Title: Diphtheria - how to recognize the disease, how to keep from catching - it, how to treat those who do catch it
Author: United States. Public Health Service
Language: English
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            Diphtheria


HOW TO RECOGNIZE THE DISEASE
  HOW TO KEEP FROM CATCHING IT
    HOW TO TREAT THOSE WHO DO CATCH IT


       KEEP WELL SERIES No. 4


        [Illustration: logo]


       TREASURY DEPARTMENT
UNITED STATES PUBLIC HEALTH SERVICE
             1919


                 GOVERNMENT PRINTING OFFICE



Diphtheria


After babyhood has passed, beware of diphtheria. Of all the deaths of
children 3 and 4 years of age, more than one-seventh are caused by
diphtheria.

Diphtheria is preventable and, when properly treated with antitoxin, is
curable. Most of the children who die from diphtheria really lose their
lives because of the ignorance and carelessness of their parents.

Diphtheria is a disease most often occurring in children and resembling
a sore throat or tonsillitis. It is caused by a small germ called the
diphtheria bacillus. The disease may resemble:

_A very mild sore throat_, the tonsils and back of the mouth being
redder than usual, and the person not feeling ill.

It may look like a _more severe sore throat_ or tonsillitis with a white
or grayish patch, called a membrane, on the tonsils. There may be only
one or a few small distinct patches, and the throat may feel somewhat
sore. The glands in the neck, below the tonsils, may be slightly
enlarged and may feel about the size of small peas. The patient may feel
rather ill.

Or the disease may be like a _very severe sore throat_, with small or
large gray or white patches. Not only the tonsils but also the uvula,
the small rounded end of the palate which hangs down between the
tonsils, may have on it white or gray patches. (If there is a membrane
on the uvula, the disease is almost certainly diphtheria.) With such a
throat the person feels very sick. Not only does the throat hurt, but
there are usually aches in the back of the neck and in the muscles
generally. The glands in the neck may be quite large and feel painful
when touched. The soreness in the throat may extend down the windpipe,
and membranes may form there. The patient is feverish and often is
delirious. The fever, however, is not necessarily high.

In some cases the membranes may form in the larynx (Adam's apple). When
this is the case the patient's voice sounds hoarse and croupy, and the
child may breathe with difficulty. In small children it is not uncommon,
if such cases remain untreated, for this membrane to choke the patient.
Therefore, in all cases of croup, send for a doctor immediately.


THROAT CULTURES.

In order to prevent the spread of diphtheria to others it is important
always to recognize the presence of the disease, even in mild cases. In
order to do this the doctor makes a culture from the throat and nose of
the suspected individual. He takes a piece of sterile cotton wrapped
around the end of a thin stick of wire and touches this to the throat
and tonsils, especially where there are patches or membranes. Then he
sends this swab to a laboratory, where cultures are planted from it. The
next day these cultures are examined with a microscope to see if
diphtheria bacilli, the germs which cause diphtheria, are present.

Since the diphtheria germs or bacilli grow on the lining of the throat
and air passages, they are easily thrown out from the mouth and nose of
the patient with particles of mucus or spit when the patient coughs,
spits, or sneezes. But even when the patient talks, especially when he
talks loudly, tiny droplets of mucus or spit are given off. These
droplets may have diphtheria bacilli on them. The same is true of
particles of food, no matter how small, falling from the patient's lips.
Eating utensils such as cups, glasses, forks, and spoons that have
touched the lips of the patient may likewise have saliva on them. When
the patient has diphtheria all these droplets of saliva and of mucus
may, and usually do, contain many diphtheria bacilli. Curiously, some
persons may have diphtheria bacilli in the nose and throat and yet
remain entirely well. Such persons are called "healthy carriers." They
are especially dangerous, because there is no outward sign which will
tell them or others that they are carrying deadly disease germs around.

All who attend the patient must be very careful not to get any of the
dangerous discharges from the patient's mouth or nose on the hands. In
fact, it is important for the attendant always to wash her hands
promptly after waiting on the patient. Besides this, care should be
taken that the germs are not carried to others by the use of eating
utensils, such as cups, glasses, spoons, forks, or plates. All of these
should be sterilized with _boiling_ water after each meal.


ANTITOXIN TREATMENT.

Depending on the way it is treated, diphtheria is one of the least
dangerous or one of the most dangerous diseases. It is one of the least
dangerous when promptly treated with antitoxin; it is one of the most
dangerous when the antitoxin treatment is not given, or is delayed or
insufficient. In the days before we had antitoxin one out of every three
children who had diphtheria died. Now, if antitoxin is used on the first
or second day of the disease ninety-eight out of every hundred children
recover. The sooner diphtheria is attended to the more certain is a
cure.

In severe cases suspected to be diphtheria the doctor always gives
diphtheria antitoxin at once. This is a wise thing to do, because the
disease goes on rapidly and a delay of 12 or 24 hours may be fatal.
Besides, no harm is done, even if the disease proves not to be
diphtheria. The antitoxin, although making some people uncomfortable for
a day or two, never does any real harm. Whenever antitoxin is given to a
person ill with diphtheria it should be given in _one dose, large enough
and early enough_.


TEMPORARY PROTECTION WITH ANTITOXIN.

Diphtheria is very contagious, and many people, especially children, can
catch it. For this reason, whenever a case of diphtheria is discovered,
the doctor injects the antitoxin not only into the patient, but also, as
a protective against the disease, into those who have come into contact
with the patient. This is spoken of as "immunizing" these individuals.
The immunizing dose is not so large as the curative dose given to the
patient, but it is usually sufficient to protect those exposed to
diphtheria for a month from the time of injection. At the end of that
time the protection disappears.


THE SCHICK TEST.

A few years ago a very simple test was discovered to tell whether a
person could or could not catch diphtheria. This is known as the Schick
test. It consists in injecting a few drops of a prepared diphtheria
toxin into the skin and then watching whether a characteristic red spot
appears where the injection was made. If such a spot does not appear
within two or three days it shows that the person can not catch
diphtheria.


LASTING PROTECTION BY DIPHTHERIA VACCINATION.

For those in whom the characteristic redness appears, and who are
therefore known to be liable to catch diphtheria, doctors now advise a
course of protective injections similar to those which have proven so
successful against typhoid fever. This protective treatment consists of
three small injections, a week apart. There is no sore, as there is in
smallpox vaccination, and the injections are harmless. The protection
lasts for years, and perhaps even for life.

Why not have the doctor make a Schick test on your child, and if this
shows the lack of protection against diphtheria have him give the three
protective injections?


PERSONAL AND BEDSIDE HYGIENE.

1. (_a_) All discharges from the nose and mouth should be gathered in
soft, clean cloths or rags or papers and destroyed by burning. (_b_) The
patient should cover the mouth and nose when coughing or sneezing, for a
cough or sneeze will throw droplets of mucus to a distance of 10 or 12
feet.

2. The attendant should wear a washable gown that completely covers her
clothing. It should be put on when entering the room of the patient and
taken off immediately on leaving it.

3. A basin of water, together with a cake of castile soap (or where
possible an antiseptic solution), should be placed in a convenient
place, so that the doctor and nurse attending the patient may wash their
hands whenever leaving the room, and even _before_ touching the door
handle.

4. All eating utensils that the patient uses should be washed in boiling
hot water separately from other dishes and used exclusively by the
patient.

5. All bedclothes and bedding should be boiled in soap and water, or
they should be exposed to the sunshine. _Direct sunshine kills disease
germs._

6. The person attending the patient should wear a double layer of gauze
or other soft thin cloth across the mouth and nose as a _face mask_
whenever near the patient so as to prevent the droplets containing the
germs coming from the patient's mouth from entering and lodging on the
lining of the mouth or throat of the attendant. _Always remember that
even though you may not get the disease if the germs lodge in your
throat they may grow there and you may carry the disease to another
person who may catch it._

7. There should be but one attendant wherever possible.

8. No visitors should be permitted in the sick room--not even during
convalescence.

9. The one who attends the sick should not prepare or handle the food of
others. Sometimes it is impossible to take this precaution, as very
often it is the mother who must take care of the patient, cook, and do
all the housework. In such cases the one attending the sick must _never
neglect_ whenever near the patient--

      (1) To wear a face mask.

      (2) To wear a washable gown (which is to be taken off on leaving
      the room).

      (3) To wash her hands when leaving the sick room.

_Every attendant on the sick should know how disease germs are carried
from the sick to the well. This knowledge should make her more careful,
and thus help to prevent the spread of the disease._

[Illustration: logo]



For other instructive Health Leaflets
write to the--

              UNITED STATES
              PUBLIC HEALTH SERVICE
              WASHINGTON, D. C.

[Illustration: medical symbol]


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