The course of an attack of diphtheria varies with the age of the patient, the general condition of the system, and the severity of the epidemic. The mortality is greatest from infancy up to the fifth or sixth year, and then declines steadily until it is practically nothing in adult life. During the prevalence of an epi demic of diphtheria, parents must keep close watch over their children. Fre quent examination of the throat may lead to an early recognition of the disease, in many cases before any other symptoms have appeared. Fig. io6 illustrates the most suitable manner of holding a child for the purpose of ex amining its throat. Any slight redness or swelling in the throat should serve as a warning, even before any membrane has appeared ; and a physician should be called at once, in order that appropriate treatment may be instituted and further dissemination of the disease prevented.
If the diagnosis has been confirmed by the doctor, the patient must be isolated immediately, and the remaining children in the family kept under close supervision. It is advisable to send children with diphtheria to a special hospital if suitable quarantine cannot be maintained at home. All articles used by the patient, or with which he comes in contact, should be either boiled for half an hour or soaked in some germicidal solution. The nurse should be dressed in gowns of washable material. Before leaving the sick-room, and also before every meal (none of which should be taken in the room where the patient lies), the hands must be thoroughly washed and disinfected, and the mouth washed out with some antiseptic gargle. At the termination of the disease, the rooms occupied by the sick person must be fumigated and then thoroughly aired. Convalescents also serve as a means for disseminating the disease, even for some time after their recovery, and this fact should always be borne in mind.
The method of treatment generally adopted at the present day, and which has been thoroughly tested by observations without number, is by the injection of the curative antitoxic serum discovered by Behring. This is entirely harmless in its action, and has triumphantly established itself in the confidence of the medical world in the face of great opposition. The earlier the patient can be given the benefit of this treatment, the more certain are its effects, and every moment of hesitation is unfavourable to the life of the patient. The brilliant results which have attended the procedure are shown by the statistics of the mortality, which has steadily declined from an average of 45 to 5o per cent. to 16 per cent. The curative effect of the serum is shown by the improvement in the general condition and strength of the patient, in the lowering of the temperature, the return of the appetite, and by the fact that the false membranes do not extend any further, but are thrown off. This favourable effect only follows the early administration of
the antitoxin, before the poison from the bacilli has had an opportunity to do much harm to the system.
In addition to the constitutional treatment, cold applications may be made to the throat, ice may be swallowed in small pieces, and if much irritation is present relief may be obtained by gargling with cold, astringent solutions. Constriction of the pharynx or of the larynx, resulting from the swelling or from the exudations, sometimes leads to difficulty in breathing, or to choking, so that life is threatened ; in such cases the timely introduction of. an intubation-tube into the larynx, or the operation of tracheotomy, may do much to revive the patient. The necessity for treating any subse quent paralysis of the various muscles must be determined by the physician, and should be left entirely to his discretion.
DISINFECTION.—Since it is known that a large number of diseases are due to the entrance of toxic bacteria into the body, and that these are present on every object with which one comes in contact, efforts should be made to reduce the possibilities of contagion by limiting or destroying the offending germs. This may be accomplished by methods of disinfection, and for this purpose heat, in the form of fire, boiling water, or steam, and chemical substances which in weak solutions kill the bacteria, but which in stronger solutions are harmful to the tissues, are employed. Fire and boiling water destroy bacteria very rapidly, usually within a few minutes. Live steam acts somewhat slower, although it kills even the most resistant forms in about half an hour. As a rule, articles to be disinfected are exposed to live steam for at least an hour.
Whatever comes in contact with a patient suffering from an infectious disease should be burned if of no value, and this applies especially to dressings soiled by purulent discharges. The linen for the bed and for personal use, as well as all metal objects, may be disinfected by boiling water. Live steam may be used for cleansing the wearing apparel. The commonly employed chemical disinfectants, which in dilute solutions may also be used in dressing wounds, are watery solutions of boric acid (5 to io per cent.), carbolic acid (r to 5 per cent.), creoline (5 per cent.), lysol (5 to 10 per cent.), formaldehyde (t per cent.), salicylic acid (1 to 3 per cent.), corrosive sublimate (1 to i per cent.), and also soap and chloride of lime. Objects exposed to the action of these solutions require varying periods of time for their disin fection, depending on the strength.