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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![involved that we encounter great swelling of the glands at the angles of the jaw. There is also apt to be a thin, acrid, bloody, or sero-purulent discharge. Jacobi states 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 dubious prognosis of true diphtheria 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 mem- ories. 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 process extends into the larynx, or the symptoms of a severe constitutional in- fection occur, the prognosis must be regarded as very serious. Only recently, however, since the introduction of the serum treatment, has the prognosis even of severe diphtheria become considerably more favorable. Formerly, before the serum treatment, it was regarded as a relatively favorable result if one half of the children with diphtheria in the hospitals, on whom tracheotomy was done, re- covered ! Sixty or seventy per cent, of the children operated on often died. At present, however, the mortality of the tracheotomy cases, treated at the same time with serum, has fallen to about twenty-five per cent., and these are only the severe cases in which the serum treatment was begun late. The improved prog- nosis under the serum treatment appears much more favorable if we compare the whole number of cases and the death-rate of diphtheria before and after the in- troduction of this treatment (Heubner, Widerhofer, Baginsky, etc.). In general, diphtheria is to be regarded as the more serious the younger the child is. In later childhood, after the eighth or tenth year, the number of dan- gerous cases is much less. The description of the symptoms shows sufficiently what the dangers of the disease are, and how they are to be recognized. We would state once more that, even in apparently mild cases, the danger of sudden paralysis of the heart, though fortunately rare, always demands the greatest caution. Treatment.—Up to a short time ago it was impossible to say anything in re- gard to any generally recognized treatment of diphtheria which was really effect- ive, but very recently a method of treatment has been discovered, chiefly by the important and interesting investigations of Behring and Roux, which de- serves to be called an actual specific. If further observations confirm the pres- ent results, this treatment is one of the most brilliant and triumphant medical acquisitions. Behring found, in continuing the important discoveries of Pasteur, Buchner, and others, that certain protective matter ( antitoxine ) was formed in the blood-serum of those animals (sheep, goats, horses, etc.) which had been infected with artificially weakened cultures of diphtheria bacilli. If the animal survive the milder infection, it is less sensitive to a severer infection, and, finally, by continued inoculation, it may even become completely immune to the severest in- fection. The blood-serum of such immune animals can now be used in the treat- ment of diphtheria in man. The treatment is simple, and consists in injecting the serum under the skin of the child who has diphtheria by means of a carefully disinfected syringe. The best places for injection are the anterior chest wall or the thigh. Since the amount of serum to be injected is usually about five cubic centimetres, we should use a special syringe which is not too small. The best are made like a Pravaz syringe with an asbestos packing. It is to be understood that the injections must be made with the strictest aseptic precautions. There are three different preparations of serum in the market, varying according to the](https://iiif.wellcomecollection.org/image/b21206296_0102.jp2/full/800%2C/0/default.jpg)
