The sovereign remedy for diphtheria is antitoxin. If given early and
in sufficient amount practically every case could be cured. Diphtheria
antitoxin was first used in Berlin in 1891. It came into general use
about 1894. Like most new remedies it met much opposition at first but
is now recognized throughout the civilized world as the one essential
means of cure. Cases given antitoxin on the first day practically
always recover, only a little over 1 per cent die. Each day of delay
is shown in the results. When given the second day, a little over 3
per cent die; the third day, over 6 per cent die; the fourth day,
nearly 11 per cent, the fifth day, 15 per cent. In hospitals where
many cases come late under treatment, about 10 per cent of the cases
of diphtheria now die. This is in marked contrast to the 50 to 80 per
cent of deaths in preantitoxin days. The patients who receive antitoxin
early not only have greater chance of recovery but they get well
promptly after a very brief illness, while those that come late under
treatment, even if they recover, do so after a tedious illness and
protracted period of convalescence.
The important things in treating diphtheria with antitoxin are early
administration and sufficient amounts. The earlier given the smaller
the dose required. The doctor from experience is able to estimate
the dose needed in each case. A moderate dose is 5 to 10 thousand
units, a full dose is from 20 to 30 thousand units. A small fire may
be extinguished by a little water, but when it has spread much more
is needed. The damage done by the diphtheria poisons before antitoxin
is given cannot be undone by any amount of antitoxin. Antitoxin only
prevents further injury. If sufficient injury to the heart and kidneys
has occurred death will follow. Lost time cannot be regained. The
antitoxin must be injected with a hypodermic needle. It cannot be given
by mouth as it is destroyed and rendered useless in the stomach.
A few hours after enough antitoxin to control the disease has been
given marked improvement occurs. The restlessness subsides, the
swelling begins to grow less and the membrane separates at the edges
and begins to peel off, the color reappears in the pasty cheeks, the
pale lips become red again, and the child which has been blue and
struggling for breath falls into quiet sleep. The change in a short
time is one of the most remarkable observed in sick persons.
Local treatment is of little value. We no longer gargle, spray and swab
the throat. We only try to keep the mouth and throat as clean as we can
with cleansing washes but this is not done with the idea of influencing
the disease.
If the obstruction to breathing from diphtheria in the larynx becomes
extreme this must be relieved by making an opening in the windpipe or
by passing a small rigid tube into the larynx through the mouth.
If antitoxin has been given late the complications which have developed
must receive appropriate treatment. The duration of confinement to bed
will depend on the time antitoxin was given. If given early the patient
may be up in a few days. Serious damage to the heart and kidneys may
require confinement to bed for several weeks. When there are heart
disturbances perfect quiet in a horizontal position is imperative.
Even rising to a sitting position or moderate exertion may be quickly
fatal. Such accidents are most apt to occur about the 5th to the 14th
day. Recovery from the paralysis is usually complete, but may require
several weeks or months. These paralyses may continue to extend for two
months, and during this time the weakened muscles must not be used. If
unable to swallow the patient must be fed with a rubber tube through
the nose or mouth.