Diphtheria
-Benson.A.R,
Diphtheria is an acute infectious disease caused by a specific germ known as the Klebs-Loeffler bacillus.
Its onset is usually sudden. There is vomiting, moderately high temperature (101 - 102°), rapid weak pulse, pain in the back and limbs, and chilliness. The breathing is rough, there is sometimes a slight hacking cough, an offensive odor to the breath, and enlargement of the glands of the neck. There may be slight pain on swallowing, and after 12 or 24 hours a white or greyish membrane appears in the throat, usually upon the tonsils. This membrane spreads upward, partially covering the soft palate and the posterior part of the roof of the mouth.
During the early stages, the disease cannot be distinguished from tonsillitis and other infectious diseases except by an examination of a culture from the throat. Such a culture should be made in all cases of sore throat.
The diseases progresses very rapidly and in two or three days the throat may be so filled up with the membrane that breathing is difficult.
The disease sometimes assumes other forms. The membrane may be located in the nose, in which case it is likely to be mistaken for nasal catarrh with a purulent discharge.
The laryngeal form of diphtheria, in which the membrane is in the larynx, was formerly known as membranous (or true) croup. In this form there is present a peculiar cough, characterized by the absence of voice sound. It is simply a forcible expulsion of air without the usual sound which accompanies a cough. Laryngeal diphtheria is a very dangerous form of the disease, and frequently, in order to save the child's life, it is necessary to place a tube in the larynx, or in extreme cases to perform the operation known as tracheotomy. False croup (so called) may be distinguished from this diphtheritic or true croup by the fact that the cough instead of lacking voice sound is loud, deep and hollow. In fact, to the untrained ear, the sound of the cough in false croup is more alarming than that in true croup.
All forms of diphtheria affect the whole system, and the after effects are fully as important as the disease itself.
There is great danger of paralysis of the heart muscles, and consequently sudden death. Children who are allowed to sit up in bed, or be out of bed before the heart has regained its normal tone, frequently drop dead without the slightest warning. There are also occasional paralyses of other muscles, notably the muscles of the throat, the eye muscles, and the muscles of the legs.
Another frequent complication is acute nephritis (Bright's disease of the kidneys), which, if neglected, becomes chronic and makes the child an invalid for years.
Treatment and Nursing : Cases of diphtheria require the most skillful treatment and nursing. The patient must be kept in bed, and not even allowed to raise the head from the pillow until all danger of heart failure has passed.
Milk may be given freely, as well as cool water. No other food, however, should be given until convalescence is well established.
Local applications should not be used except when advised by a physician, nor should there be any attempt at home medication. The first and most important point is to establish a diagnosis by means of a bacterial culture. When this point is settled, it remains for the physician to decide whether or not he will use Antitoxin. This is a question which must be largely decided by the individual case, but whatever views may be held as to the occasionally harmful after-effects of Antitoxin there can no longer be any question as to the fact that its use has very greatly reduced the death rate in diphtheria.
If there are other children in the family, their throats must be examined daily for signs of the disease, and bacterial cultures must be made at frequent intervals.
Repeated attacks of diphtheria in the same individual are common.
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| Diphtheria |
Its onset is usually sudden. There is vomiting, moderately high temperature (101 - 102°), rapid weak pulse, pain in the back and limbs, and chilliness. The breathing is rough, there is sometimes a slight hacking cough, an offensive odor to the breath, and enlargement of the glands of the neck. There may be slight pain on swallowing, and after 12 or 24 hours a white or greyish membrane appears in the throat, usually upon the tonsils. This membrane spreads upward, partially covering the soft palate and the posterior part of the roof of the mouth.
During the early stages, the disease cannot be distinguished from tonsillitis and other infectious diseases except by an examination of a culture from the throat. Such a culture should be made in all cases of sore throat.
The diseases progresses very rapidly and in two or three days the throat may be so filled up with the membrane that breathing is difficult.
The disease sometimes assumes other forms. The membrane may be located in the nose, in which case it is likely to be mistaken for nasal catarrh with a purulent discharge.
The laryngeal form of diphtheria, in which the membrane is in the larynx, was formerly known as membranous (or true) croup. In this form there is present a peculiar cough, characterized by the absence of voice sound. It is simply a forcible expulsion of air without the usual sound which accompanies a cough. Laryngeal diphtheria is a very dangerous form of the disease, and frequently, in order to save the child's life, it is necessary to place a tube in the larynx, or in extreme cases to perform the operation known as tracheotomy. False croup (so called) may be distinguished from this diphtheritic or true croup by the fact that the cough instead of lacking voice sound is loud, deep and hollow. In fact, to the untrained ear, the sound of the cough in false croup is more alarming than that in true croup.
All forms of diphtheria affect the whole system, and the after effects are fully as important as the disease itself.
There is great danger of paralysis of the heart muscles, and consequently sudden death. Children who are allowed to sit up in bed, or be out of bed before the heart has regained its normal tone, frequently drop dead without the slightest warning. There are also occasional paralyses of other muscles, notably the muscles of the throat, the eye muscles, and the muscles of the legs.
Another frequent complication is acute nephritis (Bright's disease of the kidneys), which, if neglected, becomes chronic and makes the child an invalid for years.
Treatment and Nursing : Cases of diphtheria require the most skillful treatment and nursing. The patient must be kept in bed, and not even allowed to raise the head from the pillow until all danger of heart failure has passed.
Milk may be given freely, as well as cool water. No other food, however, should be given until convalescence is well established.
Local applications should not be used except when advised by a physician, nor should there be any attempt at home medication. The first and most important point is to establish a diagnosis by means of a bacterial culture. When this point is settled, it remains for the physician to decide whether or not he will use Antitoxin. This is a question which must be largely decided by the individual case, but whatever views may be held as to the occasionally harmful after-effects of Antitoxin there can no longer be any question as to the fact that its use has very greatly reduced the death rate in diphtheria.
If there are other children in the family, their throats must be examined daily for signs of the disease, and bacterial cultures must be made at frequent intervals.
Repeated attacks of diphtheria in the same individual are common.
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