HEALTH NOTES

Southland Times, Issue 21428, 24 June 1931, Page 2

HEALTH NOTES

DIPHTHERIA. HOW IT CAN BE PREVENTED. (Contributed by the Department of Health.) Diphtheria is an infectious disease caused by a bacillus or germ which, finding lodgment generally in the throat or nose of a susceptible person, rapidly multiplies producing a greyish membrane and a poison or toxin which is absorbed into the blood. Diphtheria is justly regarded as one of the most dreaded diseases of childhood, and in earlier years its appearance in the community brought terror. There are now few diseases concerning which we know as much or which we can attempt to prevent and control more hopefully. Yet even today diphtheria takes a serious toll of the population. Thus in New Zealand for the last five years there has been 8148 cases of diphtheria with 346 deaths. Though present in the community the whole year round it is more common in the winter months. It occurs more frequently among children than among adults, children under five years of age being most readily affected.

The chief difficulty in the prevention of diphtheria is the number of healthy people harbouring bacilli in their throats (estimated in the winter season at more than one per cent, of the population). It is manifestly impossible to detect and isolate all such germ carriers. A susceptible person, especially a child, coming into association wtih a carrier is likely to fall a victim to diphtheria. The . germs enter the body through the mouth or nose. They may be transferred by kissing, or by receiving the mouth spray thrown out in coughing, sneezing and talking, or they may be carried to the lips by the use of a common drinking cup or other utensil or by fingers soiled by touching some object which an affected person has jirst touched with fingers soiled from his own lips or his infected handkerchief. It is very difficult for a person who has these germs in his mouth to avoid contaminating his fingers with them. Sometimes those who work in dairies are “carriers” or have the disease. They may sneeze or cough into the milk pail or the fingers of the milker may transfer the germs to the milk and thus cause an epidemic of diphtheria. Hence the need for extreme care in handling milk, not only in its production and distribution but also in the home. Symptoms and Course of the Disease. Since the usual sites of the disease are the tonsils and throat, the most characteristic early symptoms are sore throat, rapid pulse and fever followed by the formation of a membrane' spreading over the throat. These early symptoms may resemble those of a common cold or of simple tonsillitis so that an apparently trivial illness may be the beginning of diphtheria and no time should be lost in calling medical advice. Where the disease attacks the windpipe or larynx the greatest danger is that the membrane formed may block the air passages and choke the victim. The operation of tracheotomy (i.e., the introduction of a tube into the windpipe) may be necessary in order to prevent suffocation. The delay of an hour in obtaining treatment may determine a fatal result. As the site of the disease is not invariably the throat, the absence of membrane on the throat does not eliminate the possibility of diphtheria and hence in any doubtful case, especially if diphtheria is prevalent, .medical advice should be obtained early. Another danger in diphtheria is on account of the toxin or poison formed by the diphtheria germs in the body, -which circulating to every part has the power of destroying certain tissues, especially nerve tissues and heart muscle. In defence the body forms a protective substance, anti-toxin, to neutralize the effect of the toxin. The severity of an attack of diphtheria and its ultimate conclusion depend on b ow successful is the fight of anti-toxin against the germ toxin. In fatal cases collapse and sudden death may occur when the patient is apparently well, on the way to recovery. It is now possible, however, to reinforce the antitoxin made in the body of the patient by introducing supplies of anti-toxin manufactured without, and thus aid him in his struggle against the disease. The issue is often determined by how soon this reinforcing dose of anti-toxin is given to the patient. Were it possible to apply this remedy in sufficient doses and early enough in all cases, mortality from diphtheria would almost vanish. As it is !he disease has been robbed of much of its former terror.

There are few diseases where early treatment is so fraught with hope as in diphtheria. There is no disease in which early diagnosis and prompt treatment are more essential. If your child or other member of the family is sick with a sore, throat call in your doctor. If it looks like diphtheria the doctor will administer anti-toxin, take a culture from the throat and isolate the patient. Do not insist on waiting for a culture if the doctor advises anti-toxin. Delay is dangerous.

Prevention. Anti-toxin is also used as a preventive, being given to contacts (people who have been exposed to infection) as a protection. Unfortunately, the protection from inoculation with anti toxin lasts only from two to three weeks and at the end of that time the individual is again susceptible to the disease. Fortunately, it is now possible, however, to protect from diphtheria in the same way as vaccination protects against smallpox. This may be done by giving him an injection of a vaccine (e.g. toxin antitoxin) at weekly intervals for three weeks which confers with few exceptions practically an immunity to diphtheria. Thousands of children every year in England and America receive this treatment with the effect that the incidence of diphtheria is greatly lessened thereby. Health News, of the New York State Department, states: “Although the goal ‘No diphtheria by 1930’ was not reached the results have proved beyond doubt that diphtheria can be controlled. Some idea of the value of diphtheria prevention work to the State as a whole may be gained from the fact, that there were 23,326 fewer cases of diphtheria and 1,484 fewer deaths during 1926-30 than in the five-year period 1921-25 preceding the toxin anti-toxin campaign. In the State, exclusive of New Y'ork City, deaths from the disease decreased from 337 "in 1925 to 144 in 1930, while the number of cases dropped from 4,370 to 1,594. The diphtheria death rate has decreased from an average of 10.1 per 100,000 population for the period 1921-25 to 3.8 for the years 1926-30 during which approximately three-quarters of a million children were immunized against diphtheria with toxin anti-toxin. Of this number over 185,000 were under five, the age group most susceptible to the disease and most likely to die from it.”

In New Zealand approximately some 11,000 children have been so treated with beneficial results. It is felt right that this means of defence should be made widely available. Parents should understand that preventive treatment for diphtheria is a most valuable safeguard. It may be carried out by the family medical practitioner. Where this arrangement is not practicable and parents wish to secure immunity against diphtheria for their children, they are advised to apply to the local Medical Officer of Health or the School Medical Officer for the district when arrangements will be made to have preventive treatment carried out free of charge. The doctor and medical officer of health are required by law to perform certain duties for the protection of the community, and it is the duty of parents to comply with these requirements. The period of exclusion from school of children suffering from diphtheria as laid down by regulation, is for at least three weeks from the date of onset of the disease and until a certificate is furnished by the medical attendant that the period of isolation prescribed has been completed.' The

period of exclusion from school of children exposed to infection (contacts) is (1) if patient treat at home, until disinfection of house has been carried out; (2) if patient removed to hospital, until seven days after disinfection of house subsequent to removal; (3) in either case, until a certificate of clearance has been received from an inspector of health. Once more, in conclusion, remember that when a child has a sore throat, call in a doctor at once. Delay is dangerous. Many lives have been lost by failure to follow this advice.