A text-book of medicine for students and practitioners / by Adolf Strümpell ; With editorial notes by Frederick C. Shattuck.
- Adolph Strümpell
- Date:
- 1901
Licence: Public Domain Mark
Credit: A text-book of medicine for students and practitioners / by Adolf Strümpell ; With editorial notes by Frederick C. Shattuck. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![and extremities is least frequent, but it may be very extensive. Sometimes sev- eral of these parts are paralyzed simultaneously. Thus we see quite often paral- ysis of the soft palate and of the rauscles of accommodation combined. In some cases there is well-marked ataxia of the lower limbs with or without paresis. This renders the gait very uncertain and tottering, the tendon reflex is almost always abolished, while sensation is affected slightly if at all. Very rarely diph- theria is followed by contracture of the hands or other parts, by difficulty in artic- ulation and paresis of the bladder. A paralysis of the pharynx is sometimes left behind, so that the children have to be fed for weeks through an o3Sophageal tube. It is a remarkable fact that not only in almost every case of the nervous dis- orders which we have mentioned, but often also in individuals who have entirely escaped them, there may be no patellar reflex after diphtheria for weeks or even months. With regard to the pathological state, it is probably a degenerative con- dition of the corresponding peripheral nerves, not only in the post-diphtheritic paralysis, bvit also in the cases of post-diphtheritic ataxia (see the chapter on mul- tiple neuritis). These degenerations are probably due to the poisonous chemical action of certain toxines which are produced directly by the vital processes of the diphtheria bacilli. It is therefore of great interest to note that paralysis has been produced experimentally in animals by the action of diphtheritic toxine by Roux and Yersin and others. The prognosis of all the nervous sequelae of diph- theria is very favorable, and even in severe cases complete recovery usually takes place in the course of a few weeks or months. This is in harmony with the periph- eral nature of the disease. But there is one paralysis which is highly dangerous— that of the heart, as already mentioned. It may occur suddenly during convales- cence. Probably it is analogous to the other nervous derangements, and the result of degeneration in the [nuclei or] fibers of the pneumogastric. Diag'nosis.—The physician will seldom fail to recognize a case of actual diph- theria if he pays proper attention. The characteristic patches and the severe gen- eral and local symptoms make the diagnosis certain. It is much more common to mistake other forms of sore throat, particularly in adults, for diphtheria. The most deceptive are follicular and necrotic tonsillitis {vide infra). We must not suppose that every white spot upon the tonsils is diphtheritic, and we must speak of diphtheria only when there is an actual croupous inflammation in the phar- ynx with a true membranous deposit. The practiced eye can usually distinguish at the first glance the plugs of pus limited to the follicles of the tonsils, which are usually multiple, and also the slight and superficial necrosis of mucous membrane limited to the tonsils in necrotic angina. Of late, it has often been proved by bacteriological examination that in these tonsillar affections there are no diph- theria bacilli, and that they therefore are not true diphtheria. We must add, however, that there are light forms of true diphtheria in which the pathological changes assume a milder form, resembling the tonsillar affections just mentioned. In such cases we are therefore certainly justified, especially in dealing with children, in bearing in mind the necessary precautions, but in our opinion the physician should never alarm the family by the justly dreaded word diphtheria without sufficient reason. An absolutely definite diagnosis between diphtheria and the other tonsillar diseases can be made only by bacteriological examination. This is at present still too difficult a matter in diphtheria to be within the scope of every physician, but the constantly increasing number of good bacteriological laboratories renders it possible for almost every physician to obtain bacteriological examination of the suspected deposit in doubtful or important cases. An experienced clinician can usually make a correct diagnosis and prognosis even without a culture. [When the membranes are confined to the nose, the diagnosis may be more or less difficult; but it is especially in cases in which the nasal mucous membrane is](https://iiif.wellcomecollection.org/image/b21206296_0101.jp2/full/800%2C/0/default.jpg)
