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in any particular case it is a far safer procedure to treat
it as a case of diphtheria until it is proved not to be
diphtheritic in origin.
Many of these cases which prove on investigation to be
non-diphtheritic are sent in as cases of laryngeal diphtheria
on account of there being some difficulty in breathing. There
can be no cavil at the precautionary step taken whereby a
case of difficult breathing is sent in to hospital on suspicion
of diphtheritic laryngeal obstruction, for those who have
experience of laryngeal obstruction of this nature in an
infant know with what alarming rapidity the case may get
beyond preventive agency and reach the operating table.
If there be any cavil it is at the withholding of antitoxin
in any case where even a remote suspicion of diphtheria
exists.
In connection with laryngeal diphtheria, there is a
tendency in some quarters to regard any obstructive condition
involving the larynx and trachea of a child as due to
diphtheritic membranous exudate. This is too positive a view.
There are cases of simple laryngitis giving rise to symptoms
not unlike the early stages of diphtheritic obstruction. Then
there are the cases of laryngeal spasm and the laryngeal
symptoms which not infrequently are the harbingers of
measles and whooping cough. In this latter connection there
is an administrative risk attendant upon the admission of such
cases to a diphtheria ward. Finally, there are the cases of
mechanical obstruction from foreign bodies, and recent literature
on this subject is not wanting in evidence of the part
played in respiratory obstruction by this element.