Diphtheria

Diphtheria (Gr. diphthera, 'a pellicle') was described in 1826 by M. Bretonneau of Tours as a form of very fatal sore throat, occurring chiefly in children, and apt to be confounded with Croup (q.v.), with malignant sore throat (Angina Maligna), as it is found in connection with Scarlet Fever (q.v.), and with acute Tonsillitis (q.v.). Diphtheria is distinct from these diseases, not only in the symptoms, but in the character and position of the morbid changes on the mucous membrane. It begins by malaise, feeling of chilliness, loss of appetite, headache, and more or less fever; soon the throat feels hot and painful, whilst the neck is stiff and tender. If seen early, the throat is red and swollen, but a false membrane of yellowish or grayish colour quickly appears in spreading patches on an inflamed and ulcerated base in the pharynx or back of the throat, and often extends down the oesophagus or gullet, one side usually being more affected than the other. There may be enlargement of the glands at the angle of the jaw, and albuminuria generally occurs at some stage of the disease. Diphtheritic membrane may be got on any mucous surface, or even on a wound; if it extends into the larynx, it gives rise to cough and difficulty in breathing. The throat affection is often accompanied by a low and very dangerous form of fever, with great and rapid loss of the patient's strength, which is still further reduced by the inability to take food; in other cases, the disease is fatal by paralysis of the heart, or by suffocation, due to invasion of the larynx, when tracheotomy may require to be resorted to. After the acute disease is over, the recovery may be delayed by paralytic symptoms of various kinds; or simply by extreme debility, with exhaustion and loss of appetite. Diphtheria is contagious, and has the peculiar tendency of tacking itself on to other diseases, especially scarlet fever, when it assumes a very fatal gangrenous form. Damp and temperate climates seem to favour its development, while the contagium may remain dormant for long periods. Outbreaks have been directly traced to impure drainage and bad water. One attack affords only slight protection against recurrence. The treat- ment aims at keeping up the strength of the patient by means of concentrated beef-tea, milk, egg-flip, and alcohol. Iron in large doses is most valuable, and sometimes quinine. Locally, solvents, such as lactic acid or lime-water, are applied to the throat by a brush; antiseptics are also useful, the best being Condy's fluid, carbolic acid, and borax. Caustics ought not to be used; cauterisation, formerly in use, being cruel, dangerous, and useless; and the best authorities do not sanction the excision of the diphtheritic membrane. The paralysis may be treated with electricity. Since 1893 the treatment of diphtheria by serum-therapy proved eminently successful in the hands of Behring of Halle and Roux of Paris. The system, based largely on the researches of Löffler, is a development of the methods of inoculation explained at GERM, HYDROPHOBIA, &c. A horse is infected with a mild 'culture' of the toxin or poison (containing specific bacilli) of diphtheria. After recovery, the serum of this animal, now 'immune' against the disease, is found, when injected into the tissues of a healthy animal, to render it also immune; and injected into the tissues of a person suffering from diphtheria, it acts as an antidote, checks the malady, and promotes recovery. Dr Welch of the Johns Hopkins University declared (1895) that the treatment of over 7000 cases by antitoxin proves that anti-diphtheric serum is a specific curative agent, surpassing in efficacy all other cures.