the same time it becomes of a more opaque, dirty white hue, and more or less fissured on the surface. At the end of several days it ceases to spread, its edges begin to curl up, it becomes gradually detached, and comes away either as a complete membranous cast, or in a more or less softened and fragmentary condition. The deposition of this material is associated with, and no doubt dependent upon, a peculiar form of inflammation in the subjacent mucous membrane, attended by a variable amount of congestion and inflammatory exudation into the submucous tissue; in consequence of which a more or less brawny condition of parts is produced, especially observable in the lax cellular tissue of the larynx, when that organ becomes involved. The local inflammation is commonly neither very severe nor very deep, and disappears with the detachment of the membrane, leaving only a delicate and sensitive, or at most slightly excoriated surface behind. But, in some instances, the inflammation is of a much more intense character; involves the substance of the tonsils, causing them to swell, soften, suppurate, and even to slough; includes the lymphatic glands about the angles of the jaws; and may even extend throughout the whole of the tissues of the throat as far down as the sternum, rendering them hard, brawny, and intensely congested. It follows, therefore, that while the faucial inflammation is generally superficial, and the false membrane generally limited to the mucous membrane of the throat, the former may penetrate to any depth and be followed by any of the recognized results of inflammation, and the latter may spread to any of the adjacent prolongations of mucous membrane; either of which circumstances must materially modify the symptoms, and affect the issue of the case.

The false membrane itself varies in thickness from a line or two downwards, and in consistence from that of ordinary reeently coagulated lymph to a friable or even diffluent pulp. It consists essentially, according to microscopic examination, of a network of coagulated fibrine, in itself not materially different from that deposited on inflamed serous surfaces; buf mixed more or less with the proper epithelium of the part, with imperfectly formed or breaking down cells, and with granular matter. I believe that in the first instance the lymph is effused beneath and among the epithelial structures, entangling them

in its meshes; and that the subsequent exudation accumulates beneath the layer thus formed, becoming gradually more and more free from cell formation, and more and more purely lymph; so that in the fully formed membrane the attached surface will be found to consist of coagulated fibrine alone, the superficial of a certain amount of fibrinous exudation, together with epithelium, and any accidental matters which may have become adherent to it. It has never happened to me to detect it in any vegetable growths, and it is evident that their occasional presence is accidental only and quite unimportant. The false membrane of diphtheria has no specific character; it is not only not due to any form of parasitic growth, but it differs, according to my own examinations, in no respect from the false membrane of common croup, nor from that occurring occasionally in cases of erysipelas, nor lastly, I believe, in any important point from the exudation upon the pharynx and larynx occurring in the course of small pox. I have examined the subjacent muscular fibres, imbedded even in inflammatory exudation, and found them to display their normal, striated character.

(b.) The lungs exhibit usually, I believe, a healthy appearance; still they occasionally present conditions which deserve consideration. It is recorded that in some instances the diphtheritic membrane, as in cases of croup, has extended from the larynx and trachea into the bronchial tubes. Further, when the larynx is affected, the tubes become generally loaded with secretion. But the most remarkable condition I have observed is one which in extreme cases affects pretty uniformly the whole of both lungs. These organs become more heavy and solid than natural, in consequence of extensive hepatization; the hepatization occurring in patches of small size, which are thickly and uniformly scattered, and separated from one another by a network of still crepitant tissue. The solid patches are granular, sometimes presenting the characters of red hepatization, sometimes those of apoplexy, and sometimes those of purulent infiltration. The affection is, in fact, a well marked and true lobular pneumonia. It appeared in an early and imperfect stage in the case of T. N., but was exceedingly well developed in the case of M. A. F., and in one recently under Mr. Simon's care; both of which latter proved fatal at a compara

tively late period of the disease. This affection of the lungs is interesting and important, but is not peculiar to diphtheria. It is, I believe, a not uncommon sequel to laryngeal disease, and is allied to, if not identical with, a condition of the lungs resulting, more especially in children, from capillary bronchitis. (c.) The kidneys in all cases which I have examined, have to the naked eye appeared perfectly healthy, but when tested by the microscope have invariably displayed distinct marks of disease. The disease, which is no doubt inflammatory, manifests itself in its milder forms by a little hæmorrhagic exudation into the tubules, and a granular condition of the epithelial cells. In its more severe forms, the epithelial cells are swelled up so as almost to obliterate the channel of the tubes, are opaque with granular matter and oil, and seem often to have lost their mutual adhesion; cylinders of the diseased epithelium become shed, and in addition transparent fibrinous casts are produced, and traces of intra-tubular hæmorrhage are seen. The malpighian bodies seem generally healthy, but in some instances a little exudation matter may be recognized between the capsule and contained tuft.

(d.) The heart is usually in a normal state, but in one instance in which I examined it carefully, its fibres were in a well marked fatty condition, and in the same case there had been extravasation of blood into its muscular tissue.

(e.) The blood, so far as its appearance goes, has seemed normal, and has furnished the ordinary forms of coagula in the heart's cavities. But that this fluid is in an unnatural condition, at all events in some cases, is shown by the fact of the occasional appearance of a kind of dark measley eruption, probably petechial, shortly before death; and by the occurrence in the case of T. N. of similar extravasations on the surface of many of the internal organs, and in the substance of the heart and suprarenal capsules.

(f.) I have never observed any eruption on the skin, beyond that above alluded to, nor any evidence of desquamation. I have not recognized any traces of dropsical effusion, although from the condition of the kidneys its supervention might reasonably be expected. And, finally, I have met with no pathological conditions in any other organs, sufficiently constant or sufficiently important, to render the details of them worthy of

record. I may add that, as may be seen by comparing the case of T. N. with the others above recorded, diphtheria, like small pox, scarlatina, and some other fevers, may vary from a comparatively simple and mild disorder, to one of the utmost maliguity, attended by that rapid sinking, and by those internal hæmorrhages which characterize such types of disease.

Symptoms.-The symptoms of the disease have been so well described that I ought, perhaps, to apologize for venturing to make any observations on this head. I am desirous, however, before discussing the treatment, briefly to call attention to the more important symptoms, to contrast them with those presented by other diseases with which diphtheria is liable to be confounded, and to review the different modes in which death appears to be produced.

(a.) The usual history of a mild diphtheritic attack is, I believe, the following: The patient without, or at most with extremely mild, premonitory symptoms, is attacked with slight soreness of the throat-that soreness being associated, even from the first, with the deposition of false membrane, and unattended by the ordinary symptoms of fever. For several days the soreness of throat increases, the membrane extends, and some fulness and tenderness appear in the submaxillary regions. There is still, however, no appearance of fever, no unnatural heat of skin, no pains in the head, back, or limbs, no dryness of tongue, no marked thirst, and no tendency to delirium at night; yet the patient loses strength, and the urine possibly becomes albuminous. After the further lapse of a few days, the soreness in the throat and the external tenderness diminish; the false membrane separates, leaving the denuded surface either slightly excoriated or simply irritable, and but for the now probably confirmed albuminous condition of the urine and the increase of debility, the patient appears to be going on favorably. Notwithstanding, however, the disappearance of all those symptoms which in the beginning were looked on with alarm, the patient, with no obvious cause, except perhaps the persistence of albuminuria, still loses strength, becomes anæmic, and finally recovers health only after a very protracted and fluctuating convalescence.

The above detailed symptoms are probably those of nearly all cases of diphtheria; but the most remarkable of these are

the affection of the throat, the absence more or less complete of fever, the condition of the urine, and the great debility. They are, however, liable to vary somewhat, according to the severity of the attack and probably accidental circumstances, and occasionally others of more or less importance may be superadded. -Med. Times and Gazette.

Memoirs on Diphtheria, from the Writings of Bretonneau, Guersant, Trousseau, Bouchut, Empis, and Daviot. Selected and Translated by ROBERT HUNTER SEMPLE, M.D., with a Biographical Appendix by JOHN CHITTO, Librarian to the Royal College of Surgeons. London: The New Sydenham Society, 1859. pp. 407. Amonst the many remarkable things to be noted in the annals of our profession, we hold it to be not the least remarkable circumstance that, in a science of observation, as, more or less, medicine undoubtedly is, a disease will arise, spread, and exist for ages, die out, and almost be forgotten, reappear, be described as a new disease, its etiology be misunderstood, its pathology incorrectly described, its treatment, as a natural sequence, be established on uncertain data-until the appearance of a master mind, who, studying the symptoms of to-day by the light of the records of past ages, recognizes the identity of the two affections; by laborious toil in the dead-room establishes on correct data its pathology, and, availing himself of the experience of the past, with the increased light shed on medicine by the advanced position occupied by science at the present, directs its treatment on rational principles, and, as a consequence, is by many looked on as the original discoverer, of a new disease, though such be not the case. His only claim is to have described that which has been known for centuries, but to have done so more in accordance with the position that, at the present moment, pathology should occupy amongst scientific physicians. Such is the history of diphtherite, and such is the relation held to it by the distinguished physician of Tours.

For the present collection of papers on this subject we are indebted to a new Society that has started up amongst us-"The New Sydenham Society"-a Society that, in our opinion, seems to have adopted for its motto, de facto, if not de jure, DEEDS, NOT WORDS, this being the third volume already this year presented to its members; the first volume, Diday on Infantile Syphilis, has been lying on our table for some time,and a review of it should have appeared in the current number of this Journal, but, considering its subject to be of so important a nature, and that the intrinsic merits of the book itself demand more space than we