DIPHTHERIA
Diphtheria is an acute, specific, infectious, communicable disease. It affects the tonsils, throat, nose, or larynx. It is most frequently seen in children between the ages of two and five years, though it may appear at any time during life. The two sexes are equally liable to it. The same person may have the disease twice or more times at different ages. Children suffering from disease of the nose or throat are more likely to get it than are others. Such diseases are cold in the head with running nose, catarrh of the nose and throat, inflammation of the mucous membranes of the nose or throat.
Diphtheria may occur at any time of the year, though it is more frequent during the cold months. The incubation, or the length of time between exposure to the disease and the development of the symptoms, is between two and five days. In its mild form the disease may be present without giving any constitutional symptoms. In its severe form, however, it is one of the most dangerous diseases of childhood. In large cities it is present all the year round with more or less frequent outbreaks in the form of local epidemics. In the country it is only seen in its epidemic form. It does not arise without a cause, that is, there is always a preceding case from which an epidemic springs, though it is not always easy to trace the connection. The child inhales the bacilli which cause the disease with the air it breathes. The bacilli may lodge on toys or other articles from which the child gets them. Direct infection is usually the mode of communication through which a child obtains the disease. The saliva and mucus from the nose contain the bacilli in large quantities and if a patient coughs or sneezes they are expelled in this way and infect others. Frequently a child suffering from a mild form of diphtheria may attend school and infect others without it being known that the child has the disease.
Symptoms.—The symptoms vary with the severity of the attack. There are mild cases, as has been stated, that give no constitutional symptoms. There may be a small amount of local disturbance in the throat or nose and there may be some membrane present, but, for some reason, there does not seem to be any absorption of the poison into the system and the child escapes the systemic disturbance. Even as a local condition these cases vary. There is always a fever at the beginning, but the child never seems sick enough to go to bed. If the throat is examined it will be found to be red and slightly inflamed, there may be spots on the tonsils, or there may be a gray film over them. There is no discharge from the nose and the child does not complain of an excess of mucus from the throat. The spots may last for a week and then disappear. These cases are difficult to diagnose without making a culture, and if the physician insists upon keeping the child confined to bed while apparently well the family as a rule object, though it is absolutely necessary. These are the cases that do great harm in school, and no mother should object if the physician insists in taking preventative measures to stop an epidemic if the bacilli have been found in the child's throat. She should rather feel thankful that the child escaped so easily.
Since the introduction of antitoxin we do not see the severe cases now, so that a description of them would not be of any use in a book of this character. Mothers should, however, know that it is absolutely criminal to take any chances with a "sore throat." Antitoxin is a prompt and an absolute remedy if used soon after the onset of the disease. It is more sure if used the first or second day, still reliable the third day, but its efficacy diminishes the longer we postpone its use from the date of the onset of the disease. When, therefore, a child complains of being sick and states that its throat hurts, medical aid should be at once sought.
The disease may develop in one of two ways. It may begin as a slight indisposition for a day or two, and perhaps some soreness of the throat. The fever may be slight. The child will continue to be sick despite any treatment given and will get slowly worse until the fourth or fifth day, when it will be impossible to mistake the condition.
At other times the disease begins abruptly. The child complains of being sick. It may vomit, or suffer from headache, chilly feelings, and a fever. The glands in the neck may swell and cause considerable disturbance. There is, as a rule, an abundant discharge from the nose and there is an excess of mucus in the throat. Membrane is seen in the throat. It may cover the tonsils and spread over the entire throat cavity, or it may extend up into the nose and over the roof of the mouth. All the parts are much swollen and breathing is interfered with, sometimes seriously. If the attack is very severe there is an active absorption of poison going on from the throat which soon renders the little patient intensely sick. There is marked weakness and prostration, the circulation becomes poor, the pulse rapid and the child falls into a stupor.
The physician will, of course, have taken complete charge of the case before the patient has gone thus far. The nursing of the case, which may fall to the mother if no trained nurse is present, is most important. She should preserve absolute cleanliness of herself and of the sick room. She should never eat or sleep in the same room with the patient, and should use a gargle, which the physician should prescribe, frequently during the day. She should dress simply, so that whatever is worn can be changed often and washed easily. Every article of furniture must be taken out of the sick room that is not absolutely essential in the care of the case. If toys are allowed they should be burned as soon as the child is tired of them, never left around the house after the case is over. The room should be a large one and it should be thoroughly aired each day. The floor should be washed each day with a solution of bichloride of mercury, and all dusting should be done with a wet cloth. The bed linen and any rags or handkerchiefs used should be treated as in scarlet fever. All vessels in which the patient expectorates should have an antiseptic in them. The room must be disinfected after the case is over.
The patient must be kept in bed during the entire attack. He must not be allowed to even sit up in bed until the physician gives him permission. This is a very important essential in the treatment of this disease, and the nurse must be held responsible for the conduct of the patient in this respect. Because of the character of the poison, there is a tendency to paralysis of the heart, and frequently children have been allowed to sit up too soon only to fall back dead in bed. The same thing has occurred later in the disease when children have been allowed to play too heartily before the poison had an opportunity to completely eliminate itself. Nursing children should be fed on breast milk pumped from the mother, but they must not nurse it themselves. Older children can take milk and should depend upon it mostly. The physician will give any other special directions that he may think necessary, the duty of the mother being to see that they are faithfully carried out.