Rural Hygiene

by Henry N. Ogden

To make use of the antitoxin at the proper stage of the disease, early recognition is important, and fortunately science here can be of great service. By wiping out the throat with a sterilized swab of cotton, the bacteria present in the throat, if any, will adhere and may be wiped off onto a gelatine substance in which the germs can grow. In twelve hours, they will have developed, if present, so that with a microscope they can be positively recognized. In Massachusetts, and particularly in the city of Boston, the Board of Health maintains a laboratory with a medical expert in charge, to whom physicians may refer these smears for diagnosis. No excuse exists, therefore, in such a city for failure to recognize and prevent the further development of diphtheria, since every wise physician would take a sample of mucus from a throat in case of any irritation there, the Board of Health would furnish accurate diagnosis, and the use of antitoxin will prevent the disease.

Symptoms of diphtheria.

The disease itself acts on the human body through the formation of poisons which the bacteria generate by their growth. If the germs have secured a foothold in the upper throat, then the well-known membrane is formed and the toxins produced spread through the blood and cause headache and fever, even before any experience of sore throat is felt. The temperature rises very high, the child begins to vomit, and the pulse becomes weak, and after about seven days a large percentage of these throat cases begin to improve. The membrane breaks off, the fever declines, and the child begins to recover. If the localized attack is in the larynx, a harsh cough is one of the symptoms, and this is soon followed by a serious difficulty in breathing.

The poisons are formed, as before, in the blood, and, while a surgical operation has been performed often in the past to afford relief from the tendency to strangulation, the bacterial poisons are not affected thereby, and, while the operation might be successful, the child was quite apt to die as the result of the poisons. Now, in either case, antitoxin is administered at the very outset of the attack, with the result that the poisons are counteracted, the temperature drops rapidly, the membrane is apparently at once affected and lessened, and the child recovers at once. No greater boon to the human race in the matter of disease has ever been discovered, and it is certainly most absurd for parents to refuse the use of this wonderful antidote. Not long since, the writer found a family of four children in a home where diphtheria was rampant. The mother and two children were sick with diphtheria in its worst form, and the father refused to allow the doctor to administer the antitoxin even to those sick, much less to those who had been, up to that time, only exposed. Apparently there was no direct law requiring the administration of the antitoxin, and the physician in attendance and the health officer were obliged to stand by and wait for the death of the children, which actually happened, knowing that a dose of the antitoxin ready at hand could have been administered and the children's lives, in all probability, saved.

The diphtheria poison is so virulent that in many cases it acts on the different organs of the body, particularly on the kidneys and the heart, and the recovery from this poison may take weeks. It is very necessary, therefore, for the patient to be kept quiet, and this can best be done in bed, for at least three weeks after the crisis has passed. The nervous system is often affected, so that the child may squint or stutter or perhaps not be able to see, but these effects are usually temporary and pass away as the effect of the poison disappears.

Rabies.

Rabies is the third assumed bacterial disease which is reacted upon by the administration of an antitoxin. When it occurs in man, it is generally known as hydrophobia, although it is the same disease as that known as rabies in dogs, skunks, wolves, and other animals. The virus of the disease is in the saliva of the animal, so that when a dog bites another animal or human beings, the poison is injected into the wound made with the teeth.

The actual germ has not been found, and while there is no doubt that it originates with some specific bacterium, it is probable that the transmitted disease is due rather to the toxin of the germ than to the germ itself. The greatest number of cases, by far, are caused by the bites of dogs, and the most obvious and plainest method of preventing the disease is to prevent dogs from biting. That this is efficient in stamping out the disease has been proved by the records of cases in England and Germany. There, a quarantine on all the dogs in the country, that is, the strict enforcement of laws requiring muzzling, has eliminated the disease except on the borders of other countries where such quarantine is not enforced.

In New York State, the number of cases of rabies is increasing at an alarming rate, as determined by the examinations made on dogs' heads at the New York State Veterinary College in Ithaca. Whereas a few years ago one suspected case a month was the average number sent in, during this last year, 1909, there have been sent to the laboratory, at times, as many as five or six a day, the number being larger in the warm weather. When the disease appears in the dog, one manifestation of it is that the animal runs over large areas of country, perhaps within a radius of twenty-five or thirty miles, and in this mad race the dog may infect other dogs throughout the entire distance. It is, therefore, of small value to muzzle dogs only in a particular village, since the dogs while muzzled may be bitten by an outsider. There is no reason why the disease could not be stamped out of a state in six months by muzzling all the dogs. But muzzling the dogs in a village here or in a town there is really only temporizing with the trouble.

Hydrophobia in man requires usually from two to six weeks to develop, so that there is a long period in which to utilize preventive measures, and it is on this account that children may be sent, as happens frequently, to New York City or to Paris to be treated by what is known as "Pasteur treatment." This treatment involves the inoculation of the rabies virus which has first been passed through a series of rabbits, in the course of which the virus has become exceedingly strong. The treatment of the human being consists in successive inoculations with virus of various strengths, beginning with the weakest and ending with the most powerful rabbit virus. After this has been done, the effect of the bite of the mad dog has been neutralized, so that in most cases the disease has been robbed of its power. Of the cases treated at the Pasteur Institute in 1897, numbering 1521, there were six deaths, and these six were among those whose arrival at the Institute was so late that the treatment could not be begun in time.