ild could manage to
breathe. This was known as intubation. But these were both distressing
and painful methods, and, what was far worse, pitifully broken reeds to
depend upon. In spite of the utmost skill of our surgeons, from fifty to
eighty per cent of cases that were tracheotomized, and from forty to
sixty per cent of those that were intubated, died. In many cases they
were enabled to breathe, their attacks of suffocation were relieved--but
still they died.

This leads us to the most important single fact about the course of the
disease, and that is that the chief source of danger is not so much from
direct suffocation as from general collapse, and particularly failure of
the heart.

This has given us two other data of great importance and value, namely,
that while the immediate and greatest peril is over when the membrane
has become loosened and the temperature has begun to subside, in both
ordinary throat and in laryngeal forms of the disease, the patient is by
no means out of danger. While the antitoxins poured out by his body have
completely defeated the invading toxins in the open field of the blood,
yet almost every tissue of the body is still saturated with these latter
and has often been seriously damaged by them before their course was
checked. For instance, nearly two-thirds of our diphtheria cases, which
are properly examined, will show albumin in the urine, showing that the
kidney-cells have been attacked and poisoned by the toxin. This may go
on to a fatal attack of uremia; but fortunately, not commonly, far less
so than in scarlet fever. The kidneys usually recover completely, but
this may take weeks and months. Again, many cases of diphtheria will
show a weak and rapid pulse, which will persist for weeks after the
patient has apparently recovered; and if the little ones are allowed to
sit up too soon, or to indulge in any sudden movements or muscular
strains, this weak and rapid pulse will suddenly change into an attack
of heart failure and, possibly, fatal collapse. This, again, illustrates
the saturation of the poison, as these effects are now known to be due
in part to a direct poisoning of the muscle of the heart itself, and
later to serious damage done to the nerves controlling the heart,
chiefly the pneumo-gastric. Moral: Keep the little patient in bed for at
least two weeks or, better, three. He will have to spend a month or more
in quarantine, anyway.

Last of all, and by no means least inte