Diseases of the nose and throat, comprising affections of the trachea and oesophagus / by Sir St. Clair Thomson.

Thomson, St. Clair, 1859-1943

Date:: 1912

Credit: Diseases of the nose and throat, comprising affections of the trachea and oesophagus / by Sir St. Clair Thomson. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

754/866 page 684

$hydrochloric acid on to 9 gr. (o'6 c.c.) of powdered chlorate of potash, and shaking up with an ounce (30 c.c.) of water gradually added. This is mixed with an equal quantity of hot water, and used for syringing the throat every two to four hours. General treatment.—The patient is kept in bed, in a freely ventilated room, carefully isolated, with the usual precautions against spreading infection, and fed according to the symptoms. If there is any irregularity of the pulse, or sign of heart-failure, absolute rest is strictly enforced and all causes of strain are care- fully guarded against. In all cases, rest in bed should be continued for. three weeks, and longer if there is any irregularity of pulse. Alcohol, strychnine, and digitahs are held in reserve for collapse,, and those cases where cardiac failure persists or is due to strain. Vomiting is met by rectal feeding. .Paralysis calls for absolute rest. When the pharyngeal muscles are affected, fluid nourishment should be thickened and swallowed slowly, or given through a nasal tube or per rectum. ]\Iassage and electricity are helpful to restore the tone of the muscles. Prophylaxis.—Referring to the section on etiology, it is evident that precautions should be taken in regard to sanitation, milk, and contact with suspected individuals or animals. A prophylactic injection of antitoxic serum is recommended in. large families and schools, should an outbreak occur. The dose gener- ally recommended is 2,000 units, but the Lister Institute suggest? 250 units, i.e. i c.c. of their antitoxin. The infectivity of the aural and nasal discharges must not br; forgotten. This is a point somewhat neglected. Isolation should not be relaxed until swabs from the nose and throat taken on successive days show the absence of true diphtheria bacilli. All contacts with diphtheritic cases should be swabbed before being allowed to mix with the general population. The Hoffmann pseudo-diphtheria bacillus may be disregarded. The bacilU are apt to persist in the throat of a convalescent for eight to twenty-four days after the disappearance of the exudation. In a fair number of cases they are found to persist for six weeks, in some cases eight weeks, and in exceptional instances for as long as three months after the attack. The longest time on record is 363 days. The presence of adenoids appears to be often responsible for undue persistence of the diphtheria bacillus. But tlrese growths should not be operated on before the naso-pharj-nx is free from bacilli. To curtail the period of potential infectivity of people harbouring diphtheria bacilli in their throats, the usual sprays, gargles, and paints are useless. The fauces should be well syringed three or four times a day with chlorine solution (p. 55). This strong solution cannot be employed in the nose, where we must be content with the ordinary warm alkaline lotions (p. 51). Open air and freely ventilated and well-lighted rooms will shorten the period of quarantine. Tonsils, if present, should be enucleated, and adenoids should be removed. The injection of antitoxin does not hasten the disappearance of$