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.
97/1284 page 69
![that is definite is known, however, as to the precise chemical nature of these toxines. We may accept it as a fact that the diphtheria bacilli or their spores reach the pharyngeal cavity directly through the inspired air or in some other way, and there, in case they attach themselves to the mucous membrane and increase,, produce diphtheria. In a few rare cases they seem to be inhaled into the larynx at once, and to excite there a primary laryngeal croup (vide infra). The source of the infection is always to be referred ultimately to another case of diphtheria, but the way in which the disease spreads can not always be traced in detail. In many cases, of course, a direct ( contagious ) transmission of the poison is evident, as from coughing, or the many cases of the disease in physi- cians and nurses from sucking the croupous membrane out of the tracheotomy tube in children, etc. If several children in one house fall sick, as often hap- pens, we may here suspect a direct transmission of the disease, although it is also possible that in such an event several cases may arise from the same source of infection. We do not yet know positively how far the diphtheria bacilli can lead an independent existence outside of the human body (the earth, the floors of dwellings, etc.). It seems certain that the infection can be carried from one person to another by some intermediary, by clothing, linen, toys, and other objects to which the diphtheria poison clings. The resistance of the latter to external in- fluences—temperature, drying, etc.—is very considerable. After complete recov- ery from diphtheria, virulent diphtheria bacilli may be found in the oral cavity for a considerable time. This is particularly to be noted on account of its prac- tical importance. We must mention, in conclusion, that attention has lately been called to the possibility of the transmission of diphtheria from sick animals (hens, doves, calves, [cats]) to man, since diseases resembling diphtheria undoubt- edly occur in the domestic animals mentioned. Diphtheria, as is well known, is a disease chiefly of childhood, but some cases, and even very severe ones, may occur in adults. In advanced life the dis- ease is very rarely seen. In large cities sporadic cases occur from time to time, but the disease often takes on an epidemic character. At such times some places appear to be much more subject to the disease than others. [While it seems in the highest degree probable that the poison is usually purely local at the start, cases occur which suggest that constitutional infection through the pulmonary blood-vessels may precede the local manifestations. Infection through the alimentary canal is not probable, though its occurrence can not be positively denied. There are still points in the etiology and pathology of this affection which are involved in obscurity. Much has been said and written in this country and in England about the relations of filth and diphtheria. That filthy surroundings contribute a soil favorable to the development of the poison, and at the same time diminish the resisting power of the human organism, can not be doubted; but, as long as the parasitic theory of infectious diseases prevails, sewer-gas and the like must be classed among the predisposing or accessory causes. Some of the frightfully virulent epidemics of diphtheria in sparsely settled country districts and on the Western plains are difiicult to explain under the theory that each case is mediately or immediately the result of a previous case; these difficulties will, however, doubtless be cleared away in time.] Clinical History.—The incubation is rather brief, seldom exceeding two to five days. The disease itself almost always begins with general malaise, headache, fever, and pain on swallowing. Little children, however, often do not complain of this last symptom, and in older children the sore throat may not be very troublesome at first. It is therefore a very important rule for the physician to examine the throat carefully in every child who presents ill-defined general symp-](https://iiif.wellcomecollection.org/image/b21206296_0097.jp2/full/800%2C/0/default.jpg)
