Sacramento daily record-union. [volume] (Sacramento [Calif.]) 1875-1891, 1890-11-15
DIPHTHERIA.
HOW TO DETECT THE DISEASE IN
ITS EARLIEST STAGES.
What to Do Before the Family Physi-
clan Arrives-valuabIe Hints
for Parents.

The following information and advice il
regard to diphtheria is from pamphlet
on the disease issued by DR.. Henry Dwight
Chaplin, Professor of diseases of children
at the New York Post Graduate Medical
School and Hospital, and at the Woman's
Medical College of the New York In
Urinary
There is, perhaps, no disease whose type
varies within such wide limits as diph-
liberia. Many cases are so mild that the
children are hardly considered i'll, and are
not even put to bed. The true nature of
such cases is frequently overlooked, and
they infict great danger by spreading the
disease in neighborhood. On the other
hand, diphtheria may be so malignant as
to kill almost in few hours, before the
false membrane has time fully to form. Be-
tween these extremes there is every grade
of severity. 1t must be thoroughly under
stood at the start that all cases of diph-
iberia are liable to be dangerous, if not
fatal The disease does not usually begin
very abruptly. There may be slight chilli
ness, followed by fever, with headache and
pains in the back and limbs. The appetite
is lost, and feeling of languor is often
experienced. The fever does not usually
run very high, even in severe cases, and
by the third day the temperature may be
down almost to the normal, although the
disease has by no means run its course.
The earlier signs of diphtheria are a
great deal like those of heavy cold. This
makes an early recognition of the throat
symptoms of great Importance. Patients
generally COMPLAIN first of feeling of
soreness, with more or less fullness in the
throat. The sensation of pain is no
greater, as rule, than is experienced in
ordinary inhammations of this part. In
deed, there is often no complaint of sore
throat at all. | have seen cases of malig-
nant diphtherja, where all the structures
of the throat were covered with false men,
brane, and yet the children, when ques-
toned, would deny the existence of any
local pain. In every case of illness in
throat should be made.
To be able to make satisfactory exami-
nation some knowledge of the structure of
the throat is necessary. When the mouth
is opened wide there are seen on either
side of the root of the tongue two small,
oval bodies called tonsils. These lie be-
tween the pillars of the palate which ex-
tend up to the soft palate that forms the
upper and back boundary of the mouth.
Hanging down from the middle of the
soft palate is a small structure called the
uvula. All these parts must be brought
distinctly into view to make a satisfactory
examination. In order to do this the
tongue must be pressed downward A
tongue-depresser, or the handle Of spoon,
will soon accomplish this end. The mis-
take commonly made is in not putting the
depresser far enough back to reach the
base of the tongue. If pressure is made
upon the forward part of this organ the
back will Immediately arch up and COM
pletely conceal the other structures of the
throat After inserting the depresser well
back, pull downward and forward, and all
parts will come into plain view. 1t is alb
solutely necessary to have a good light
The child should sit upright on the nurses
lap, if possible before a window with
southern exposure. If the examination is
made at night it is generally useless to try
to see by gaslight. By using candle,
however, held in the examiners hand,
with the bowl of tablespoon for re-
fector, and to keep the glare from the ex-
aminer's eyes, good light can be thrown
into the mouth When this is not to be
had, | have used lighted match. Some
small object like this is much more salts
factory than large lamp that cannot be
well regulated to the movements of the
child. If the child is young its hands
should always be held, in order to avoid
interference at the critical moment. Some
times child will refuse to open its mouth
at all. In such case the nose may be
held until the mouth is partly opened for
air, when the depresser can be quickly
slipped in and the parts brought to view.
The diphtheritic false membrane is often
est seen first upon the tonsils and pillars
of the palate, hence these parts must be
subjected to careful scrutiny. The whole
throat is usually redeemed and inflamed,
but some hours after the beginning of the
disease slightly raised patch appears at
some part which is the first manifestation
of a diphtheritic false membrane.
The false membrane has grayish-white
color, and not only lies upon but deeply
penetrates the mucous membrane, upon
which it is situated Persons often in
quire why liptheritic false membrane can
not be easily detached when in plain sight.
The mucous membrane of the part is so
penetrated by the false membrane that an
liberated bleeding surface is left behind
when it is forcibly detached. Upon this
raw surface di phtheritic membrane will
quickly reform, thicker than ever, from
the irritation to which the part has been
subjected. 1t is like trying to tear up
grass without disturbing the soil in which
the roots are grounded. We only renew
the strength of the false membrane, as
irritation of all kinds provokes its growth
and spread.
The false membrane consists Of a coagu-
lated, tenacious substance, called fibrin,
that is exuded from the blood-vessels as a
result of diphtheritic inflammation, of de-
generated epithelial cells, of pus, and
small living organisms called bacteria.
Decomposition of the false membrane be-
gins in a few DAYS, when it softeus and
changes to dirty-brown color. Its separ.
alton is effected by the secretions of the
mucous membrane, and is usually gradual
and accompanied by sort of liquefaction
The edges of the diphtheritic path are
thinner than the center, and surrounded
W I6u, lDHdutu MUCOUS LneInDIdne' ue
severity and danger of an attack of dipth.
eria depend largely upon the extent of the
false membrane and its tendency TO spread
to the structures outside Of the throat.
When the diphtheritic membrane is only
situated upon the tonsils the disease is no.
apt to be severe. The reason of this i,
that the breathing is not much interfereC
with, and, as the abSorbents are not active
in the tonsils, the poison will not reacl
the blood in large quantity. If the falst
membrane spreads up or down. however
the results are serious
Sometimes the false membrane will ex
tend downward, reaching the larynx, o
opening of the windpipe, and cover owe
the vocal cords. This is very fatal &C
cident, as sufocation is caused by closun
Of the air passages by false membrane
The crOupV Svmptoms pAme ON Oraduai II Y