Diphtheria

“ When a bacteriological examination is impossible, or when the clinical features do not coincide with the results obtained, the patient should always be treated on the assumption that he suffers from diphtheria. So much doubt exists as to the real nature of membranous croup and its relationship to true diphtheria, that when the diagnosis between the two is uncertain the safest plan is to treat the case as one of diphtheria. ”

“ It isn’t a chronic weakness. Diphtheria is apt to leave the heart in bad shape—it passes. Didn’t they tell you about that? That’s the treacherous character of diphtheria; you get well, then some day after a week or two you fall down. It’s an after effect that has to work off.”
“It isn’t serious then, doctor?” Wilfred’s mother asked anxiously.
“Not unless he makes it so. He must favor himself for a while.” ”

“ The germs that cause diphtheria always come from some person or animal that carries diphtheria germs. 2. Diphtheria is always caused by the diphtheria germ, and the diphtheria germ cannot cause any other disease. 3. People are quarantined to prevent other people from getting the disease. 4. If there is diphtheria in your neighborhood, and your throat becomes sore, have the doctor examine it. 5. Every person who has been staying in a house where there is a case of diphtheria should have his throat examined to make sure he is not carrying germs. ”

“ Diphtheria.—The most striking symptom of diphtheria is the growth of a substance in the upper part of the windpipe, which threatens to close it entirely. Good medical skill is of first importance here, yet much may be done where that is not available. We have often seen the swallowing of a little hot water and treacle enable the children to throw up the entire obstruction and make the breathing perfectly free. Mark at once whether the feet are cold or warm. If cold, oil them well with olive oil, and pack in a hot blanket fomentation to the knees. ”

“ Diphtheria is an acute infectious disease, the essential feature of which is a peculiar inflammation of the lining membrane of the mouth, nose, throat, and windpipe, characterised by the formation of a membrane upon the inflamed surface. Diphtheria occurs in the tropics but happily does not spread much in hot countries. ”

“ The generation of medical men is not yet passed who refused to credit the thought that the diagnosis of diphtheria would ever be made only by the microscope and culture methods, and who considered that they could tell very well what was diphtheria, and what not, from the appearance of the throat. ”

“ I do not know that sex exerts any predisposing influence over diphtheria, yet of the six hundred cases or thereabouts of laryngeal diphtheria in which I either personally performed tracheotomy or observed the progress of the disease in the practice of others, I found the majority in males, and the recoveries in inverse proportion to the number thereof, the mortality being greater among boys. ”

“ The heart and blood are affected in various ways by the diphtheritic process. Where the disease runs a slow course, accompanied by high fever, a granular degeneration occurs, similar to that appearing in other acute infectious disorders—typhoid, for example. In diphtheria, however, it would seem that this condition may arise even without marked elevation of temperature. The pathological changes in the heart produced by diphtheria are not always the same. Ecchymoses, cellular hypertrophy, and granular degeneration have frequently been noticed after death where the symptoms had been severe. ”

“ Exactly the same procedure has been adopted for diphtheria, and it is now found that by injecting anti-diphtheritic serum into children who are exposed to the infection of diphtheria, they can for several weeks be prevented from developing the disease. This is of great practical importance, as meanwhile the source of infection can have been removed. Furthermore, the protective serum is also curative, and by its means diphtheria, if early treated, can be reduced from a dangerous to an insignificant disease. ”

“ With such more or less real affinities in the pathology and etiology, it may be made a question whether the recent increase of the death-rate by diphtheria in London and some other places has depended, as if in the way of correlation, upon the decrease in the [Pg 746] death-rates of scarlatina and of enteric fever [1385] . Diphtheria is perhaps the most obscure and complex of all the infective diseases in its causes and favouring conditions. A certain explanation may seem to suit one outbreak and be wholly irrelevant for another. ”

“ On the vulva and vagina of little girls diphtheria is sometimes met with; probably in every case it is due, under the epidemic influence, to a local catarrh or erosion. In but few cases, comparatively, the inguinal glands are swollen. There are not many cases of vaginal diphtheria which are followed by the pharyngeal affection. Diphtheria of the vagina in puerperal women is liable to become the cause of general sepsis, and is a dangerous disease; it is seldom complicated, but uterus, Fallopian tubes, and peritoneum may become the seat of inflammatory and septic disturbances. ”

“ An Italian cook, suffering from diphtheria, in the month of November, 1881, while being subjected to local treatment with carbolic acid, bit the head-nurse's left foot and hand. Both these wounds became diphtheritic, the man falling sick with high fever, and requiring three weeks for his gradual recovery. Besides, four of the six workingmen employed in taking care of the hens of the establishment were taken with diphtheria. Not a single case, however, occurred in the neighboring village. Thus, it is safe to assume that the diphtheritic disease of hens can be transmitted to man. ”

“ Diphtheria. — In regard to no disease has medical opinion undergone greater modification than it has in respect of diphtheria. Accurately applied, bacteriology has here gained one of its greatest triumphs. Not only have the aetiology and diagnosis of this disease been made clear, but knowledge acquired in connexion with the production of the disease has been apphed to a most successful method of treatment. In 1875 Klebs described a small bacillus with rounded ends, and with, here and there, small clear unstained spaces in its substance. ”

“ Of these 160 cases, 103 showed the germ for seven days, thirty-four for twelve days, sixteen for fifteen days, four for three weeks, and in three for five weeks, after the exudation had completely disappeared from the upper air-passages. The circular infers, thence, that “these results show that in a considerable proportion of cases persons who have had diphtheria continue to carry the germs of the disease in their throats for many days after all signs and symptoms of the disease have disappeared.” ”

“ Those sick with diphtheria must be isolated, though the case appear ever so mild, and, if possible, the other children must be sent out of the house altogether. If that be impossible, let them remain outside the house, in the open air, as long as feasible, with open bedroom windows during the night, in the most distant part of the house, and let their throats, and those of their nurses, be examined every day. The watching eye of a father or mother will discover deviations from the norm, so that the physician can be notified. ”

“ The introduction of the serum treatment has, however, had a marked effect on the mortality of the disease; and the actual number of deaths from diphtheria has either not increased at all, or has slightly diminished." (Lancet, 5th Aug. 1899.)
Of course there will still be bad diphtheria years and good diphtheria years: for example, the death-rate of the population of England, from diphtheria, was higher during the years 1893-1899 than during the years 1889-1892. Antitoxin can no more prevent a bad diphtheria year than an umbrella can prevent a wet day. ”

“ Two per centum is a liberal mortality in membranous croup, yet a certain class of physicians are constantly reporting deaths from this disease. In a series of 286 cases (not deaths) diagnosed as membranous croup by physicians of New York {188} City a few years ago, Park found the diphtheria bacillus in 229, or 80 per centum. I have never examined the throat of a child dead from so-called membranous croup in which I did not find the diphtheria bacillus. This is the experience of almost every bacteriologist who has had to do with diphtheria. Some men report deaths from diphtheria as thrush! ”

“ It will often get into a throat and grow a little, just enough to keep alive, but without making the throat sore at all. The person in whose throat the germs are will have no idea that they are there, but when he comes in contact with some one who has a delicate throat, he may give diphtheria to that person. The disease does not develop in some throats because the body cells are all healthy and doing their work so well that, when the diphtheria germs try to take hold, they are driven off and not allowed to grow. ”

“ The principal conclusion which I would draw from this paper is that our study of the results of the treatment of over seven thousand cases of diphtheria by antitoxin demonstrates beyond all reasonable doubt that antidiphtheric serum is a specific curative agent for diphtheria, surpassing in its efficacy all other known methods of treatment for this disease. It is the duty of the physician to use it. ”

“ Actual diphtheria of the stomach is rare. So is that of the intestine, which is much more liable to be affected in animals than in man. In the cow intestinal diphtheria is frequent (Bollinger) . In the gall-bladder, resulting from the irritation produced by calculus, it was seen by Weisserfels. The diphtheritic form of inflammation of the human colon and rectum—dysentery—is frequent enough, but will be the subject of discussion in another place. ”

“ She should remove her finger rings or they will be blackened. The patient should not be handled except when absolutely necessary, to avoid needless exposure to infection; it is also injurious to a child ill with diphtheria to lift it up. The nurse's covering wrapper should be soaked in the tub as often as possible. Some ignorant persons give as an excuse for a lack of care in {192} handling patients having contagious diseases like diphtheria, that they are not afraid of the infection. Fear has nothing to do with the matter. ”

“ In certain infectious diseases such knowledge is of great importance, not only in the interest of the patient, but of others liable to infection. This is especially true in diphtheria and in tuberculosis of the lungs. In the first-mentioned disease an early differentiation of true diphtheria from pseudo-diphtheria is often impossible without resort to methods by which the bacteriologist is able to detect the presence of the diphtheria bacillus. ”

“ In the first epidemic period, 1855-61, Farr reckoned that 1553 adults had died of diphtheria above the age of twenty-five, while the deaths under that age had been 28,216. In its age-incidence diphtheria is very different from croup, which attacks chiefly children of one, two, and three years of age, the boys dying in greater numbers than the girls [1377] . ”

“ They were being carried out from the receiving tents as fast as possible, after their cards had been made out and their throats examined for diphtheria suspects. We have had a lot of diphtheria brought to us and a number of our own people have caught it. We now have four nurses away in the contagious{120} hospital near here, one has diphtheria and the other three had positive throats without any clinical symptoms, so they just have to be kept away from everybody until they are negative. So all suspected throats are isolated in a special line until cultures can be made and examined. ”

“ The constitutional symptoms are due to the absorption of a toxin produced by this bacillus.
Diphtheria involving the larynx is sometimes termed true croup or pseudomembranous croup. This form is characterized by irregular fever, hoarseness of the voice, croupy cough, and progressive difficulty in breathing. Death frequently results from suffocation, unless tracheotomy or intubation of the larynx be performed.
The chief complications of diphtheria are pneumonia, degeneration of the heart-muscle, inflammation of the middle ear, and paralysis the result of an inflammation of the nerves. ”

“ They will usually get well with this treatment alone. The cases of genuine diphtheria, complicated with a great deal of stomatitis and pharyngitis, also indicate the use of chlorate of potassium; not, however, as a remedy for the diphtheria, but as a remedy for the accompanying catarrhal condition in the neighborhood of the diphtheritic exudation. For it is a fact that, as long as the parts in the neighborhood of the diphtheritic exudation are in a healthy condition, there is but little danger of the disease spreading over the surface. ”

“ No sooner had Bessie, Charlie’s nurse, been released from quarantine by the doctors in Yokohama than our older boy, Robert, developed suspicious symptoms which, upon diagnosis, were pronounced to be diphtheritic. The sore throat began before Mr. Taft left for Manila, and he was loathe to go, but as the new serum treatment for diphtheria had robbed the disease of much of its terror, and as we were in the hands of an excellent American physician, Dr. Eldridge, I felt confident there was no cause for serious apprehension. ”

“ Diphtheria is one of the most common of all the preventable diseases. It causes more deaths than any of the other diseases that can be prevented, except tuberculosis. The great prevalence of diphtheria is due to lack of care on the part of those who have this disease and of those who come in contact with them. ”

“ Don’t you see that school attendance offers the one best chance of keeping track of such an epidemic, among the very ones who are most liable to it, the children? Diphtheria is contagious in the early stages, as soon as the throat begins to get sore, and before the patient is really ill. Just now there is an indeterminate number of children in every one of our schools who have incipient diphtheria. ”