This is a disease of the throat. It is caused by the germ that causes diphtheria, that is, by the Bacillus diphtherae. There is no doubt about this. In fact so certain are medical men that this germ causes the trouble that when they fail to find the germ in the excretions ("Bacteriological examination is necessary for diagnosis since some cases cannot be told on inspection alone from acute tonsilitis, and other cases have no membrane at all"--Emerson, Essentials of Medicine), they name the disease something else. The disease may present a perfect clinical picture of diphtheria and no germ be present. This is pseudo-diphtheria and receives another name. One may only have ordinary tonsilitis, "sore throat," and, if the germ is found, it becomes diphtheria. It was adding thousands of cases of this latter type to the diphtheria figures that enabled them to show a 100% increase in the diphtheria case rate and a corresponding nearly 50% decrease in the death rate, without any lessening of the actual number of deaths, but often with an increase in deaths, when diphtheria antitoxin came into use. The supposed diphtheria germ is often found in the mouth and throat of healthy people who do not have, have not had, and do not subsequently develop diphtheria.
The Encyclopedia Britannica tells us: "If, in diphtheria, the bacillus is not found, the illness is renamed something else." Sir Wm. Oster, M. D., says in his The Principles arid Practice of Medicine, Page 151, under diphtheria: "The presence of the Klebs-Loeffler baccillus is regarded by bacteriologists as the sole criterion of true diphtheria and as this organism may be associated with all grades of throat affections, from a simple catarrh to a sloughing, gangrenous process, it is evident that in many instances there will be a striking discrepancy between the clinical and the bacterial diagnosis."
The germ is found in simple catarrhal conditions and also in the mouth and throats of healthy infants and children; and is often absent from the throats of those presenting clinical pictures of diphtheria.
The germs almost never get into the blood. They are on the body, not in it. They remain on the false membrane, or leather which caused the trouble to be named diphtheria. The membrane is a fibrogenous exudate poured out by the mucous membrane as a protective covering. Virulent protein poisons and lost immunization are the causes. I have never known a case of diphtheria in strict vegetarians on a low-protein diet. Intestinal indigestion in children who are habitually over fed and have a chronic state of decomposition and putresence in the intestines, and whose resistance has been broken down by the usual enervating influences, are the ones who fall prey to diphtheria, as well as whooping cough, measles, etc. Healthy children, who are properly cared for, do not have these diseases.
It is the fat, soft, sleek, "well-fed" children, so generally admired, who develop this disease. Such children are chronically diseased, are predisposed to "attacks" of all kinds and, if they reach adulthood, supply the greater portion of cases of tuberculosis. Children who spend most of their time out of doors, are thinly clad, sleep in cold, well-ventilated rooms, have a spare diet and who are not pampered, do not develop this disease.
SYMPTOMS: The symptoms of this disease are out of all keeping with its much advertised dangers. The patient seldom feels as ill as in acute tonsilitis. The fever is seldom high and soon falls to normal. The throat is not very sore. In some of those cases which have the severest suffering and little membrane, some even have no fever. In some the temperature is subnormal, indicating a lack of reacting power. These cases are especially dangerous. Diphtheria of the nose, of the eye and around a recent wound may cause no serious feeling of discomfort.
The disease begins with fever, chilly feelings, pains, in the limbs and back, headache and malaise. The throat is not very red and the tonsil is not greatly swollen. The glands in the neck enlarge and the face becomes an ashen gray. The patch of white membrane enlarges and extends beyond the tonsil. The membrane may grow rapidly and extend over the soft palate to the posterior wall of the fine bronchi. The membrane may even extend through the Eustachian tube into the middle ear, along the nose into the nasal sinuses and sometimes it extends down the oesophagus into the stomach. Under the membrane there is death of tissue and there follows sloughing. The disease is self-limited and after about ten days the membrane loosens and falls off in shreds. In the more severe cases the temperature runs 102 to 103.
Within recent years medical men have recognized that "membraneous croup" is diphtheria and these cases are now quarantined. When the writer was younger, cases of membraneous croup were not quarantined and no one ever "caught" the disease from these cases. An unquarantined case did not produce an epidemic.
In his Mother's Hygienic Handbook, 1874, Dr. Trall asserted "the pathological identity of croup and diphtheria."
"Membranous croup" is the worst form of diphtheria. These cases seldom appear to be very ill. For two or three days there is a rough, croupy cough which becomes a little more croupy each afternoon and evening, but wearing off somewhat in the forepart of the night and in the morning. The child's breathing is not affected, he has an appetite and there is usually little uneasiness on the part of parents. Then, suddenly, the child almost suffocates. He tosses about on the bed, sits up and struggles in various ways in an effort to breathe. He becomes blue In severe cases the child suffocates unless relieved by incubation or tracheotomy. In the milder cases the paroxysms are soon over, but they some times recur later.
Dr. Tilden says of this type: "I never knew a case to get well where this disease is located in the pharynx, and passes down only a very short distance into the trachea, sometimes the membrane is thrown off and the child recovers, but this is so rare that I have heard only of a few cases." Again he says: "I have never seen a case of bronchial diphtheria get well, and I never expect to." The disease is best prevented.
COMPLICATIONS: Under regular medical care, acute myocarditis, severe nephritis, and bronchopneumonia are common. The first two, at least, are results of anti-toxin. Various forms of paralysis, especially of the throat and eye muscles and of the limbs develop as sequealae in about one-fifth of medically treated cases. Paralysis is often the result of antitoxin, although we cannot always attribute this to the antitoxin, for it sometimes occurs in cases which have had no antitoxin.
Antitoxin does not cure the disease and toxin-antitoxin does not prevent it. Both these foreign proteins are responsible for many deaths in both the well and the sick, and for much other injury short of death.
CARE OF PATIENT: The decrease both in the number of cases of diphtheria and in the percentage of deaths has not been as great as that of scarlet fever, due, no doubt, to antitoxin. Yet the medical profession claims that it knows nothing of scarlet fever.
No food of any kind should be given. In croupy cases, whether it is or is not membraneous croup, it is well to stop all food the instant the first sign of trouble (the cough) shows. These cases may stand some chance of recovery if proper care is taken before the membrane spreads to such an extent thee breathing is made impossible.
Put the child to bed in a well ventilated room. If it is winter place a hot water bottle at his feet.
Drinking should be discouraged. Swallowing tends to break up the membrane and carry it into the stomach. Small water enemas, given after the bowels have been throughly cleaned out, must take the place of drink.
The throat should not be gargled. No sprays or washes of any kind are to be employed.
The child should be placed in a position so that everything will drain well out of the mouth. Place him on his right side so that he leans well forward and with his face down. If the child is permitted to lie on the back, the secretion tends to run down the throat and into the trachea and stomach. This must be avoided. It he tires of lying on one side he may be placed on the other, or may be placed on his face.
These children should be left alone and not allowed to talk. No questions should be asked them which require answers.
No drugs of any kind are to be tolerated. These lessen the chance of recovery.
Although comparatively few who come in contact with this disease develop it, it is considered highly contagious and, due to the contagion-superstition, these cases are quarantined. The writer has never handled but one case and saw this but once. After the quarantine was slapped on the case I handled it over the phone. The child made rapid recovery with no complications or sequelae.
Food must not be given until the throat is healed. Then fruit juices may be given for two days and then a gradual return to the normal diet.
Death in this disease results from suffocation, and from maltreatment. The exudation into the wind-pipe, with the subsequent formation of the false membrane, chokes the patient to death. In so-called membraneous croup this is seen at its worst.
If this can be prevented there is no danger from the disease. If the above methods are not sufficient to control the exudate. In any given case, a certain amount of drugless suppresion will form the lesser of two evils. Cold cloths around the neck and ice held in the mouth and applied directly to the inflamed parts will suppress the inflammation and exudate. Dr. Trall who treated hundreds of cases by this method says of it:
"There is little danger of this formidable disease, which often desolates the family circle of all the little ones, terminating fatally, if this plan of "treatment is thoroughly carried out--unless it is a very frail and scofulous child. Nor have I yet known it to fail in but one such case."
Plenty of fresh air and sunshine should be had during convalesence. As the disease is most common after the thanksgiving and Christmas feasts, it is best prevented by avoiding protein decomposition and by maintaining good health. Diphtheria is a phase of albumenuria.