HEALTH COLUMN.

Otago Witness, Issue 2664, 5 April 1905, Page 68

HEALTH COLUMN.

Diphtheria. I. The last decade has been fruitful of groat 1 advances in medicine and surgery, and in no field has more satisfactory work been done than in tli3 study of the cause and! treatment of diphtheria. Previously a good deal was shown of the disease, although if; ie not a generatioi since it was mixed up with Other conditions under the name of "croup." Croup is really a symptom chars cterised by difficulty of breathing, acco*npanied by a hard, "&tridorous" cough— croupy cough. Then a special group wag formed of "membra aous croup," and an opposing one of "nonmembranous croup." Gradually the " membranous croup" became recognised as really a separate dir-ease called "diphtheria." These are wl'at might, appear to bo distinctions in name merely, out they marked a distinct advance in knowledge, and were not merely "academic" in character. Diphtheria was recognised as a disease in typical cases in which a dud grey membrane formed on the part attacked. It- was usually in the throat or some part of the upper air passages; but the infection of any other mucous surface, such as the eyelid or anywound, gave ris<> to the same sort of formation, and was coasideivd characteristic. It was al-=.o found that the dull, grey membrane wis not merely a surface growth — Euch as the white fungous growth of "thrush" — but was formed by the death of the tissue of the surface affected. It was known, too, that the disease is infectious, and that it might be present in oases where no membrane could be found. These latter cases were a graat source of difficulty, for although when seen they could not be definitely said to be- diphtheria, it was found that such cases could spread the disease, and set yp disease in others which was accompanied by membrane and caused death. When this did not occur, too, mild cases coul I be sometimes definitely said io to diphtheria after the throat rad becomo well, because the patient migho s.iffer from "diphtheritic paralysis" about six weeks after the slight sore throat; ex* others who came into contact with the patient might suffer in this way, and the presence of this paralysis was just as sure a .guide to the nature of the disease as if the characteristic membrane had appeared at first. It was all very interesting, but it did not help to set us on our guard to limit the spread oi the disease; and, since it is very deadly when left alone, it was highly unsatisfactory. Epidemics were found to occur in districts which were frequently put down to defective drainage, and led to certain parts having a bad name. The scientific work of the past 15 years ha-3, however, revealed to us the true nature of the disease, and, as we shall see presently, we now understand it more completely than almost any other disease. It is due to a bacillus, which grows in the> membrane in tho throat or other part. The virulence of the irritation causes the tissues at the part to die, and this dead film of tissue forms the membrane. This membrane is crowded with bacteria, which secrete virulent poison to be absorbed into the blood, but they do not enter the blood themselves.

In a scientific aspect diphtheria is caused by a bacillus which is conveyed in the breath from the diseased to the healthy. It attacks the mucous membrane of the throat most usually, but it may attactk the nose or larynx, and spread its influence both upwards and downwards. In its growth the bacillus produces virulent poisons, which destioy the tissue in their immediate vicinity. In this way the "false membrane" is formed. It is really a superficial slough, or dead surface of the tissue, and in tho moshes of the destroyed tissue the bacilli thrive actively and produce more poison. The poison is absorbed into the body, and produces the effects of the disease — a feeling of illness, tiredness, etc., gradually passing into a febrile condition, and even delirium in the more severe cases. If the membrane formed' as we saw spreads _ upwards or downwards, and covers a- considerable area, the condition of the patient is apt to be more serious, because the amount of poison produced by the bacilli living and growing in the more extensive membrane and absorbed into the blood is correspondingly larger ; but, besides this, the membrane itself may block up the air passai^es and produce difficulty of breathing. Occasionally the membrane blocks up the larynx and trachea, and it may even spread downwards along the air passages till it reaches the very smallest tubes, which can only contain a piece the thickness of a cotton thread. Such cases demand relief by tracheotomy; but in the more severe casea, wlero the disease has spread beyond the trachea (windpipe), they are well-nigh hopeless, and although the immediate difficulty of breathing is overcome, the general poisoning ie so severe that they are apt to succumb to this cause, and die of heart failure.

We shall see when we discuss up-to-date fL-ealment that it is of the utmost importance that the nature of the disease should be recognised early, in order that the treatment may be most likely to be successful. This early recognition demands that a doctor's attention be called to the case whenever it arises ; and when typical false membrane is present the diagnosis is easy ; but there are not a few cases where no grey membrane is visible, and yet the diseasemay be true diphtheria, and of serious consequence to tho sufferer and to the friends who come into contact. In suspicious cases a swab from the throat should be> examined baoterioloajically, and if diplrtheria bacilli are found the case must be treated as diphtheria, whether "false membrane" appears or not. If a group of cases occurs in the same family, great differencesmay be seen in the appearance and in the severity of the illness, although all are produced from, the sania cause. — Liverpool Mercury.