General of all, the sick-room should be well lighted and ventilated. Care in this respect is es pecially necessary in children's hospitals. Crowding a number of cases of diph theria together in one ward is undoubt edly harmful. It is much better to have a number of small wards, accommodat ing three or four patients, than one large one in which all are assembled together. Cases in which pneumonia has developed should not be kept in the room with those still free from it. Attention should be given to feeding the patients, as the best means of enabling them to bear the attack of the disease upon the vital pow ers. Usually, on account of the soreness of the throat, fluid foods can be best taken, but semisolids can be given in some cases. Our chief reliance must be upon milk. It should be given at regu lar intervals, every two hours, and in such quantity as the patient will take. There is little danger of overfeeding. The difficulty- is usually to get the chil dren to take sufficient nourishment. In addition to the milk, we may give beef juice, beef-tea, or thin gruels. In chil dren that have been intubated semi solids can sometimes be taken better than fluid nourishment. Bread and milk answer the purpose in such cases.
Nursing children should be fed with milk drawn by a breast-pump. In this way the children are saved the exertion of suckling and the mothers are pro tected from the danger of infection.
In septic cases the children often re fuse food altogether or vomit it imme diately it is taken. They may then be fed by the stomach-tube. If the tube cannot be passed through the mouth, we can usually succeed in passing it through the nose. This method may also be em ployed in intubated cases where the at tempt to swallow food is followed by vio lent coughing or choking.
Rectal feeding with peptonized rnilk is a last resort, and seems to be of little value in children.
Rest in bed is an essential feature of proper treatment. Whatever handling or interference is required should be so arranged as to tax the patient as little as possible. Zeal for thorough local treatment has often led to fatal excite ment and exertion on the part of the patient. Especially in cases of cardiac weakness should absolute quiet be en joined, and all treatment that tends to excite the child or cause it to struggle avoided. Opium or morphine may be used to insure quiet under these circum stances.
Steam inhalations have long been em ployed for the purpose of increasing the secretions of mucus from the mucous membranes, softening the diphtheritic deposits, and hastening their separation. The croup-kettle has almost become a household utensil. To increase the effi cacy of the steam, carbolic acid, turpen tine, eucalyptol and other aromatic anti septics have been added to the boiling water. These measures are of doubtful
value at any time, and when they are employed under a close canopy at the sacrifice of fresh air, as is usually the case, may be positively harmful. The testimony of adults is that, at least, the steam is very comforting.
Convalescents should use disinfectant gargles for a considerable period. Good results are obtained by the constant em ployment of a disinfectant vapor, as eucalyptus, tuTentine, carbolic acid, creasote, or tar. Either of these agents is added to water in a convenient ves sel, and is constantly simmering by a moderate beat underneath. Mildly de tergent and antiseptic gargles, such as diluted carbolic acid, boric acid and water, thymol, menthol, wintergreen, or bichloride of mercury (I to 10,000) should be frequently employed by all persons exposed to diphtheria, as the nurse, physician, and thc patient himself. Beverly Robinson (N. Y. Med. Jour., Aug. 5, '94).
Local Treatment. — The local treat ment in diphtheria is of importance.
The object sought in such treatment has changed considerably within recent years. We no longer seek to remove the membrane by local applications or by me chanical means, nor do we expect to de stroy the bacilli in the throat. Experi ence has taught us that we can get rid neither of membrane nor of bacteria by local treatment, and also that too ener getic efforts to accomplish these ends do harm instead of good. We have, there fore, abandoned the mechanical removal of the membrane, the application of de structive powders or solutions to it, and the use of strong antiseptics to the af fected parts. We endeavor simply to keep the nose, mouth, and throat clear of the secretions which may either ob struct them or by their decomposition and absorption increase the toxminia.
To this end we employ bland fluids, such as normal salt solution, or a satu rated boric-acid solution. The method of using the solution must be varied to suit each particular case. The most effica cious is undoubtedly the fountain-syr inge. To employ this, we need only the douche-bag fitted with a smooth glass nozzle adapted to the size of the nares. The child is wrapped in a blanket so that the arms and legs are controlled. It is then laid upon its side on a table beneath the douche, tbe nozzle inserted on one side the nose, and the fluid, which should be lukewarm, allowed to flow freely for a moment. As it escapes from the mouth or the other nostril, it usually carries with it considerable quantities of mucus, or muco-pus, and possibly bits of mem brane. The injection is repeated till the escaping fluid is clear. Sprays are inef fective, and should not be used.