Since the diphtheria germs or bacilli grow on the lining of the throat and air passages, they are easily thrown out from the mouth and nose of the patient with particles of mucus or spit when the patient coughs, spits, or sneezes. But even when the patient talks, especially when he talks loudly, tiny droplets of mucus or spit are given off. These droplets may have diphtheria bacilli on them. The same is true of particles of food, no matter how small, falling from the patient's lips. Eating utensils such as cups, glasses, forks, and spoons that have touched the lips of the patient may likewise have saliva on them. When the patient has diphtheria all these droplets of saliva and of mucus may, and usually do, contain many diphtheria bacilli. Curiously, some persons may have diphtheria bacilli in the nose and throat and yet remain entirely well. Such persons are called "healthy carriers." They are especially dangerous, because there is no outward sign which will tell them or others that they are carrying deadly disease germs around.
All who attend the patient must be very careful not to get any of the dangerous discharges from the patient's mouth or nose on the hands. In fact, it is important for the attendant always to wash her hands promptly after waiting on the patient. Besides this, care should be taken that the germs are not carried to others by the use of eating utensils, such as cups, glasses, spoons, forks, or plates. All of these should be sterilized with boiling water after each meal.
ANTITOXIN TREATMENT.
Depending on the way it is treated, diphtheria is one of the least dangerous or one of the most dangerous diseases. It is one of the least dangerous when promptly treated with antitoxin; it is one of the most dangerous when the antitoxin treatment is not given, or is delayed or insufficient. In the days before we had antitoxin one out of every three children who had diphtheria died. Now, if antitoxin is used on the first or second day of the disease ninety-eight out of every hundred children recover. The sooner diphtheria is attended to the more certain is a cure.
In severe cases suspected to be diphtheria the doctor always gives diphtheria antitoxin at once. This is a wise thing to do, because the disease goes on rapidly and a delay of 12 or 24 hours may be fatal. Besides, no harm is done, even if the disease proves not to be diphtheria. The antitoxin, although making some people uncomfortable for a day or two, never does any real harm. Whenever antitoxin is given to a person ill with diphtheria it should be given in one dose, large enough and early enough.
TEMPORARY PROTECTION WITH ANTITOXIN.
Diphtheria is very contagious, and many people, especially children, can catch it. For this reason, whenever a case of diphtheria is discovered, the doctor injects the antitoxin not only into the patient, but also, as a protective against the disease, into those who have come into contact with the patient. This is spoken of as "immunizing" these individuals. The immunizing dose is not so large as the curative dose given to the patient, but it is usually sufficient to protect those exposed to diphtheria for a month from the time of injection. At the end of that time the protection disappears.
THE SCHICK TEST.
A few years ago a very simple test was discovered to tell whether a person could or could not catch diphtheria. This is known as the Schick test. It consists in injecting a few drops of a prepared diphtheria toxin into the skin and then watching whether a characteristic red spot appears where the injection was made. If such a spot does not appear within two or three days it shows that the person can not catch diphtheria.