Diphtheria is an acute contagious disease characterized by moderate
fever of an irregular type, and of from one to two weeks’ duration;
by considerable weakness and prostration; and by the formation of
a grayish or whitish false membrane upon the throat, nose, larynx,
and adjacent parts. The exciting cause of disease is the _bacillus
of diphtheria_, which is found chiefly in secretions of the affected
mucous membrane. The constitutional symptoms are due to the absorption
of a toxin produced by this bacillus.
Diphtheria involving the larynx is sometimes termed _true croup_ or
pseudomembranous croup. This form is characterized by irregular fever,
hoarseness of the voice, croupy cough, and progressive difficulty
in breathing. Death frequently results from suffocation, unless
tracheotomy or intubation of the larynx be performed.
The chief =complications= of diphtheria are pneumonia, degeneration of
the heart-muscle, inflammation of the middle ear, and paralysis the
result of an inflammation of the nerves.
=Preventive measures= consist in isolation of the sick, the thorough
disinfection of the bedroom, bedding, clothing, and all articles used
by the sick, and the administration of an immunizing dose (500 units)
of antitoxin (see page 25) to those who have already come in contact
with the patient or who have otherwise been exposed to the contagion.
The sick-room should be well ventilated and maintained at a temperature
of 70° F. The atmosphere should be made moist by slaking lime in the
room or by generating steam in a kettle. In membranous laryngitis
treatment in a steam-moistened tent is desirable. On account of the
tendency to sudden heart failure absolute quiet and rest are to be
enjoined. The diet should consist of milk, unseasoned broths, koumiss,
junket, and eggs.
The patient’s temperature, pulse, respiration, nourishment, urine,
sleep, and bowel movements should be noted as in other fevers. Local
applications of boric acid solution, hydrogen peroxid (1: 3), or normal
salt solution are usually ordered; they should be made with utmost
gentleness. Externally, ice-poultices or hot fomentations are useful in
relieving soreness.
The utmost care should be exercised during convalescence to guard the
patient against undue effort, as at this time sudden heart failure is
especially liable to occur.