Page:Diphtheria - a lecture delivered at the Norfolk and Norwich Hospital (IA b22345656).pdf/7

the phenomena as they have been witnessed in various parts of this connty. The intensity with which the child (for the great majority of its victims are children) is attacked is very variable. In some instances he appears to ail so little as to blind the eyes of the most anxious parent to the storm which is hovering over his hearthstone; he makes but little complaint, beyond some slight difficulty in swallowing, and in the intervals of transient dulness and apathy will occupy himself as usual with his toys or ordinary occupations. In other cases, the patient suffers more severely at the very outset; he is seized with feverishness and vomiting, and is prostrated at once; and the lapse of a few horn’s only is sufficient to manifest to an ordinary observer that the system has succumbed to some overpowering morbific agency. In either case the complaint which first calls attention to the throat is a slight embarrassment in swallowing, with a sense of heat and fulness, but the dysphagia and pain are trifling compared with that of the early stage of acute tonsillitis. On inspecting the throat at this time, its condition will be found to vary in appearance according to the early period of the attack and its absolute severity. In some cases the tonsils, soft palate, and uvula, are seen to be simply red and œdematous; and on a casual view nothing more would be noticed, so that the case might be erroneously set down as one of simple tonsillitis. But if true diphtheria exists, even a few hours after the first feeling of uneasiness, a more careful examination will disclose one or more white patches of variable size on the tonsil or elsewhere (see fig. 1), not larger, perhaps, than a split pen, but enough to warn any one who has previously seen