Treatment

Diphtheria is not a disease that requires, or will bear depletion. The bowels may be cleaned out at the commencement by a gentle aperient. The internal remedies from which most benefit is said to have been derived, are the Chlorate of Potash, and the Tincture of the Perchloride of Iron. The former may be given in doses of from 15 to 30 grains, dissolved in water, every three or four hours, and the tincture may be given in half-dram doses, mixed with water, every two or three hours. These doses are for adults, and must be diminished, according to the ages, for children. As a local application to the throat, considerable relief and comfort is said to have been derived from swallowing small lumps of ice. Dr. T. Leavitt strongly recommends a Gargle of Permanganate of Potash, made with ten grains of the Permanganate to twenty ounces of water, which may be used several times a day; with the Muriated Tincture of Iron (Perchloride) and Port Wine internally.

The patient should be well nourished, with bread sopped in Beef Tea, with eggs and iced milk, Corn Starch, Sago, etc. If the strength seems to fail, the skin becomes dusky, and the pulse weak and frequent, Wine or Brandy in liberal doses, and frequently repeated, will be necessary to sustain life.

Mr. Courtney of Leatherhead, who attended many cases of Diphtheria when it first became prevalent in England, states that he was very successful in removing the false membrane from the throat by applying to it with a broad painting brush, a coating of Creosote. It was sometimes necessary to apply the Creosote the next day, and sometimes even a third time.

In Diphtheria, Tracheotomy is most likely to succeed in cases of recent origin and rapid progress, and the earlier the operation is performed, the more successful is it likely to be. Trousseau says: "I have now performed the operation in more than two hundred cases of Diphtheria, and I have the satisfaction of knowing that one-fourth of these operations were successful." He thinks that half the cases operated on in private practice ought to be successful, when recovery is possible. He maintains that "the earlier the operation is performed, the greater are the chances of success," and that there is a chance of success wherever the local mischief constitutes the chief danger: when the symptoms of suffocation predominate over all the patient's other symptoms.

Diphtheria, like Scarlet Fever and Measles, often leaves serious disorders behind it. The most common of these is paralysis of the soft palate, causing a snuffling nasal tone in the voice, and some impairment of the power of swallowing. The uvula is seen to hang motionless in the throat, and to be insensible to ordinary stimulants. Besides this, the patients are liable to obstinate vomitings, to dimness of sight, to numbness, tingling, and diminished power in the hands and feet. And it is remarkable that these paralytic symptoms are often fugitive and shifting, affecting first one part, and then another. In general, however, they are recovered from, in time.

Dr. Priestly, Professor of Midwifery in King's College, gives a very interesting account of his own experience, after having Diphtheria, caught from some patients he had been attending. The attack does not seem to have been very severe, as, at the end of a fortnight, being apparently convalescent, he went down to Brighton. There, nearly a month after the first attack of the complaint, the nervous affections began to develop themselves. "I had not been many days at the seaside," he writes, "when I began to experience an overwhelming sense of general weakness. My pulse began to intermit; and, on my getting upright, particularly in the morning before breakfast, the heart's action flagged, and, I was obliged to lie down, pale and faint, with my toilet uncompleted. A little later, and 1 found it impossible to read. In a few minutes after taking up a book or paper, the print gradually grew smaller, and receded from my vision. This was to me a great trial, as hitherto I had managed to amuse myself, and break the tediousness of recovery. In another day or two, it was noticed that I squinted, and in a few more days my voice became altered, and I could not manage it so as to complete a sentence. With this came difficulty of swallowing of a totally different character from that experienced at the outset of the Diphtheria. The muscles of the soft palate acted in so imperfect a manner that in swallowing fluids a portion was pretty sure to pass upwards and return through the nostrils. In another week I found my fingers less dexterous, and the holding of a knife, fork, or spoon was not so easy as formerly. I managed these articles well enough at first, so long as my eye was fixed upon them; but, if my attention was diverted away, they dropped at once. Hereafter the paralysis gradually extended downwards. Soon I began to totter in walking, and although I was able to go on for a while with the assistance of a stick, or the arm of a friend, eventually these aids ceased to be of use, and I was reduced to such utter helplessness that my hands could neither seize nor retain any object put into them; and the lower extremities were so powerless that I should have fallen at once to the ground if I had attempted to stand. Indeed, if I lay down flat on my back I could not rise without help; and I frequently fell into some uncomfortable position on a bed or sofa, and was obliged to remain there till extricated. My intellect was quite clear through all this, and I was able to observe that, while sensibility of the skin remained intact-perhaps was in some degree exaggerated-I lost entirely what is called muscular sense. I felt as if my legs were clogged by some heavy weight, and when I was supported between two men, my feet dragged along the floor as though they did not belong to me; the noise of my trailing boots only attracting my attention. Before the loss of voluntary power was complete, I had a constant tendency to put my feet down on their sides, and was obliged to keep my eyes upon them to keep the soles downwards, and thus avoid the risk of falling. Often I awoke in the night with a sense of discomfort, which I erroneously attributed to my legs being crossed and fixed in that position,but when they were looked at they were straight and apart. During the progress of the paralysis, I had an almost constant sense of tingling in the extremities, as though they were asleep. This did not pass until the morbid condition was fully developed and the loss of power was complete. When the climax was passed it subsided. There was severe neuralgic pain along the trunks of the nerves of the left arm, and in that limb alone, during the development of the paralysis. It was so severe as to deprive me of sleep, and was probably associated with some organic change going on in the nerves or their neurilemma, as that arm was longer recovering than the rest of the body. Now, seven years after the illness, slight pressure along the course of the digital nerves gives a tingling sensation at the tips of the fingers, not experienced in the other hand, and the left hand is still a little weaker than the right. Improvement began about three months after the first symptoms of paralysis, or four months after the invasion of Diphtheria. I had been depressed, and had apparently taken cold from the use of cold water douches, which had been recommended to me, and was driven to bed again by febrile symptoms and sore, throat, almost like a miniature attack of Diphtheria again. From this time I began to mend. It was first noticed as a favourable augury that galvanism, which had previously failed to excite any contraction of the muscles, began to produce slight twitching of the toes; and improvement after this was rapid. It was curious to notice that, as the loss of muscular power gradually progressed from above downwards, so the amendment was observable in the same order. Thus, when I had regained the power of reading, because the muscles of the eyeball had recovered their force, the paralysis was still in progress in the limbs below, and deglutition and the proper modulation of the voice returned to their natural condition long before I was able to walk. Neither the sphincters of the anus or the bladder were affected at any time. Strychnia, with several preparations of iron, change of air, and generous diet, were the chief remedies. No specific remedies seemed of much use. The morbid condition, no doubt, ran its course, and then recovery began as a natural sequence.