some influential teacher-sometimes the result of real advances in pathology and therapeutics.

The Lectures are dogmatical in tone, because they were addressed to students; and I believe dogmatism to be essential for successful student-teaching. I endeavoured to make them practical in regard of diagnosis and treatment, because they were delivered to a clinical class. The details of the cases are few, partly because the majority of the patients were seen in private, and partly because I have found that students are more confused than instructed, when copious details of a case are placed before them.

Since the Lectures were delivered, several other cases of Diphtheria have come under my observation. Some of these having presented special points of interest, or peculiarities illustrating general statements in the Lectures, I have added materially to the text, and slightly modified its arrangement.

8, HARLEY STREET, CAVENDISH SQUARE,

January, 1861.

DIPHTHERIA.

LECTURE I.

GENTLEMEN:

On the table are several pieces of "false membrane," coughed up by a young gentleman twenty-one years of age, while suffering from diphtheria; also the pharynx, larynx, and lymphatic glands connected with those parts, from two children who died a few days since from the same disease.

Diphtheria is one of the acute specific diseases; that is to say, it is a general disease, runs a quick and definite course, and has a specific cause. Its anatomical character is-spreading inflammation of the mucous membrane of the pharynx, attended by exudation of lymph.

About three years since, diphtheria became epidemic in London. Since the early part of 1858, I have seen about fifty-eight cases, of which thirty-four have proved fatal.* And these cases

*From these numbers it is not to be concluded that half

B

have, with few exceptions, been scattered over the district bounded on the south by Holborn and Oxford Street, on the north by the Highgate and Hampstead hills, on the east by Hackney, and on the west by Shepherd's Bush: they may be considered to represent the general characters of the epidemic in its severer forms in the north of London. As several of the cases occurred within the last three weeks, and as they differed in no essential particulars from some of the cases I saw three years ago, I conclude that the epidemic preserves its original characters.

As in the other acute specific diseases, so in diphtheria, the general or the local symptoms may predominate, and give its special feature to the case. The patient may die from the severity of the general disease, or he may die from the severity of some one of its local consequences. In this particular, diphtheria bears a closer affinity to typhoid fever than to any of the other acute specific diseases; for in typhoid fever, as you know, the patient may die of the general affection :

the cases of diphtheria prove fatal, seeing that a very large proportion of the 58 cases came under my observation solely because of their extreme gravity, many of the patients being in a dying state.