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Preventable Diseases of Children: Diphtheria

DIPHTHERIA Diphtheria is a germ disease caused by the growth of the diphtheria bacillus, usually in the throat, nose or bronchial tubes. This bacillus was discovered by Klebs (1803) and shown to be the cause of diphtheria by Loeffler (1884), hence it is called Diphtheria germs greatly magnified.

These minute plants, by growing in the throat, cause diphtheria. the Klebs-Loeffler bacillus after its discoverers. It throws off in process of growth a powerful poison, or toxin. This is absorbed in the blood and tissues and produces the symptoms of the disease. Adults are not as susceptible to this poison as are children over one year old, nor are all persons equally susceptible.

Hence all cases are not equally severe. The germs are often found in the throat or nasal passages of persons who are perfectly well or who may exhibit only the mildest symptoms. But if there is any redness or soreness in the throat and the diphtheria bacillus is present, the disease should be regarded as diphtheria and treated accordingly. These bacilli frequently live and grow for months and even years in the throats and noses of persons who have recovered from diphtheria even after they have become quite well and strong. Recovery from the disease does not necessarily freedom from the germs that caused it. mean Symptoms. — The symptoms of diphtheria vary from a mild redness of the throat to the formation, in severe cases, of a thick, grayishwhite membrane which may cover the whole throat and cause death by choking. It is extremely important to recognize this disease at the outset, since there is an antitoxin which cures diphtheria if administered promptly. It is the delay in securing treatment that kills. A case treated on the first day very rarely terminates in death. Every case of simple sore throat in children should be suspected as possibly diphtheritic. Call the doctor early. Give antitoxin as soon as a diagnosis of diphtheria is made.

The patient first complains of sore throat. This gradually grows worse and in a few hours fever is observed. But sometimes the throat is not complained of until the fever has appeared. Or nausea and vomiting may be the first symptoms. After the fever appears the child usually becomes sleepy. This condition is brought about by the absorption of the poisonous product of the germs.

In severe cases this drowsiness may pass into a stupor from which the child is hard to rouse. The germs do not usually circulate in the blood but grow in masses in the throat.

First a small whitish speck will appear on one or both tonsils. The extent of this growth varies with the severity of the disease from small patches to the entire surface of the throat. Any grayish deposit on the tonsils or other part of the throat, if attended with the slightest fever, should arouse suspicion and a physician should be promptly consulted. The first symptom of membranous croup or diphtheria of the larynx may be a harsh cough or difficulty in breathing. Croupy conditions, not promptly relieved by ordinary remedies, should always be suspected as possibly diphtheritic, especially if there is diphtheria in the community.

Diphtheria of the lining membrane of the nose is frequently mistaken for ordinary cold. The discharges, however, are different, being frequently tinged with blood and causing lip sores. Such conditions when diphtheria is prevalent should be regarded as suspicious. Diphtheria occurs chiefly in children between the ages of two and fifteen years. Girls are attacked in larger numbers than boys. But adults are not infrequently infected. The disease is most prevalent in late fall.

It prevails more in winter than in summer. It develops in from two to seven days, oftenest two days after exposure.

If a child or adult has sore throat with the formation of a thick graywhite membrane in any part of the mouth, throat or nose, the disease is diphtheria. The sick room should be made ready, as recommended under typhoid fever, and the patient promptly isolated. If there is no membrane formation, but the patient appears to be stupid, drowsy or much prostrated, the case may be diphtheria and should be isolated until a positive diagnosis can be obtained.

A "culture" should be taken from the throat of all persons who have come into contact with the patient before he was isolated. If the germs of diphtheria are present they should be protected by an immunizing dose of 1,000 units of diphtheria antitoxin.

Prevention and Disinfection. - Isolate the patient in a sick room prepared as recommended for typhoid fever and observe all the precautions therein suggested to prevent secondary infection. The germs are most numerous in the discharges from the PREVENTABLE DISEASES OF CHILDREN nose and throat. Hence take especial care to receive the sputum on soft rags which should be promptly burned, or in a sputum cup containing disinfectants No. 4, carbolic acid (5 per cent), or No. 5, formalin (5 per cent). The nurse and attending physician should wear a gown of washable material, preferably with a hood, to avoid carrying the infection in their hair and clothing. After the recovery or death of the patient, the sick room should be thoroughly disinfected by formaldehyde or sulphur fumigation.