p. 11 | Practical Hydrotherapy by GEO. THOMASON, M. D.

Seventh-day Adventist Publishing Association · Battle Creek, Michigan · Apr 15, 1902

Practical Hydrotherapy

By GEO. THOMASON, M. D.

Lesson 9—Diphtheria and Its Treatment

GEO. THOMASON, M. D.

DIPHTHERIA is an acute disease, and in the process of its development the chief seat of the disease is localized in the throat. The specific cause of the disease is a germ. From the various manifestations of the disease processes, it was known for many years that it was directly produced by germs, but it was not until 1880 that the specific microbe causing the disease was discovered. The access of the germ to the throat does not always condemn one to the disease, since this germ, as is the case with many others, is frequently found in the throat of healthy persons. It is necessary that conditions shall be favorable within the body for the growth and development of the germ in order that the disease may be produced. In other words, the vital resistance must be lowered, or the natural defenses of the body weakened, before the germ can gain a foothold. Children are most frequently affected with the disease, although it may occur at any age. The liability to contract the disease diminishes as a person advances in age.

Many of the lower animals are also subject to the disease. Dogs, pigs, sheep, fowls, cows, and other animals frequently suffer from it. Milk may be one of the means of communicating the disease. The milk of a cow suffering from diphtheria, being set aside in a warm place, will develop diphtheria germs in great numbers; and milk thus contaminated, when given to another animal, will give rise to the disease. There seems abundant evidence for believing that true diphtheria may be transmitted from cats to children, and even to adults.

Diphtheria is a highly contagious disease. The closer the contact with the patient, the greater is the danger of contracting the disease. Unhygienic surroundings favor the spread of the disease, as, for example, living in damp, dark, poorly ventilated houses. Foul cesspools, deficient drainage, and living where one is obliged to breathe air vitiated by decomposing vegetable or animal matter, or by barnyards or other sources of contamination, lower the vital resistance, and increase the susceptibility to the disease.

One principal manifestation of diphtheria is the formation of a grayish-colored membrane in the throat. When the disease is prevalent, it is well, as soon as the child appears to be ailing, to take the temperature regularly, and systematically to examine the throat, as diphtheria frequently develops rather insidiously, and it is possible for the disease to become considerably advanced before the child complains of throat symptoms. The disease sometimes reaches a stage where it may prove fatal within a few hours, before the real situation is appreciated. The extent of the false membrane is quite an index as to the severity of the disease. It is sometimes

very small, not larger than a dime, or it may become very extensive, covering the inner surface of the mouth and cheeks, reaching out upon the lips, also extending from the throat upward into the nose, or downward into the esophagus, and reaching even to the stomach. It frequently enters the air passages, when it is often the cause of death by suffocation.

Symptoms

At the beginning of the disease, the child usually complains of being tired; there will be headache and loss of appetite, and vomiting frequently occurs. After a few hours the patient complains of dryness or soreness in the throat. Looking into the throat, there will often be observed a marked redness, and perhaps one or two small grayish spots on or near the tonsils. The child's temperature will rise, frequently reaching 104° or 105°, although at times the thermometer may not show a temperature of more than 102°. The height to which the temperature rises, however, cannot be taken as a true index to the severity of the disease, as in many cases the body is so overwhelmed with poisons generated by the microbes that there is a marked tendency to collapse, and to a fall in the temperature. When the air passages are involved, the child frequently has spells of coughing, and portions of the membrane may be raised. The pulse increases greatly in frequency, and is often irregular and feeble. The duration of the disease is usually from ten days to two weeks. Very severe cases may extend over several weeks or even months. The germs frequently lurk in the throat for some time after the membrane has entirely disappeared.

Treatment

In treating the disease, careful attention should be given to the local processes in the throat. Treatment should consist of carefully spraying the throat every hour with an antiseptic solution of some sort, such as a ten-to-fifteen-per-cent solution of peroxide of hydrogen, or a solution consisting of a dram of carbolic acid to an ounce of listerine, diluted in a third of a glass of water. In addition, external applications should be made in the form of fomentations, or very hot compresses, to the throat for ten or fifteen minutes every hour or two, with an ice bag applied to the throat continuously during the interval between the fomentations, during the first days of the disease. Later, the fomentations may be applied to the throat every three or four hours, a compress being worn during the interval, consisting of from four to six thicknesses of cheese cloth wrung slightly from very cold water, and covered with at least three or four thicknesses of flannel.

To control the fever, the patient may be given a short, hot, full immersion bath at a temperature of from 100° to 105° for five minutes, or a hot-blanket pack for fifteen minutes, either of which could be followed by a neutral full immersion bath at from 93° to 96° for twenty or thirty minutes, or more, or by friction of the body with cold water. A copious enema at 80°, repeated several times, is a very successful means of lowering the temperature, and in any case the enema should be administered twice daily. The child should be given water to drink copiously, at least from two to four pints daily, and more if possible.

Fomentations, or flannels wrung from very hot water, should be applied to the spine, renewed every four or five minutes, and continued for fifteen or twenty minutes two times a day, to be followed by some form of cold friction. It is often gratifying to the patient to be allowed bits of ice to hold in the mouth. The carbolic acid and listerine solution in very hot water, in the strength of a teaspoonful to half a glass of water, is of great service as a gargle, if the child is old enough to understand the method of gargling. As the disease progresses, if there is a tendency to collapse, as indicated by chill, paleness of the skin, rapid, weak pulse, and cold perspiration, a short hot immersion bath or a hot enema should be administered, followed by surrounding the patient with dry blankets, with hot-water bags placed at the feet and sides, to promote activity of the circulation in the skin.

If there is indication of suffocation, the child should be placed in a hot bath, and cold water poured upon the chest and spine to aid in the effort to clear the throat of portions of the false membrane. Frequent inhalations of steam will assist in loosening the membrane.

To prevent the spread of contagion, the patient should be completely isolated from other members of the family. The room in which the patient is kept should be largely divested of its superfluous furniture, such as rugs, curtains, etc., retaining only the essentials. The room should be thoroughly ventilated. All discharges from the patient should be carefully disinfected with quicklime or with a two-per-cent carbolic-acid solution. The patient should use cheese cloth in place of handkerchiefs, and these should be promptly burned. Attendants upon the patient should wear a linen gown or sheet, entirely covering the clothing, which should be removed upon leaving the room. As a precautionary measure the attendants should also gargle or spray the throat every two or three hours with the solution of peroxide of hydrogen or carbolic acid and listerine, as mentioned above.

After Recovery

After the patient has recovered, the body should be cleansed with a hot soap-and-water bath, and the scalp should be thoroughly shampooed. All the clothing which has been worn in the sick room should be disinfected by boiling, and also by soaking at least five or six hours in a 1/2000 solution of bichloride of mercury, or for twenty-four hours in a two-per-cent solution of carbolic acid. The walls and floor of the room should be carefully washed and scrubbed with either the bichloride or the carbolic-acid solution. As an additional measure, the room should be completely closed, stopping up cracks in doors and windows with paper, and placing on the floor a pan of water in which is placed two bricks, and upon these a vessel containing sulphur and charcoal in equal quantities, and in amount equivalent to two pounds for every one thousand cubic feet of space. This should be allowed to burn and the room kept tightly closed for at least from twenty-four to thirty-six hours, when it may be thoroughly aired. It will then be safe to occupy.