n beyond the hope of recovery.

It is not that here, as in cases of catarrhal croup, the ailment has
really come on suddenly, but that the disease has been silently making
unsuspected progress. Whenever then a child, after a few days of slight
causeless ailing, accompanied with some little discomfort in swallowing,
is seen to have white patches at the back of its throat, do not allow
yourselves to be lulled even by their disappearance into a feeling of
absolute security. Watch the child, and beg the doctor to watch it
carefully, until it is perfectly well again, for though the deposit may
have disappeared from the back of the throat it may continue to be
formed in the windpipe, and in the somewhat depressed state of the
nervous system which attends diphtheria it may not excite that
irritation which any such cause would produce in a child in perfect
health, and consequently not announce its presence until its amount has
become so considerable as to offer an almost insurmountable obstacle to
the entrance of air. Any, even the slightest, hurry of breathing, a
hissing sound when the child draws its breath, hoarseness of voice, or a
ringing cough, should quicken your apprehension of danger, and make you
seek for immediate help.

It may be as well, however, to mention here, that not every white speck
seen at the back of the throat is of necessity due to diphtheria, but
that in some cases of ordinary sore-throat white spots may form on the
surface of the tonsils. These white spots are due to the collection at
their openings of the secretion formed in the minute glands which beset
the surface of the tonsils, and which at these seasons is poured out in
greater abundance than usual. They are distinct from each other, and do
not coalesce into a membrane; the surface beneath is not the uniform red
shining surface on which the membrane in diphtheria has formed, but the
separate tiny openings from which the white matter has exuded may be
distinctly seen if the surface is wiped with a camel's-hair brush. It
is, of course, wise in every case to leave to the doctor the decision as
to the nature of the deposit, but it may sometimes relieve needless
anxiety to know beforehand that there is another cause besides
diphtheria to which white spots at the back of the throat may be due.

There are other dangers, indeed, besides those arising from croup, which
accompany diphtheria, though those just mentioned are of all the most
frequent. There