Diptheria, sa nature et son traitement. La matière éliale, et peut-être maintenant et puis de l'éclatement des follicules wosecells ont augmenté par prolifération et ont subi une métamorphose d'atrograde et une dégénérescence graisseuse/1 amygdalite folliculaire aiguë se produit sporadiquement dans la connectionavec la pharyngite cataractrale ordinaire, endemiquement à partir de conditions insanisaires variales et épidiaires. Dans cette dernière forme, il est sans aucun doute une maladie spécifique, et est probablement incertains degré contagieux. J'ai été conduit à cette dernière conclusion d'avoir si souvent vu qu'il passe par des familles de chil- 1 De la T

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Diptheria, its nature and treatment . elial matter, and perhaps now and then from the bursting of follicles whosecells have increased by proliferation and have undergone aretrograde metamorphosis and fatty degeneration/1 Acute follicular tonsillitis occurs sporadically in connectionwith ordinary catarrhal pharyngitis, endemically from vari-ous local insanisary conditions, and epidemically. In this lastform it is undoubtedly a specific disease, and is probably insome degree contagious. I have been led to this last conclu-sion from having so often seen it go through families of chil- 1 From The Tonsils, their General, Surgical and Minute Anatomy, by D. Bryson Delavan, M.D., Archives of Laryngology, December, 1880. DIAGNOSIS. 125 dren, successive cases occurring- at intervals of one, two orthree days, just as occurs with dipntheria or scarlatina. Follicular tonsillitis is not a milder grade of diphtheria, but is a totally distinct disease. Diphtheria, it is true, maysupervene upon follicular tonsillitis, as upon other catarrhal. Fig. 9.—Hypertrophied Tonsil. (Enlarged drawing, Luschka.) This figure shows the posi-tion of the lacunae and their orifices ia the tonsil, as is above described. affections, but then it is usually, at least, only after the latterhas run its course. As this requires only a few days, it is notstrange that the two affections have been supposed by someto be related. Follicular tonsillitis differs from diphtheria in not causingconstitutional poisoning, either septic or specific. It is not 126 DIPHTHERIA; ITS NATURE AND TREATMENT. accompanied with nephritis (except as any febrile catarrhalaffection may occasionally be); it is not followed by paralysis, and I have never known of a fatal case.1 The onset of follicular tonsillitis is undistinguishable fromthat of diphtheria in the amount of febrile and-nervous dis-turbance which accompanies it. Its second stage, that of fol-licular exudation on the inflamed tonsil, may closely resemblediphtheria. Its thi

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