The unhappy result of mistaken diagnosis is usually limited to delay in proper treatment. At times the penalty is greater. During the past few years we have been impressed with the high fatality among patients with diphtheria after surgical incision of the peritonsillar tissues in the belief that the condition was one of peritonsillar abscess.
There are two indications for surgical intervention in diphtheria. Intubation or tracheotomy is necessary when membrane invades the larynx or trachea to such an extent as to interfere with respiration. Extraneous conditions in a patient suffering with diphtheria may require remediation, as acute appendicitis or fracture of the humerus, both of which have been seen in patients with diphtheria.
The disease is primarily a local infection of the mucous membrane of the nose, throat or nasopharynx. At the site of the lesion, a powerful exotoxin is elaborated by the invading infectious agent. This toxin passes