Rural Hygiene

by Henry N. Ogden

The actual treatment of a case of smallpox consists in little more than providing suitable food, in sponging the body to reduce the fever, and in anointing the skin to allay the irritation of the pustules. As in measles, the eyes are badly affected, and a darkened room is essential for the comfort of the patient as well as for the avoidance of permanent injury to the eyes. Carbolic acid solutions or ointments are to be used continually on the surface of the body, relieving the irritation and to some extent preventing pitting, which is a lasting mark of the disease.

Diphtheria.

Diphtheria was also formerly a much-dreaded disease, physicians standing helpless before severe attacks and in all cases unable to do more than suggest ameliorating remedies.

The disease usually begins with a cold, sore throat, and local inflammation, which develops sometimes with alarming rapidity. In the days of our grandmothers, the first thing that the anxious mother did when a child complained of sore throat was to get a spoon and look for white patches in the back of the throat. With severe cases of diphtheria which these white patches foretold, the growths of membrane would be so rapid as to obstruct the breathing, and the child—for the disease is preëminently one of childhood would be in danger of dying of strangulation. The doctor's remedy for this condition was to make an incision in the throat below this accumulation and insert a tube through which the breathing might continue. The writer will never forget having lived through a sickness and death of this sort in his family, seeing as a boy a bottleful of the membrane which the doctor was taking away after the death of the victim, and, while doubtless the size of the bottle and the amount of the membrane has been magnified by the lapse of years, it still remains to him as a terrible visitation and an inevitable cause of death.

Cause of the disease.

The immediate cause of diphtheria has been known only within recent years. Sewer air was for a long time thought to be responsible, and overcrowding or congestion in tenements was believed to be a fruitful source of the disease. Some years ago, when diphtheria had been epidemic in one of the state institutions and when experts had been called in to suppress the disease, the elaborate reports which they made dwelt on the quality of the drinking water and on the method of disposal of the sewage as if those factors would account for the disease. About twenty-five years ago, it was shown definitely that the disease was due to certain bacteria, and that while the membrane in the throat was the result of the rapid development of these bacteria, yet the mortality from the disease was not due to the suppression of the act of breathing, but to the development of a poison by the bacteria which went into the circulation of the body and produced death, just as any poison, as strychnine, for example, would do.

When once this fact was accepted, namely, that the disease was dangerous because of the poisons involved, scientists undertook to find a way to neutralize these poisons, and it was soon discovered that such neutralizing substances could be grown in the blood of guinea pigs. It was found that if a small dose of diphtherial toxin was injected into a guinea pig,—a dose small enough so that the guinea pig would recover,—it could then be given a larger dose from which it would also recover. This process might be repeated, until at the end of several weeks it could be given a dose the size of which would have been sufficient to have killed it almost instantly at the beginning, and which it could take and enjoy at the end of the series. The point was that evidently, as with smallpox, successive inoculations resulted in the formation in the body of some substance or agent capable of neutralizing the poisons of the disease, subsequently formed. The guinea pig is so small that the amount of restraining substance available made it desirable to find a larger animal, and the horse, equally susceptible to the disease with the guinea pig, was selected as the animal best suited for producing what is now known as diphtheria antitoxin.

Production of diphtheria antitoxin.

In laboratories, to-day, sound horses incapable of ordinary labor are devoted to this life-saving task, and, without serious injury or inconvenience to themselves, they develop artificially in their blood this agent which neutralizes the effect of the diphtheria germ. The blood of the horse, when removed, precipitated, and strained, contains this property which is used almost exactly as vaccine in the case of smallpox, except that in the case of diphtheria the development of the disease is so slow that it is not necessary to use this treatment until the disease has appeared. In smallpox, on the other hand, the disease is so rapid that when contracted it is too late for vaccination to be of much value. In New York State, the Department of Health furnishes this horse antitoxin free of expense to health officers to use with persons or families unable to purchase the preventative, so that no longer does any need exist for the continuance of diphtheria as a cause of mortality.

If the disease is early recognized and a proper amount of antitoxin injected, that is, forced in under the skin so that it may be absorbed by the blood, the probability is that in all cases the patient will recover. It is equally useful with vaccine as a preventative of disease, and in a school, for instance, where diphtheria has broken out, it is only a reasonable precaution to use antitoxin freely to prevent infection of those exposed to the disease.