NONDIPIITHERITIC AFFECTIONS Aside from conjunctival diphtheria, formation of pseudomembranes is seen in blennorrhcea, in very severe eczematous or congestive catarrh, in pemphigus, in herpes iris of the conjunctiva, and in traumatic con junctivitis following burning, scalding and chemical irritations. The other symptoms of diphtheria and the bacilli are absent.
The mortality of diphtheria varies greatly according to the type of the epidemic. In injected cases it is, on an average, from 12 per cent. to 16 per cent.; in uninjected cases, according to the figures of Zucker in Styria, about 40 per cent. (in the preserum period, according to Bayeux, 55 per cent.). The number of fatalities in the separate forms of diphtheria is very varied. The figures in the Chil dren's Clinic in Gratz (Pfaundler) in the decade from 1595-1904 gave in 1594 injected cases of localized pharyngeal diphtheria, 1.2 per cent.; for descending diphtheria (croup), 17.S per cent.; in malignant diph theria, 37.1 per cent. (see F:g. S1). Aside from the form of the diph theria the termination is dependent on the age and strength of the pa tient, as well as the care and attention given; in brief, on the attendant circumstances. Diphtheria in nurslings is most dangerous because of the frequency of septic complications, and in children up to five years of age, because of the tendency of pharyngeal diphtheria to spread to the respiratory tract. The disease is especially threatening when it attacks radically weak and badly nourished children or those depressed by other diseases (as tuberculosis), or when it appears as a complication of measles or in the course of scarlet fever, pertussis or influenza. Every
thing depends on an early diagnosis and the prompt injection of the anti toxin, likewise on the strictest observance of all the rules of hygiene. It is necessary to exercise caution in giving a favorable prognosis as to the outcome, because even apparently mild cases may suddenly take a turn for the worse. Extension of the fibrinous exudate to the larynx always renders the prognosis dubious because there may be a sudden spread to the bronchial tree and death may be almost unavoidable in spite of the use of the antitoxin. The prognosis is hopeless when signs of malignant diphtheria appear: great and painful swelling of the glands with periglandular haemorrhages into the skin and false membrane, diazo reaction in the urine, signs of heart weakness and early paralysis.
As favorable signs may be considered a profuse flow of saliva, a change of the pharyngeal secretion from a thick mucus to a thin fluid; also the appearance of a hyperleucocytosis three to four hours after the injection of the antitoxin. (The serum-injection is immediately followed by a hypoleucocytosis and then three or four hours later in favorable cases by a hyperleucocytosis, which is greater than that existing before the injection of antitoxin. In fatal cases the hypoleueoeytosis follow ing the injection does not yield to a hyperleucocytosis, a proof that the serum is not acting.—L. G. Simon).