The bacteriology of diphtheria, including sections on the history, epidemiology and pathology of the disease, the mortality caused by it, the toxins and antitoxins and the serum disease / by F. Loeffler et al. Edited by G.H.F. Nuttall and G.S. Graham-Smith.

  • Loeffler, Friedrich August Johannes, 1852-
Date:
1908
Catalogue details

Licence: In copyright

Credit: The bacteriology of diphtheria, including sections on the history, epidemiology and pathology of the disease, the mortality caused by it, the toxins and antitoxins and the serum disease / by F. Loeffler et al. Edited by G.H.F. Nuttall and G.S. Graham-Smith. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    Its Eastern origin is also indicated by the statement of the celebrated Cappadocian physician Aretaeus (Mann, 1858), who lived in Rome at the end of the first century. Indeed, he was the first to give us an accurate account of pharyngeal diphtheria. After a minute account of the various forms of angina, the Gynanche, in which the inflamed tongue, owing to its excessive size, protrudes between the teeth, and the Synanche, in which the disease, hiding itself in the unseen parts of the chest, as it were clasps and torments the sick man inwardly, he describes in detail the diseases of the uvula, the aTa^vXr], the i^avTiov and the Kpt'taireBov and (in the ninth chapter) the ulcers of the tonsils. Ulcers sometimes arise on the tonsils, of which one kind is common, benign, and innocuous, the other rare, malignant and fatal. The benign ulcers are clean, small, shallow, uninflamed and painless; the malignant forms on the other hand are broad, deep, dirty, and covered with a white, bluish or black membrane. The latter are termed Aphthae, except when the disease extends more deeply, when it is called an Eschara. At tlie commencement of the Eschara there appears a vivid redness, and inflammation and pain in the veins as in carbuncles ; then isolated pustules arise, to which new ones are continually added. These pustules coalesce and give rise to a broad ulcer. If the disease extends into the buccal cavity it attacks the uvula and destroys it, and then passes on to the gums, the tongue, and the angles of the mouth. The teeth are loosened and become black, and inflammation appears in the neck. Such patients die in a few days from the inflammation, fevei-, foul smell, and defective nutrition. When, however, the disease extends through the trachea into the thoracic organs death occurs on the same day by suffocation, for the lungs and heart can endure neither the smell nor the ulceration nor the pus, which excites coughing and dyspnoea. This disease may be produced by eating cold, rough, sharp, astringent things Hence it occurs most commonly in children up to the age of puberty, as these generally inhale much cold air, because they have the greatest warmth As regards its local disti'ibution this disease is most commonly found in Egypt, because in this country the air is dry for breathing and the food is varied, consisting of roots, herbs, many vegetables, pungent seeds, and thick beverages, either Nile water or sharp beer. The disease is very common too in Coele Syria. Hence the ulcers are often called Egyptian or Syrian idcersj' This description by Aretaeus does not quite agree with the symptoms of diphtheria. It is remarkable that he considers these malignant ulcers to be rare, and describes no epidemics. The disease seems therefore to have occurred at that time only spoi'adically as an importation from Egypt and Syria, and never appears to have attained epidemic dimensions. The remarks of Aretaeus on the treatment of this disease are of great interest ( Curative treatment of malignant diseases of the throat in the ninth chapter of the first book on the treatment of acute diseases). 1—2
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