, scarlatina, erysipelas, or it may be affected by aparticular epidemic condition, in which it becomes complicatedwith hemorrhage of the nose, skin, and mucous membranesof the intestines or lungs, or a typhoid type oldisease.Prognosis.—When diphtheria is confined to the tonsils, \\usually terminates in a restoration to health ; but when thefalse membranes extends to the nasal cavities or the laryniespecially if accompanied with grave constitutional symptoms, the patient is placed in imminent peril. Even in favorable cases, the prognosis should be given with muclconsideration.Treatment.—The practitioner has three important indicalion to fulfil in the treatment of diphtheria :