The Pacific commercial advertiser. [volume] (Honolulu, Hawaiian Islands) 1885-1921, 1891-01-08
DIPHTHERlA.
How 10 Detect the Disease I'm Its
Earliest Stages.

The following information and advio,
in regard to diphtheria il from a pam.
pblet on the disease issued by DIR. Henry
Dwight Chaplin, Professor Of diseases oi
children at the New York Post Graduate
Medical School and Hospital. and at tho
Woman's Medical College OF the New
York Infirmary:
! There is, perhaps, no disease whose
type varies within such wide limits "a
diphtheria. Many cases are 50 mild that
the children. are hardly considered i'll.
and are not even put to bed. The true
nature Of such cases is frequently over
looked, and they infiict great danger by
spreading the disease in neighborhood
On the other hand, diphtheria may be 90
malignant as to kill almost in g few
hours, before the false membrane has
time fully to form. Between these ex.
tremes there is every grade of severity.
1t must be thoroughly understood at the
start that all cases of diphtheria are
liable to be dangerous, il not fatal. The
disease does not usually begin very abb
ruptly. There may be slight chilliness,
followed by fever, which headache and
pains in the back and limbs. The appe.
tite 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 tempera-
ture may be down almost to the normal,
although the disease has by no means
run its course.
The earlier signs Of diphtheria are
great deal like those Of heavy cold.
This makes an early recok milton of the
throat symptoms of great importance.
Patients generally complain first OF
/ Of ,..,t
| fullness in the throat. The sensation Of
pain is no greater. as rule, than is ex-
perienced in ordinary iDfammations of
this part. Indeed, there is often no COM
plant of sore throat at all. I have seen
cases of malignant diphtheria, where all
the structures of the throat were covered
| with false membranes, ard yet the chill
dren, when questioned, would deny the
existence of any local pain. In every
! case of illness in children . careful ex-
animation of the throat should be made.
To be able to make satisfactory ex-
animation some knowledge Of the struc-
ture 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 between the pillars Of the
palate, which extend 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 q small structure called the
uvula. All these parts must be brought
distinctly into view to make satisfac-
tory examination. In order to do this
the tongue must be pressed downward.
A tongue-depresser, or the handle of q
spoon, will soon accomplish this end.
The mistake commonly made Is in not
putting the depresser Tar enough back to
reach the base of the tongue. III pres
sure is made upon the forward part of
this organ the back viii Immediately
arch up and completely conceal the
other structures of the throat. After in
serting the depresser well back, pull
downward and forward, and all parts
will come into plain view. IL is abso-
lutely necessary to have good light.
The child should sit upright on the
nurses lgp, il possible before window
with southern exposure. If the exam
ination is made at night il is generally
useless to try 10 see by gaslight. By
using candle, however, held in the
examiners hand, with the bowl of
tablespoon for reflector, and to keep
the glare from the examiners eyes, a
mouth. When this is not to be had,
have used lighted match. Some small
object like tins much more satisfactory
than a large lamp that cannot be well
regulated to the movements of the child.
Ii the child is young it's hands should
always be held, in order to avoid inter-
ference at the critical rnoment. Some
times a child will refuse 10 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 il
oftenest 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 infismed, but some houis 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 il is situated. Persons often
inquire why diptheritic false membrane
cannot be easily detached when i'm plain
sight. The mucuos membrane of the
part is SO penetrated by the false MEM
brane that an liberated bleeding surface
is left behind when il is forcibly do.
tached. Upon this raw surface diph-
theritic membrane will quickly reform,
| thicker than ever, from the irritation to
which the part has been subjected. Ii
| is like trying TO tear up grass without
disturbing the soil i'm which the roots
are grounded We only renew the
| strength OF the false membrane, as irri-
tation Of all ki..ds provokes It's growth
and spread.
The false membrane consists of
coagulated, tenacious substance, called
hhrin, that is exuded from the blood
vessels az result of diphtheritic infian-
nation, of degenerated enithelial cells,
OF pus and small living organisms called
bacteria decomposition Of the false
membrane begins in a few DAYS, when
u soitens and changes to dirty brown
color. lts separation il effected by the
| secretions ct the mueoue membrane, and
is usually gradual and accompanied by
sort OF liquelaction The edges of the
ldiphtheritic path are thinner than the
center, and surrounded by red. intlamed
mucous membrane, The severity and
danger of an attack of Aiphtheria depends
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