This is a very formidable complaint, and frequently fatal. It has been known under different names for ages. In modern times Starr has described an outbreak of the disease, about one hundred and twenty years ago, in Cornwall. In its epidemic form, it has been much more prevalent in France than in Great Britain. Bre-tonneau watched, and has recorded a visitation which desolated Tours in 1818 and the three following years; and he it was who gave it the name by which it is now commonly known.

Dr. Watson says: "I had been for more than a quarter of a century in practice in London before I met with a case of Diphtheria; or scarcely so much as heard of such a disorder. In the year 1855 alarming rumours reached this country of its prevalence and fatality at Boulogne. Soon afterwards scattered cases of the disease began to appear among us, and presently so multiplied in number as to constitute a real epidemic. It has never since ceased to be the dread of parents, and I may truly say of medical men also."

"No case (says Mr.Eastes) of Diphtheria had ever been seen in Folkestone during my time, until Isabella W., aged four and three quarter years, arrived from Boulogne on the evening of July the 2nd, 1856, being then in an advanced stage of the disease. She died on the following day. On July 6th, Catharine W., her sister, aged ten, was attacked, but she had never been in France; she had always resided on the East Cliff, Folkestone, in the same house to which her dying sister was brought four days previously. One other case occurred in the same house three days after, and all terminated fatally."

The disease is highly contagious, but Sir William Jenner, fully admitting its contagious character, says: "There is not the shadow of ground for the belief that the disease can be carried by the clothes, etc, from one house to another." But Trousseau affirms that any person being in an atmosphere tainted with the Diphtheritic poison, having any wound or abrasion of the skin, may catch the disease through the wound or abrasion. It is therefore highly necessary that persons having open sores should be kept away from the contagion.

Diphtheria commences with sore throat. On looking into the throat you will perceive that the surface is of a dusky red colour, with here and there a white or gray coloured patch, the matter on the surface of which soon stiffens into a membranous form, and which may vary in consistence from that of cream or paste to that of a thin kid glove. The inflammation, and the membrane resulting from it, are apt to spread, and to spread in different directions, into the air passages, and Sir William Jenner has seen two cases where it extended into the stomach. At the same time there is a certain amount of fever, a peculiar tint of the skin, bleedings from the nose, great debility, a rapid and feeble pulse, or, which is worse, a morbidly slow pulse: the glands at the angle of the jaw become swollen and tender. The formation of the false membrane takes place more rapidly in children than in adults.

Occasionally, but not always, the patient's breath becomes very offensive, and you might suppose that there was gangrene and sloughing of the throat; but the smell arises from decomposition of the membranous mass, or of portions of food or drink which get entangled in it; and the unpleasant smell may be got rid of by cleansing the throat with some deodorizing wash.

Dr. Watson says: "With some few exceptions, in which a peculiar state of the throat and uvula makes deglutition exceedingly painful, there is seldom in the outset any great difficulty of swallowing; nor is pain of the throat of frequent occurrence. Hence the complaint is apt to be insidious in its approach. The patches of false membrane may come, and go, without our knowledge, if we are not careful, and on the alert upon the slightest hint, in looking into the fauces (throat). In the case of a young child this inspection will be difficult and abortive, or easy and instructive, according to your method of procedure in making it. Both Trousseau and Sir William Jenner give the requisite rules; which are too often neglected, or unknown. In the first place the child's head and limbs must be firmly held, and fixed immovably, by an assistant. Then a broad and strong unbending spatula, the handle of a table-spoon, if nothing better can be had, must be passed far back into the child's mouth as soon as it opens it to cry: as far back as the root of the tongue, which is to be forcibly depressed and pulled forwards. The throat will thus, if the light be properly managed, come clearly into view, and the suitable applications may be made to the seat of the disease. I should recommend you to make use, on these occasions, of the reflecting mirror, placed upon your forehead, as directed in Dr. Johnson's little book. This will enable you with great ease and certainty to throw the light upon any part within the mouth; and, what is of great importance, you will have both hands at liberty-the one wherewith to depress the patient's tongue, the other to apply your remedies."

Cough is one of the symptoms of the disease, at first short, dry, and coming on in fits. Then, as the disease spreads to the Larynx, both cough and voice grow hoarse, husky, muffled, extinct. Paroxysms of severe shortness of breath occur; the lips and face become pale or livid, and death by suffocation closes the scene.

Strips of the false membrane are sometimes detached and brought up by the cough, with temporary, or possibly with permanent relief: but the membrane is too apt to be renewed, and it may be renewed with great rapidity. It has been known to reform in from six to seven hours.

Sir William Jenner's experience of about 58 cases, showed a duration of the disease of from forty-eight hours to fourteen days. When death took place within a week from the first symptoms of illness, it was always preceded by extension of the inflammation to the larynx. He had never known laryngeal symptoms begin after the expiration of the first week of the disease. They were now and then the first symptoms to attract the attention of the patient or the patient's friends. Twice he had seen death occur within twelve hours from the time when the laryngeal symptoms were first noticed, and he had never known death delayed more than five days from the time when symptoms indicated clearly that a false membrane had formed in the larynx. In rather more than half of the fatal cases, death was the result of the disease in the larynx; and in rather more than half the remainder, laryngeal disease was present, although death apparently took place from debility. When death occurred from debility-the consequence of the general disease-the fatal event had usually happened during the second week of the disorder, unless the patient had been greatly weakened by some previous illness. In the cases that recovered, the specific disease terminated between the eighth and the fourteenth days.