The Topeka state journal. [volume] (Topeka, Kansas) 1892-1980, 1921-09-17
BY EARLE G. BROWN, M. d

BY EARLE G. BROWN, NJ. D.
Diphtheria is an acute infectious
disease that is caused by a germ, the
Klebs-Loeffler bacillus. The disease
is contracted by direct contact with a
person who is sick with diphtheria;
By contact with carriers, that is per
sons who are we'll but have the germs
in their nose or throat; by food and in
rare instances, clothing, books, play
things, etc.
Diphtheria as a disease has been
known for many centuries. AS far
back as 100 B. c. the operative method
to prevent a diphtheria patient from
Btrangling to death was known and
used. The name of diphtheria which
literally means membrane, was first
used 1921. The treatment with anti
toxin was originated in 1873 by Ben
ring and Roux, the germ was first des-
cribed by Klebs in 1888 and first
grown by Loeffler in 1884.
Is Communicable Disease.
Diphtheria is a communicable dis
ease which begins in the nose, throat
or air passages. 1t Use characterized
in most cases by the formation of
dirty, white or grayish membrane on
the part affected. In some cases, the
membrane is located so low down in
the throat that it is not possible to
see it.
Formerly it was thought that Group
and dlphtheria were two separate dis
eases. but it is now definitely known
that only an occasional case is not due
to diphtheria. Any case of Group that
does not respond to simple home reme-
dies or lasts more than 20 hours, is
reasonably certain of being due to
diphtheria. In all cases. membranous
Group is subject to reporting and the
same quarantine regulations as diph-
iberia.
Attacks in Two Ways.
The diphtheria germ attacks the
body in two ways; first, locally in
the throat or nose, it produces an in
flammation, kills the tissues, and
form a membrane. Secondly, the
germ gives off a poison which is alb
sorbed by both blood and lymph YES
sells and is then carried to all parts
of the body. 1t is this poison that is
largely accountable for the complica-
lions.
While the disease is characterized,
most often by the formation of a
membrane, there are many cases that
are very mild, the patient complain
ing of a slight sore throat, and on
examination shows a red, moist,
glistening surface, but on culture,
shows diphtheria germs in great num-
bers. Removal of a piece of the
membrane, leaves a raw bleeding sur
face, on which membrane rapidly
forms. In some cases, where there is
great involvement of the trachea or
larynX. it is sometimes necessary for
the physician to insert a tub into the
throat to prevent the patient from
suffocating.
Diphtheria paralysis occurs in per
cent to 10 per cent of cases. This
percentage has been reduced by the
use of antitoxin, depending on how
early it was used. The common form
81 ,fo1l fV7F1 fav-a
with speech, occurs most often after
diphtheria of the throat and two to
chance there is of recovery.
The introduction of antitoxin has
greatly lowered the death rate. Ac-
cording to Bayeux, the death rate in
100000 diphtheria patients was SIS
per cent before and 16 per cent after
the Introduction of antitoxin. The
value OF antitoxin is in using it early
and in sufficient dosage, for the
longer its use is delayed, the less
chance there is of recovery.
The Shiclz Test.
In spite of the fact that all agencies
necessary for the elimination of diph-
iberia are available, we still have the
disease present. For the United
States. the calculated yearly mortality
is from 10000 to $4,000. In the days
before antitoxin the mortality was 70
to 10 per cent. Yet diphtheria con-
lAnueS 10 occupy AL4IO P4aGC
the communicable diseases, and the
mortality remains stationary at about
10 per cent.
Experience has taught us that diph-
iberia will never be controlled by the
use of antitoxin~alone or by cuituring.
Antitoxin is, Of course, necessary for
curative purposes and the Immediate
immuniZation of contacts. Prevention
was ever better than cure. Conse-
quently in the Shick test. we have
method that if properly applied, would
not only check diphtheria. but would
head off all epidemics of this dread
disease.
Reliable Clinical Test.
The Shick test is a reliable clinical
test to determine whether a person is
susceptible or immune to diphtheria.
II has been discovered that if a person
has 1870 of a. unit of antitoxin per
cubic centimeter of blood, he is i'm
muue. This test is Of special value in
determining the immunity of school
children to diphtheria, in hospitals, in
situations and in homes during an cpl
deric.
The Shick test is not an experiment.
IT was introduced by Doctor Shick in
1918 and taken up by Doctors Park
and Zingher Of the department of
health. New York City. It has long
ago passed the eXperim entail stage and
is now a recognized procedure in the
control OF diphther;a infection.
The test itself consists of the injec-
ton of small amount tot diphtheria