A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck.
- Date:
- 1887
Licence: Public Domain Mark
Credit: A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
99/1022 page 67
![Jacobi stales that while diffuse pharyngeal injection may or may not point to imminent diphtheria, marked local congestion is either traumatic or diphtheritic. An examination of the urine should never be neglected in doubtful cases; in diph- theria a trace of albumen is very common; in simple or follicular sore throat albumen is very rare, if indeed it occurs at all.] Prognosis.—The unfavorable prognosis of the disease is universally known, even by the laity. The very fact that the best-developed and healthiest children so often fall victims to it associates the name diphtheria with the saddest memories. There are indeed many mild cases which recover in a week or two, and severer ones which end happily in three or four weeks; but in most cases, where the pro- cess extends into the larynx, or the symptoms of a severe constitutional infection occur, medical interference has, unfortunately, no power to control the unfavor- able issue. What the dangers are, and how recognized, can be well enough in- ferred from the preceding description of the symptoms. We will only remind the reader how carefully the physician should watch the behavior of the heart, since danger is apt to arise from this source, even when the case seems otherwise to be taking a favorable course. Treatment.—If we take the ground that diphtheria begins as a merely local pro- cess, then local treatment of it certainly seems rational, at least at first. Unfor- tunately, the practical result bears out the theory very imperfectly. An actual and complete destruction of the croupous exudation is but seldom possible ; and the attempt to accomplish this in a struggling child is so difficult and disagreeable that to-day most physicians have entirely abandoned the application of caustics or other substances to the throat. If it does, nevertheless, seem desirable to try ener- getic local treatment at the commencement of the disease, the best agents to choose are a concentrated solution of argentic nitrate (1-10), or a solution of corrosive sublimate (1-1000), or a mixture containing equal parts of carbolic acid and alco- hol. If the disease has already made some progress, we may well spare the patient needless torture, and consider that, by destroying the mucous membrane and by wiping off the exudation, we are likely to contribute to a further extension of the diphtheritic process. We do not, therefore, regard actual local treatment as justifiable except at the very beginning of the disease ; but we do believe that both then and at a later period it is extremely desirable to disinfect the mouth and throat as thoroughly as possible. Although this has little effect upon the diphtheria itself, it is at least a factor in preventing secondary septic infection. Adults and older children should rinse the mouth and gargle frequently, using disinfectant solutions, e. g., of potassic chlorate or carbolic acid. Inhalations and the cautious syringing of the pharynx are still better. A spray apparatus for inhalation may be employed with such patients as are not too young. If the child be young or very weak, we may at least keep up a constant spray at the bedside, so as to load the inspired air with the vapor. A five-per-cent, solution of carbolic acid is most frequently em- ployed for this purpose ; but, considering the possibility of carbolic-acid poisoning, it is a good way to substitute now and then the following solution : Acid, salicyl., parts 4 ; acid, boracic., 20; aq. destil., 1200, or a two-per-cent, solution of hyposulphite of sodium.* The best substances for direct inhalation are a one- or two-per-cent, carbolic solution, liq. calcis mixed with an equal amount of aq. destil., and a two- per-cent. solution of potassic chlorate. It is not so very difficult to syringe out the nose, mouth, and throat in almost any child by the exercise of a certain amount of * In the Leipsic surgical clinique it was formerly the custom to add to every J hiss. (100 c. c.) of this solution a teaspoonful of a twenty-per-cent, solution of lactic acid. This caused the precipitation tf sulphur in extremely minute particles.](https://iiif.wellcomecollection.org/image/b21981565_0099.jp2/full/800%2C/0/default.jpg)
