Look in the Throat by Charles E. Stone, M. D.

Review and Herald Publishing Association · Takoma Park Station, Washington, D. C. · Nov 23, 1916

Look in the Throat

By Charles E. Stone, M. D.

THE arrival of the first cool weather, with the consequent shutting of doors and windows in both home and schoolhouse, is usually marked by a great increase in the number of cases of diphtheria.

The children who have been out of doors through the summer are now housed, either at home or in school, where in either case poor ventilation soon lowers their resistance to a point where they become very susceptible to contagion. It is now that the so-called “carrier” of diphtheria—that is, a child or adult who carries the germs of diphtheria in the throat or nose without manifest symptoms of having the disease—is to be dreaded.

If the carrier attends school, where he comes in contact with a large number of children, many serious cases may develop. If he happens to be an adult, the contagion may be spread in factory or tenement house. From this it is easily seen that a widespread epidemic may arise from a child or adult who unconsciously starts the trouble.

Again, there are numbers of children with mild cases of diphtheria, who may attend school one or more days before their condition becomes known to teacher or parents, and who may thus infect a number of classmates.

In street cars, railroad trains, or any other place where people crowd together, there may be carriers, or even well-defined cases of diphtheria at any time of year.

Recent investigations make it reasonably certain that fifty or sixty per cent of children and ninety per cent of adults are naturally immune to this disease. This, of course, explains why it is that in large epidemics a relatively small number of people are attacked, although a large number must have been in contact with those having the disease.

There are few diseases with so insidious an onset as diphtheria. Contrary to the usual belief, the invasion of this disease is slow and subtle until the patient is gradually prostrated. The symptoms in children frequently lead mothers to believe that the child affected has taken a slight cold, and is only a little dumpish and indisposed. As the temperature rarely is high, the child is apt to be pale rather than flushed, and to make few if any complaints. Cases are often beyond human aid before a physician is called.

In laryngeal diphtheria (membranous croup) the situation is different. On account of the membranes interfering with respiration, the symptoms of asphyxiation overshadow those of toxemia (poisoning). The face takes on a dusky hue, inspiration is prolonged and harsh. Here there is no dumpishness or apparent prostration; for in order to breathe, the child uses every muscle of respiration, and in drawing in his breath may often be heard all over the house, and even outside. As the battle progresses, the child gets purple in the face; there is a sinking in of the muscles above and below the collar bone and at the attachment of the diaphragm.

This form in the early stage has been mistaken for ordinary croup or even bronchitis. On account of the danger of asphyxiation, plus that of poisoning, we have a double foe to fight, which brooks no delay. For not only will the child need antitoxin, but a tube inserted in the windpipe as well.

In every instance when a child is sick, it is the duty of the mother or whoever may be in charge to “look in the throat.” If this had always been done, many lives might have been saved.

It is not always easy, even for physicians, to make an immediate diagnosis, but in every case where there are white, yellow, gray, or other colored deposits in spots or patches on the throat, a physician should be called; and if there is any doubt as to the diagnosis, a culture should be sent at once to the city or State laboratory.

These patches may be located in any part of the throat, and may vary in size from a spot as small as a pinhead to a mass entirely covering the throat. They may even occur on the roof of the mouth and on the soft palate. In certain cases the membranous deposit may be confined to the nasal passages, and may or may not be visible; but there is nearly always a foul-smelling discharge, which should always excite the suspicions of the mother.

The odor of any form of diphtheria is foul and characteristic. There is nothing else just like it, but in very mild cases it is sometimes absent.

Diphtheria today is both a preventable and a curable disease. Theoretically there should be no deaths, for it is one of the very few diseases that have a specific and infallible treatment. I have never known of a death to result where antitoxin was given in sufficiently large doses on the first day of the appearance of membrane or nasal discharge; and very rarely when it was given on the second day of the disease. After the second day, unless antitoxin has been administered, the chances of recovery are slight.

Cases so mild as to require cultures to determine whether they are diphtheria or tonsillitis may recover without treatment, as they did before the days of antitoxin; but there can be no assurance that such cases will not later develop into those of such serious import that not even antitoxin can aid them.

While antitoxin is a specific when given early in the disease, it rarely, and probably never, repairs damage already

done. In other words, the antitoxin must neutralize the toxins before the latter have time to poison the patient, just as an antidote for swallowed poison must be administered before the latter is absorbed.

Antitoxin is as much a preventive as a cure. I have never yet seen diphtheria develop in a child or adult where even the small dose of five hundred units had been given before any symptoms appeared, even though one or more members of the family had been two or more days sick with the disease. Of course natural immunity may prevent a large number from taking the infection, but if no test for immunity has been made, all should receive immunizing doses.

Until the time arrives when our government shall more closely guard the health of its citizens, we as individuals must be on the constant lookout for early diagnoses of contagious diseases. On mothers, school-teachers, school physicians, and school and district nurses will fall the burden of this responsibility.

Again I repeat, When children are ill, “look in the throat.”—Charles E. Stone, M. D., in The Mother’s Magazine.