DIPHTHERIA

is a disease named from the Greck for a membrane, that is a skin-like substance. The cause is bacillus or germ which attacks the throat, nose or windpipe and multiplies therein. It produces there a white or grey membrane from which poison is absorbed into the blood and carried to all parts of the body. Tho bacillus itself does not enter the blood. The swelencaliig causes are those which render the body a suitable soil for the diphtheria bacillus to grow on. They are exposure to sewer gas from bad drains in the house, or to foggy or damp weather. Infection is conveyed either directly from a case of diphtheria or indirectly by means of infected clothing, books, dust, milk or such domestic pets as cats. The symptoms at tho onset are slight; they are pain in swallowing, a fecling of languor, a quickened pulse, a rise of temperature and often eran tn ng Anes p baal AS are different and are described later. Within a few hours of the onset patches of grey membrane appear on onc’ or both tonsils. To see this it is e entialMo have a good light and an a istant to hold the head and hands of the child. If now the child says “ Ah!” whilst the observer pre es down the tongue with the handle of a spoon or tooth brush a good view of the throat is obtained. To disregard these an is sure to result in frightening the child without seeing its throat at all. In mild cases the membrane does not spread much; it separates within the week and comes away piecemeal; it is either coughed out or swallowed. Recovery in these cases is rapid, the sa soma falls, the appetite returns and tho - patient is convalescent in a week. In severe cases on tho other hand the membrane spreads, extending to the nose, and often to the windpipe. This causes factor, discharge from the nose, swelling of the neck, great prostration. fo the worst cases the blood is so badly poisoned that the blood-ve els rupture and hamorrhage occurs under the skin or from the stomach or throat. Such cases terminate in death within the weck, vomiting and gradual exhaustion receding this. The convalescence of the severe cases, and le often of the mild also, is apt to be interrupted by certain forms of paralysis. Paralysis of the heart, of the palate, of the eyes, of the lips, of the clepheag may occur in this order of precedence in time. The first is to be feared, specially at the ninth day, the last at the thirty-sixth day. The first and last are highly dangerous, the others are transicnt. Paralysis of the palate causes fluids to return through the nose during the act of swallowing. Jelly and semi-solids of this kind are then swallowed more easily than fluids. Paralysis of the eyes may cause either inability to read or else a squint. In children under three diphtheria is prone to attack the windpipe, either by spreading down from the throat or by beginning in the windpipe. This condition is known as membranous croup, because it is only recently that this has been proved to be a form of diphtheria. The symptoms are hoarsene and cough, both 2 = having a metallic ring in their sound, laboured breathing and rest les ne . Soe an ren is oo ieee for bronchitis until it = too As the attack pr gees occur in which the child springs up aa fights for breath. In such attacks the colour of the child ch to a dusky blue, the eyes start nearly out of the head, the hands clutch at tho rails of the cot, until air is drawn into the lungs with a lon ‘hi ing inspiration and the child sinks down rotlavad temporarily but exhausted. The ph pe occurrence of such attacks rapidly exhaust a child make tracheotomy nece ary. This operation consists in inserting a tube into the windpipe below the obstruction. The relief this affords is immediate and complete. It is well worth having it done, even though the attack of diphtheria is ayowedly too severe for recovery to occur. Treatment. Ina area case of diphtheria carry tho child to a bedroom at the top of the house. It is unsafe to allow it to walk upstairs. Put it to bed, isolated from the others, and keep the child lying fat. The great danger of diphtheria is sudden failuro of the heart, which any sudden exertion may induce. Let the child never be left on this account. Send at once for the doctor, without waiting to see how the child is in the morning, because every hour is of importance. In the event of your suspicions rep (a firmed, a hospital nurse will probably be Be in addition to the mother. Failing this the advisability of sending the child to a fever hospital will have to be faced. The life of the child must be your only consideration; the grief of parting with it for a time must be bravely borne. It is surprising how soon young children settle down to ital life. If nursed at home the room must be as directed in the article on scarlet fever. [Read also the articles on Ferers, on the Sick Room and on Anti to zin.] Except in the very mildest cases antitoxin must be given at once. On the promptne with which this can be done the chance of recovery largely depends. The diet is that for scarlet fever (which see). When fluids are returned through the nose, milk thickened with arrowroot should be given. Syringing out tho throat will probably be ordered; this requires a trained nurse, the mother may be required to help; tho child is sure to struggle for the first few times at least from fright at this new experience; this is not the fault of the nurse. In the event of the throat being blocked and swallowing not po ible, the child is fed sic a soft india rubber tube pa ed through the nostrils and down into the throat. This again requires a nurse aided by the mother; it is wise to pour down s little water first to make sure the tube is not in the windpipe before anything thicker, like milk, is added. The child may cough membrane into the face of the mother while she is sca bas a in the above duties. This should be avoided if po ible, but if it does occur there is reason for cond action, none for panic, as this accident is common in ever hospital life. Tho treatment in such a case is to wash the face at once in plain me and water. If the membrane be coughed into the eye, let the nurse syringe this out eo at once with warm boric lotion. Emphasis must be laid on a few other points in nursing this disease. The value of fresh air cannot be grasped too thoroughly, both for the sake of the patient and the nurses. The health of the nurse must be cared for by two hours daily spent out of the house; the dre must be changed first; a ride on the bt Aa tebnsenc tram is better than a walk; any sorene of throat must be reported to the doctor at once; the dre is to be of cotton; over this an apron and sleeves are to be worn; these are to be clean daily and must oe be taken off before meals; cracks in the hands must be protected by flexile collodium; these cracks are to be avoided af not using disinfectant lotions; plain soap and water is all suficient. The ordinary case is confined to bed for two or theve weeks and sent to the seaside in six weeks. Disinfection of the house is then undertaken by the sanitary erg a The room must be repapered and the ceiling lime washed. The drains should be tested and defects corrected. [s. 353]