DIPHTHERIA.
Diphtheria is an acute contagious disease characterized by moderate fever of an irregular type, and of from one to two weeks’ duration; by considerable weakness and prostration; and by the formation of a grayish or whitish false membrane upon the throat, nose, larynx, and adjacent parts. The exciting cause of disease is the bacillus of diphtheria, which is found chiefly in secretions of the affected mucous membrane. 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.
Preventive measures consist in isolation of the sick, the thorough disinfection of the bedroom, bedding, clothing, and all articles used by the sick, and the administration of an immunizing dose (500 units) of antitoxin (see page 25) to those who have already come in contact with the patient or who have otherwise been exposed to the contagion. The sick-room should be well ventilated and maintained at a temperature of 70° F. The atmosphere should be made moist by slaking lime in the room or by generating steam in a kettle. In membranous laryngitis treatment in a steam-moistened tent is desirable. On account of the tendency to sudden heart failure absolute quiet and rest are to be enjoined. The diet should consist of milk, unseasoned broths, koumiss, junket, and eggs.
The patient’s temperature, pulse, respiration, nourishment, urine, sleep, and bowel movements should be noted as in other fevers. Local applications of boric acid solution, hydrogen peroxid (1: 3), or normal salt solution are usually ordered; they should be made with utmost gentleness. Externally, ice-poultices or hot fomentations are useful in relieving soreness.
The utmost care should be exercised during convalescence to guard the patient against undue effort, as at this time sudden heart failure is especially liable to occur.