The Symptoms of Diphtheria

CATARRHAL FORM: Slight fever; mataise; drynessin throat, with slight pain on swallowing; glands of throat swollen; mucous membrane red; small grayish- white or whitish-yellow spots; frequent nausea and vomiting.

CROUPOUS FORM: Symptoms of catarrhal form intensified; more fever; head hot; mind confused; much pain in throat; one or more whitish patches in throat; peculiar offensive odor of breath; tongue coated.

MALIGNANT FORM: Foregoing symptoms, with extreme prostration; pulse weak and slow; face sodden; neck swollen and shiny; breath very offensive; false membrane very extensive.

Fig. 337. Picture of Mouth.

Fig. 337. Picture of Mouth.

This disease is of so great practical interest on account of its great and increasing prevalence at the present time that we shall be justified in devoting more space to it than to most of the other affections considered in this volume. In the following account of the disease, its history, causes, and treatment, we have drawn, liberally from our popular monograph on the subject, written in 1878:The disease is by no means a modern one, as is generally supposed. Homer and Hippocrates, who wrote several centuries before the Christian era, were each familiar with this disease under the name of Malum,

Aegyptiacum. As the ancient name indicates, the disease was by early writers supposed to originate in Egypt and Syria.

An epidemic of diphtheria occurred in Rome A. D. 380. Holland was visited by the disease in 1557. Many other parts of Europe suffered from its ravages in the two last centuries. The first recorded occurrence of this affection on the American continent was in 1771, described by Samuel Bard in 1786. In 1856 another very severe epidemic visited this country, since which time it has been very common, seemingly increasing in virulence from year to year, sometimes abating its ravages for a single season, then breaking out with redoubled fury and fatality the next.

The characteristic feature of the disease when fully developed is a peculiar membranous formation which makes its appearance usually upon the fauces or tonsils, and is called diphtheritic membrane, from its resemblance to skin, which is the signification of the Greek word from which the name is derived.

This membrane, or rather false membrane, when first formed, is of a grayish-white color; very tough, of leathery consistency, and adheres to the mucous membrane beneath it with great tenacity, it being very difficult to tear away except in shreds, and then only by laceration of the mucous membrane, leaving a bleeding surface. The false membrane, in fact, is not formed upon the mucous membrane or other tissue where it may occur, but in it. At least it sends down numerous rootlets which are imbedded between the cells of the tissue beneath. In this respect the membrane is very different from that formed in croup, which often separates from the mucous membrane upon which it is formed, leaving the tissues entirely uninjured.

The membrane is not confined to the fauces. It may occur on any portion of the structures of the mouth, the inside of the cheeks, the gums, the tongue, the edges of the lips, as well as on the tonsils, the uvula, the soft palate, and the pharynx generally. It may also occur in the nasal cavity, either primarily or secondarily, extending upward from the fauces.

We recently treated a case in which the whole back portion of the mouth was covered with the diphtheritic membrane, which also extended throughout the nasal cavity, and even appeared at the edges of the nostrils. The exudation may also occur at any other parts of the body where there is a union between skin and mucous membrane. Even the stomach and intestines sometimes become the seat of a diphtheritic membrane.

The exact nature of this membrane has been the subject of much experimental inquiry. Besides being subjected to a most careful microscopical inquiry by hundreds of skilled microscopists in the Old World as well as the New, eager pathologists have submitted it to the test of physiological analysis by applying it in various ways to lower animals. The results of these inquiries have seemed to establish the following facts:

1. The active cause of the characteristic features of diphtheria are vegetable organisms.

2. The false membrane is formed by the growth of these vegetable parasites in and upon the infected mucous membrane, and the vital resistance of the tissues to the depredations of the organisms.

These conclusions are disputed by physicians of eminence, while warmly defended by Oertel, and others, and cannot be said to be absolutely proven; but since the most successful mode of treating the disease is that which is based upon this theory of its nature, it is a perfectly safe and practical one for us to adopt.