Secondary affections of various sorts may follow any form of diphtheritic disease. The most common of these is paralysis. Paralysis of the soft palate and pharynx is the most frequent; but the disease may involve any part or the whole of the muscular system. This affection usually comes on after the local disease is cured, even as late as the fifth or sixth week. It usually appears in the second or third week, beginning so insidiously as to be scarcely noticeable, and gradually increasing until fully developed. The soft palate is first affected. The uvula hangs down, making it impossible to give the open sound of the vowel a. If the paralysis is of one side only, the uvula will be drawn over toward the healthy side. The patient finds difficulty in articulation, in swallowing, and in expectoration. The speech is thin and nasal. The. sounds of syllables run into each other, being sometimes almost unintelligible. The patient will sometimes complain of liquids getting into the nasal cavity in drinking.

Paralysis of the muscles of the upper and lower extremities, of the larynx, of the face, the eye, the neck, trunk, and diaphragm, and of other parts also, occurs in many instances, especially in the more severe cases, appearing a week or two after convalescence begins.

An important fact to be recollected is that one attack of diphtheria is no protection against subsequent attacks. Indeed, a person who has had diphtheria is often more susceptible to the poison, and more liable to infection than if he had not suffered from the disease, on account of the chronic inflammation of the throat which frequently follows the disease.