The Hawaiian gazette. [volume] (Honolulu [Oahu, Hawaii]) 1865-1918, 1891-01-13
DIPHTHERlA.
How to Detect the Disease in Its
Earliest Stages.

Earliest stages.
The following information and advice
In regard to diphtheria is from pam
phlet on the disease issued by Dr.Henry
Dwight Chaplin, Professor Of diseases OF
children at the New York POst-Gr2duate
Medical School and Hospital, and at the
Womau's Medical College Of the New
York InErmaTy:
There is. perhaps. 10 disease whose
tyne varies within such wide limits as
diphtheria. Many cases are so mild that
the children are hardly considered III,
and are not even put to bed. The true
nature of such cases Is frequently over
looked. and they infict great danger by
snreafiug the disease in q neighbOrhOOd.
on rhe other hand, diphtheTia may be so
malignant as TO XIII almost in q few
hours. before the false membrane has
time fully to form. Between these ex-
remes there Is every grade Of severity.
il must be thoroughly understood Of the
start that all cases OF diphtheria are
liable TO be dangerous, il not fatal. The
disease does not usually begin very alb
ruutiv. There NAV be slight chilliness,
followed by fever, which headache and
,.yaius in the back and limbs. The appe-
iten 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 It's course.
The earlier signs OF diphtheria are a
great deal like those OF a heavy cold.
This makes an early Tecog milton OF the
-
Patients generally complain first OF
feeling OF soreness, with more or less
fullness in the throat. The sensation Of
pain is no greater, Is q rule, than Is eX-
perieaced in ordinary inhammations OF
this part Indeed, there is often no com
plant OF sore throat aI all. l have seen
cases of malignant diphtheTia, where all
the structures OF the throat were covered
with false membranes, and yet the chill
dren, when questioned, would deny the
existence OF any local pain. In every
case of illness IN children q 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
AThese lie between the pillars OF the
bpalate, which extend up 10 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 satisfac-
tory examination. In order to do this
the tongue must be pressed downward.
4 tongue-depresser, or the handle Of
spoon, will soon accomplish this end.
The mistake commonly made is in not
putting the depresser far enough back to
reach the base of the tongue. Ii 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
sorting the depresser well back, pull
downward and forward, and all parts
viii come into plain view. 1t is abso-
lutely necessary to have a good light
The child should sit upright on the
nurses lap il possible before a window
with southern exposure. II the exam
lnatiOn is made at night it is generally
useless to try to see by gaslight BY
using a candle, however, held in the
tablespoon for reflector, and to keep
the glare from the examiners eyes, a
good light can be thrown into the
mouth. When this is not to be had, l
sAave used a lighted match. Some small
S5ject like this much more satisfactory
than a large lamp that cannot be well
regulated to the movements of the child.
Ii the child Is young its hands should
al rva no halI in rGa 70 ir,fn
ference 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
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 inhamed, but some hours after the
beginning OF the disease a slightly
: raised patch appears at some part,
awaich Is the first manifestation Of q
Sdiphtheritic false membrane.
The false membrane has a grayish-
white color, and not only lies upon but
upon which it is situated. Persons often
inquire why diptheritic false membrane
cannot be easily detached when in plain
sight The mucuos membrane OF the
part Is so penetrated by the false mem
brane that an liberated bleeding surface
is lett behind when 1t is iorcibly de-
tached Upon this raw surface diph-
thelidc membrane will quickly reform,
thicker than ever, from the irritation to
which the part has been subjected. It
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 irri- |
tation OF all kinds provokes its growth |
and spread.
The false membrane consists OF
c0agula.ed, tenacious substance, called I
Ehrn, that is exUded from the blood
vessels as "a result OF diphtheritie infam- |
NATION, OF degene,ated epithehal cells, !
OF pus and small living organisms called |
bacteria. Decomposition OF the false |
mem araue begins in few DAYS, when |
it saieas and changes TO d dirty brown |
co.or, lis separation is effected BY the |
secretions OF the mucous membrane, and |
Is usually gradual and accompanied by q |
sor o., liqueiaction. The edges Of the |
diphiheriuc path are thinner than the |