Health on the Farm: A Manual of Rural Sanitation and Hygiene

by H. F. Harris

As complications we may have broncho-pneumonia, acute Bright's disease, inflammation of the internal structures of the ears, bleeding from the nose, inflammation of the valves of the heart, and sometimes paralysis of this organ, with death; the last named sequel of diphtheria comes on during convalescence, usually from two to four weeks after the subsidence of local symptoms, and is due to inflammation of the nerves that control the heart. Much less commonly paralytic conditions of the palate, throat, eye muscles and the nerves of taste occur, and under rare conditions, paralysis of the lower extremities. Paralysis of some kind follows in from ten per cent. to fifteen per cent. of the cases, and appears with equal frequency after the mildest as well as following the most severe cases.

Mode of Infection.—The germs of diphtheria may be carried in articles used by persons with the disease, or they may be communicated by direct contact. The micro-organism is found in the secretions from the mouth, throat, or nose, and in particles of detached membrane. Bedding, utensils, etc., used in the room where a patient has diphtheria, are liable to carry the germs if taken from the sick-room, and consequently should be always properly disinfected before being removed. Milk-bottles carried into the sick-room, or handled by persons caring for the patient, should never be returned to the dealer without being disinfected. Cats, and less frequently dogs, may contract the disease and convey it to those with whom they come in contact. Unrecognized mild cases are a frequent means of spreading the disease, as also is a too early release of patients after recovery. It is a much safer method of procedure to require at least two negative examinations before releasing a patient from quarantine, as during convalescence the germs may be entirely absent on one day and a few days later be quite abundant. The bacilli may remain in the throat from a few days to several years after the disease is apparently entirely well, and under such circumstances the persons carrying them become quite as great, if not a greater, menace to those with whom they came in contact as they were during the height of the disease. A thorough disinfection of the room and everything used about the sick person should be carried out after the patient is released. Complete isolation should be observed during the illness, and as long as the bacilli remains in the throat.

Treatment.—Diphtheria antitoxin is the specific treatment of this malady, and should be given early in the disease. The chances of recovery decrease in proportion to the length of time existing between the onset of the affection and the time of administration of the drug. Antitoxin may be repeated in six hours after the initial injection if improvement is not noticed, but ordinarily twenty-four hours should elapse between doses. It is well to remember that it is safer to give too much antitoxin than too little. The initial curative dose varies from 2,000 to 5,000 units, according to the age of the patient and the severity of the disease. When a case is seen late it is often advisable to begin with a large dose,—it being good practice under such circumstances to use at once as much as 10,000 units or even more. The average case requires from the beginning to the end of the treatment a total of from 10,000 to 20,000 units, but occasionally 50,000 or even 100,000 units may be necessary. There are very few risks in giving antitoxin. In a series of 50,000 cases treated with it only two deaths occurred sufficiently early after the injections to warrant the belief that this unhappy result was produced by the drug. It is worth remembering that asthmatic cases bear the administration of antitoxin very poorly; a marked and sometimes serious embarrassment of respiration, with cyanosis, unconsciousness, and general collapse may follow its use, but recovery is usual in such cases.

A condition known as anaphylaxis or hypersensitiveness, which at present is being much studied, may sometimes occur in the human being. This hypersensitiveness is manifested by the extraordinary peculiarity that any number of doses of antitoxin may be given provided they are administered within a period of less than ten or twelve days. On the other hand a single minute dose may induce this state after the period named, and, as we never know whether a patient is going to develop it or not, it becomes a question as to the safety of giving a second injection after ten or twelve days have elapsed following the administration of the initial treatment. As it is true that this hypersensitiveness once established in animals may continue throughout life, it becomes a question as to whether or not it is quite safe to administer antitoxin to an individual who has had the drug given him at some prior time, and we are not as yet in a position to definitely determine the risks that are involved in such a procedure. There is no reason to doubt that this hypersensitiveness is much less marked in man than in the lower animals, and there can be no question that it much less commonly develops, but notwithstanding this it would be the part of prudence to avoid a second administration of the drug after the interval referred to in all instances where this seems possible. Anaphylaxis is thus seen to bear an important relationship to what is commonly called the “immunizing treatment” to prevent diphtheria, which consists in giving a moderate dose of antitoxin to a person immediately after exposure to the disease. Under such circumstances a degree of immunity is undoubtedly secured, but this passes off in the course of a few weeks, and the patient then becomes just as susceptible as he was before. Should he now contract diphtheria, we would be confronted with the possibility that the treatment by means of antitoxin might possibly produce serious and even fatal results.

Occasionally rashes occur several days after the inoculation, but such disturbances are insignificant except for the immediate discomfort experienced. Antitoxin concentrated by the Gibson method has reduced to a considerable extent the number of cases in which rashes occur.

Treatment other than by antitoxin is symptomatic. Where the disease occurs in the wind-pipe, it may be necessary to pass a tube into its upper opening to allow the patient to breathe, and in other instances the wind-pipe is itself opened from the outside in order to permit a sufficient amount of air to enter the lungs to maintain life.

It is of the utmost importance that patients be kept in bed until all danger of complications has passed. Death from heart-failure several weeks after the diphtheria in the throat is well, is not an uncommon result of the disease, and is especially prone to follow even the slightest exertion. Patients under such circumstances have been known to die from raising themselves up in the bed.

CEREBROSPINAL MENINGITIS.

Meningitis, or spotted fever, is one of the most terrible and fatal of all diseases, every case proving fatal in some local epidemics.

Although the cause of the disease has been known for a number of years, the exact method by which the germ that produces it spreads from man to man was until quite recently entirely unrecognized, and even now it cannot be said that the whole matter has been demonstrated.