Sometimes the disease attacks the air-passage only, without any previous attack of the tonsils, no white patches being seen at the back of the throat. In very young children the formation of the membrane in the windpipe may proceed so quickly that death occurs within a few hours of the hoarseness and cough indicating the dis ease.
Further, there are cases of diphtheria in which death occurs within a few days, even in grown-up persons, not from suffocation, but from the violence of the poison. Indeed death may occur without any apparent formation of membrane, and so rapidly as to leave some doubt regarding the true nature of the disease.
Nor yet is all danger passed when the throat affection has passed away, for death may even then suddenly occur from loss of blood, failure of the heart, and other causes.
Treatment.---The person is to be put to bed in a large well-ventilated room, which must be kept continually at a moderate heat, and in which no draughts must be permitted. A fire must be kept on constantly, and a kettle should always be on the fire pouring its steam into the room. If the least suspicion of the throat being affected is present, the kettle should be a bronchitis kettle (see Plate XXXI.—APPL1 A NeES FOR THE N uRsERY), and the steam should be plentifully poured in the immediate neigh bourhood of the bed. If the bowels are confined, castor-oil must be given, or an injection. From the beginning every effort should be directed to maintain the strength, sips of warm milk or warm beef-tea, strong mutton-broth freed from fat and vegetables, eggs beat up in milk, &c., should be administered in small quantities often. Port wine in small quantities is also to be frequently administered. Cold drinks are not to be withheld, and ice may be given to suck. When the patient cannot swallow, nourishing injections become necessary. The method of administering them is explained in another part of this work. (Refer to index for INJECTIONS.) Diphtheria is now cut short, the growth of the membrane arrested, and the disease cured in a few days by the injection under the skin of diphtheria antitoxin or diphtheritic serum (see p. 514). When this method is not at hand, the treatment by medicine is twofold. The throat must be regularly painted several times daily, in the hope of arresting the growth of the false membrane, and a mixture is to be given. The paint is made of equal parts of glycerine and liquor of perchloride of iron—the strong liquor. To each ounce of this 1 drachm of
sulphurous acid is added, and the whole shaken together. A brush is used camel's hair or goose quill—firmly set on a long handle. The tongue of the patient is held down by a spoon, and the back of the throat thoroughly painted over. The painting must be repeated twice or thrice daily. With children it is difficult to accomplish, and help is necessary. The follow ing mixture is to be given : Chlorate of potash in powder, 120 grains.
Solution of dialysed iron, ounce.
Syrup of orange, 1 ounce.
Water, to 4 ounces.
Of this from a half to one tea-spoonful is to be given four or five times daily. When suffoca tion is threatened steam is to be kept streaming about the bed, and hot cloths may be applied on the neck. A surgeon would probably suggest opening the windpipe by the operation known as tracheotomy (p 363). During recovery quin ine and iron tonics, nourishing foods, cod-liver oil, and, when the patient can bear it, removal to the sea-side, are valuable aids to full restora tion of health.
Disinfection (p. 516) must not be forgotten.
Croup, true croup, has been considered in the preceding paragraphs as an extension of diphtheria down into the top of the windpipe—• the larynx (p. 354), or into the windpipe itself ; or it may be the diphtheria attacks the larynx and windpipe first and directly. There is, how ever, an ordinary inflammation of the top of the windpipe and windpipe itself, not attended by formation of false membrane, to which chil dren, of two and three years old, are specially liable, to which the term croup is also applied.
Its symptoms may come on suddenly with alteration of voice, some hoarseness, and fre quent dry short cough. The cough speedily takes on special characters, it becomes barking and " brassy." There is fever, with difficult and hurried breathing, crowing and piping noise with taking in of breath, quick pulse, and the child is restless and anxious and plucks at its throat. It may be impossible to say whether the symptoms are due to the formation of a false membrane in the windpipe, as in diph theria, or to inflammatory swelling. Death may rapidly occur by suffocation or exhaustion.
Cronpy symptoms are often present at the commencement of measles.
The treatment is the same as that described on p. 362 for inflammation of the larynx.