DIPHTHERIA. 



231 



teems to attract the poison. The disease is fre- 

 quent ly a follower of measles, scarlet fever, and 

 smallpox. At times it comes in the wake of 

 typhoid fever and whooping COUgh. 



A- n-^anls any protective influence of an at- 

 tack of diphtheria against recurrence, there is 

 prolialily a slight one, hut it is not so marked as 

 i> 'In' ca-" in other /ymotic diseases. 



The symptoms of diphtheria are often so 

 masked ami slight that, until the unmistakable 

 membrane is >ccn, the true character of the af- 

 fection is not recognized. There are four forms 

 of the disease, each having its special symptoms 

 the catarrhal. the croupous, the septicarmic, and 

 the irangrenous. The catarrhal at first presents 

 symptoms of catarrh. The croupous comes on 

 more suddenly, with pain in the throat. In 

 hoth these forms there is fever, headache, nau- 

 sea, and debility. In certain cases the symptoms 

 are very pronounced. The tongue is covered 

 with a thick creamy coating, which comes to the 

 tip, a viscid secretion covering all. The odor of 

 the breath is peculiar, and. when the patient is 

 old enough to know, he will complain of a bad 

 taste continually. This is said to resemble the 

 taste of bad eggs or of brass children say " like 

 cents.'' There is also a peculiar metallic ring to 

 the voice. The false membrane begins to form 

 about the second day. It may be at one point 

 or at several. Where these points are numerous 

 they soon run together. In the catarrhal form 

 the patches of membrane are not so thick, come 

 off easily, and are not so prone to reform. As 

 the membrane comes off, the fever decreases. 

 In, the croupous form the temperature runs be- 

 tween 101 and 104 ; above this indicates a se- 

 rious case, one with much systemic infection. 

 The septic form of the disease manifests the 

 well-known signs of blood poisoning. The pulse 

 is weak and rapid, the temperature below 100, 

 at times being below the natural rate. There is 

 diarrhoea, the stools have the odor of the breath, 

 the urine is small in quantity and full of albu- 

 men. The membrane forms quickly in the 

 throat and soon becomes foul and puslike. 

 The septic form of diphtheria is very fatal, 

 death usually resulting about the third day; 

 very rarely does the victim live five days. When 

 the pulse gains in volume and force, with a rise 

 of temperature, and we notice an improvement 

 in the throat symptoms, recovery may be looked 

 for. The gangrenous form is the septic intensi- 

 fied. Gangrene appears in the throat, the parts 

 slough, the odor is horrible. The patient is 

 overwhelmed with the poison, and dies quickly. 

 At times the membrane extends into the nasal 

 cavities, and this indicates a serious case. 



Diphtheria is one of those diseases having se- 

 quela-. Even very mild and localized cases 

 may be followed by dilative derangement. 

 Nervous manifestations may also arise. In the 

 severe forms, heart troubles remain, kidney dis- 

 turbance, and, what is most serious, paralyses. 

 This may he local, or quite extensive. Recovery 

 may usually be looked for from these results, but 

 it is very slow, and taxes a little patient's strength 

 to a great extent. 



The treatment of diphtheria must be prompt, 

 local, and constitutional. The patient should l>e 

 at once isolated ; no child should be allowed 

 near him. It is best to have a trained nurse, and 



all handkerchiefs, cloths, and soiled bcdclothing 

 should be burned. All .spoons, forks, glasses, 

 and tubes should be kept in the sick-room, and 

 washed and di-infected then-. Too much care 

 can not be taken to avoid spreading the disease. 

 There is so much foundation for the theory of a 

 local infection, followed by a systemic poison- 

 ing in diphtheria, that the greatest chances of 

 succos in it.-, treatment COHMM in the early rec- 

 ognition of the disease, and the quick detection 

 and removal, or destruction, of the first natch of 

 false membrane. If possible, it sh mid be care- 

 fully teased off, removed. Strong caustics do 

 more harm than good. Most recent writers con- 

 demn their use. We should keep the throat 

 clean, and have it frequently painted or sprayed 

 with one of the many disinfecting solutions, not 

 water, a solution of the tincture chloride of iron, 

 or, what the writer has found most serviceable, 

 a solution of permanganate of potassium. Very 

 recently it has been recommended to spray the 

 throat with a very weak solution of bichloride 

 of mercury. This has been urged by men of 

 considerable experience, but the danger of toxic 

 symptoms should be borne in mind. The local 

 applications recommended have been so numer- 

 ous that it is not necessary to mention them; 

 every practitioner that has had any experience 

 with this horrible affection has his favorites. 



In treating diphtheria, the physician must per- 

 sonally see that all the minute directions are 

 carried out. It is one of those diseases that 

 require close watching on his part. The hygienic 

 surroundings of the patient must, receive careful 

 attention. In every case of diphtheria, no matter 

 how light, there is a tendency to marked weak- 

 ness and dissolution of the blood ; hence sustain- 

 ing treatment is demanded. Every care must 

 be given to sustain life for a certain number of 

 days, as Nature makes a great curative effort. In 

 short, like all diseases of this class, diphtheria 

 runs a special course, and when this is done there 

 is, except in the septic and gangrenous forms, 

 an attempt at recovery. The diet must be very 

 nutritious and easily digested; beef tea, beef 



J'elly, eggs, and milk must be frequently given, 

 f there is any specific in the treatment of 

 diphtheria, it is alcohol. Alcoholic stimulants 

 seem to antagonize the poison, and it is wonder- 

 ful how much even a little patient will stand. 

 It is a most excellent practice to administer 

 strong sherry wine or brandy in beef tea. 

 Where there is much nausea, champagne will be 

 found valuable. If the prostration seems to in- 

 crease early in the case, nothing equals brandy. 

 Large amounts must be given, and it is well to 

 combine it with small quantities of lime water. 



The medicinal remedies that have been recom- 

 mended are numerous, new ones having bwen 

 thrown aside for old ones. It is necessary, how- 

 ever, to mention those only which the latest ex- 

 {>erience seems to approve. Kind ies should rarely 

 >c given ; if it is necessary to do so. one that act> 

 quickly without producing much depn 

 should be selected. Ipecac or sulphate of /inc is 

 the best. It is unsafe to repeat the eniotic 

 more than twice. One of the most nvent 

 emetics suggested is npomorphia. This has an 

 advantage in being administered hypodormically 

 and acting very quickly. Jaborandi is one of 

 the most recent favorites in treatment, and it 



