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[Ill.u.s.tration: Diphtheria (view of infected throat)]
LARYNGEAL DIPHTHERIA, Formerly Called Membranous Croup.--Diphtheria in the larynx may occur alone or with the pharyngeal kind, and was formerly called "Membranous Croup." After several days of hoa.r.s.eness and coughing the breathing suddenly becomes hard, generally at night, and it is at first in paroxysms, but later it is constant. The s.p.a.ce above the breast bone (sternum) is depressed and there is a drawing in of the s.p.a.ces between the ribs during inspiration accompanied with a husky voice and blue look. The fever is slight. If the obstruction in the larynx is severe the cyanosis,--blueness,--and difficulty of breathing increase, and gradual suffocation leads to (coma) deep sleep and death.
Diagnosis.--Diagnosis can only be made certain by proper chemical tests.
The presence of membrane on a tonsil and a small patch streak, or speck of membrane, on the adjacent surface of the uvula or tip of the uvula; a patch of membrane on the tonsil and an accompanying patch on the posterior wall of the pharynx; the presence of a croupy cough and harsh breathing with small patches of membrane on the tonsil or epiglottis. These symptoms are very suspicious and warrant separation of the patient. If such conditions are seen in any one, it will be the part of prudence to send for your doctor immediately. You give the patient a better chance by sending early, protect yourselves and also your neighbors.
Recovery.--Chances in mild cases are good. Ant.i.toxin has brought the death rate down from forty to twelve per cent. Death may occur from sudden heart failure, obstruction in the pharynx, severe infection, complications or paralysis.
MOTHERS' REMEDIES.--Diphtheria is such a dangerous disease and so rapidly fatal that the family physician should be promptly called. Until he arrives the following may be used to give some relief:
2. Diphtheria, Kerosene Good for.--"Kerosene oil applied to the throat of child or adult is very good."
3. Diphtheria, Hops and Hot Water Relieves.--"Make two flannel bags and fill with hops which have been moistened with hot water; place bags in a steamer and heat. Keep one bag hot and the other around the throat. Change often, relief in short time." Mrs. Shaw has tried this in a case of diphtheria and other throat trouble and recommends it as an excellent remedy.
[186 MOTHERS' REMEDIES]
PHYSICIANS' TREATMENT for Diphtheria. Prevention.--The patient should be isolated as soon as the spots or membrane are seen. Other children who have been with the sick one should at once be given "immunizing" doses of ant.i.toxin, and the furniture of the sick room such as hangings, carpets.
rugs, etc., should be removed and disinfected, only the necessary articles being kept in the room. The room should be kept well ventilated, but no draught should get to the patient. The one nursing the patient should not come near the other members of the family. All articles of clothing worn by the patient should be dipped in a 1 to 2000 solution of corrosive sublimate before they are removed from the sick room. (Other solutions may be used; see Nursing Department). Dishes, etc., should be treated in the same way and foods left over should be put in a vessel containing an antiseptic solution, and then burned. Everyone going into the sick room should cover their head with a cap and wear a robe-covering over their clothes, and on leaving the room should gargle or rinse their mouth with a solution of boric acid, about one or two teaspoonfuls to a gla.s.s of water, The infant should not be nursed at the breast lest the breast become infected; the milk should be pumped out and fed to the infant with a bottle. If the infant has diarrhea milk must be stopped, the bowels irrigated, and no milk given until all danger from this source is past.
The nurse must be careful of the discharges from the nose, mouth and bowels. Discharges from the bowels and the urine must be received in a vessel with an antiseptic solution in it like copperas, lime, etc. Cloths used to receive the discharge from the nose and mouth should be thrown in a vessel containing a solution of 1 to 2000 of corrosive sublimate and then burned. The nurse should wear a gauze protection over her nose and mouth when she is near the patient, and gla.s.ses, so that no sputum or discharge from the patient can enter these organs. When the nurse leaves the sick room for a rest or walk, she should change her clothes in an unused room and put them where they can air, wash her hands, face and hair in an antiseptic solution. Great care must be taken by the nurse, or she will carry the disease. The doctor also must take the same care.
PHYSICIANS' MEDICAL TREATMENT.--Ant.i.toxin is the best. 1/100 grain of corrosive sublimate or more according to age is frequently given in the severe cases and is beneficial.
Local Treatment.--In older persons, inhaling steam may benefit. Gargling the throat or spraying the nose and throat is cleansing and helpful; but in children it is sometimes hard to do this, for they may struggle and thus injure and weaken themselves more than they can be benefited by the spraying or gargling. Swab the throat if you can with solution of corrosive sublimate, 1 to 1000. Peroxide of hydrogen, one-sixth to one- half to full strength, is good in many cases, used as a gargle and a swab.
Wash out the nose with a normal salt solution. One dram to a pint of water. The persons doing this must take great care or the patient will cough and the discharge will go over them.
When in the Larynx.--Steam inhalations without or with medicine in them and the application of cold or hot to the neck are good. Compound tincture of benzoin is good to use in the water for steaming; one-half to one tablespoonful to a quart of water. A tent can be made by putting a sheet over the four posts of the bed and steam vapor introduced under this covering.
Diet.--The main food is milk, alb.u.min water, broths, eggs given every two hours. Some doctors give stimulants with the food.
[INFECTIOUS DISEASES 187]
Cautions.--Members of the family have no idea how much they can aid the physician in this terrible disease. Pay particular attention to the directions the doctor gives you, if you are doing the nursing, watch so that you may detect any bad symptom, and immediately inform the physician.
A harsh cough with increased difficulty in breathing may mean that the disease has extended to the larynx. If such symptoms are first noticed in the physician's absence, he should be sent for at once so he can treat it properly at the start. If the kidneys do not act properly he should be informed. One may take nephritis in diphtheria also. I was called one morning at 3 a. m., to see a case I was attending; she seemed to the parents to be worse; she was, but today she is living, and I believe her life was really saved by her parents. I would rather a loving mother and father nurse a case any time than a selfish, lazy professional nurse. Good nurses are a blessing; selfish ones are a curse; I have met both kinds.
After an attack of this disease the patient is left "weak" in many organs.
He should be careful, not only of taking cold, but of over-doing. The heart and nervous system in some cases have been terribly wrecked. Take life easy for some time, for you may be thankful that you are alive.
ACUTE TONSILITIS. (Follicular Inflammation of the Tonsils). Causes.-- Authors regard this as an infectious disease. It is met with more frequently in the young; infants may take it. Some authors state it can be communicated either through the secretions or by direct contact, as in the act of kissing (Koplik). It is frequent in children from the second to the fourth year, but it is more common after than before the fourth year. s.e.x has no influence. In this country it is more common in the spring. The predisposing causes are exposure to wet and cold and bad hygienic surroundings. One attack renders a person more susceptible. It spreads through a family in such a way that it must be regarded as contagious. The small openings (Lacunae) of the tonsils become filled with products which form cheesy-looking ma.s.ses, projecting from the openings of the (Crypts) hidden sacs. These frequently join together, the intervening tissue is usually swollen, deep red in color and sometimes a membrane forms on it in which case it may look like diphtheria.
[188 MOTHERS' REMEDIES]
Symptoms.--Chilly feelings or even a chill and aching pains in the back and limbs may precede the onset. The fever rises rapidly and in the young child may reach 105 degrees in the evening of the first day. The infant is restless, peevish and wakeful at night; it breathes rapidly, and there is high fever and great weakness. Nursing is difficult, not only on account of the pain in swallowing, but because in the majority of cases there is more or less inflammation of the nose. The bowels are disturbed as a result of swallowing infectious secretions from the mouth with the food.
The tonsils are enlarged and studded with whitish or yellowish white points. The glands at the angle of the jaws may be enlarged. In older children the tonsils are enlarged and the crypts plugged with a creamy deposit. The surface is covered with a deposit and the pillars of the fauces, uvula and pharynx may all be inflamed. The tongue is coated, the breath is bad, the urine high colored, swallowing is painful; the pain frequently runs to the ear and the voice sounds nasal, as if one had mush in his mouth when talking. In severe cases the symptoms all increase, and the parts become very much swollen. Then the inflammation gradually subsides, and in a week, as a rule, the fever is gone and the local conditions have greatly improved. The tonsils, though, remain somewhat swollen. The weakness and general symptoms are often greater than one would suppose. The trouble may also extend to the middle ear through the eustachian tubes.
Diagnosis Between Acute Tonsilitis and Diphtheria.--Follicular form. "In this form the individual, yellowish, gray ma.s.ses, separated by the reddish tonsilar tissue are very characteristic, whereas in diphtheria the membrane is of ashy gray and uniform, not patch."--Osler. A point of the greatest importance in diphtheria is that the membrane is not limited to the tonsils, but creeps up the pillars of the fauces or appears on the uvula. The diphtheric membrane when removed leaves a raw, bleeding, eroded surface; whereas, the membrane of follicular tonsilitis is easily separated as there is no raw surface beneath it.
MOTHERS' REMEDIES. 1. Tonsilitis, Raw Onion and Pork for.--"Take a raw onion and some salt pork, chop together, make a poultice on which put a little turpentine and wrap around the throat." This is a very good remedy and should be used for some time. Change as often as necessary.
2. Tonsilitis, Peppermint Oil Good for.--"Apply peppermint oil thoroughly on the outside of the throat from well up behind the ear nearly to the chin, also just in front of the ear. This will soon penetrate through to the tonsils; apply freely if the case is severe and later apply hot cloths if relief does not follow without."
3. Tonsilitis, Borax Water for.--"One-fourth teaspoonful borax in one cup of hot water, gargle frequently." This may be used for ordinary sore throat not quite so strong.
4. Tonsilitis, Salt and Pepper Will Relieve.--"Apply salt pork well covered with pepper to the swollen parts; will often give relief."
5. Tonsilitis, Peroxide of Hydrogen Will Cure.--"Tonsilitis and contagious sore throats are just now extremely popular. Persons having a tendency to them will seldom be sick if they gargle daily with a solution of peroxide of hydrogen and water in equal parts for adults. Peroxide diluted with five parts of water and used as a head spray will prevent catarrhal colds." Children, are often sent to school immediately after an attack of tonsilitis, when they should be at home taking a tonic and building up by a week of outdoor play.
6. Tonsilitis, a Remedy Effective for.--"Rub the outside of the throat well with oil of anise and turpentine, and keep the bowels open." Care should be taken not to take cold. The anise is very soothing and the turpentine will help to draw out the soreness. This would be a good remedy for children.
[INFECTIOUS DISEASES 189]
PHYSICIANS' TREATMENT for Tonsilitis. 1. First Home Treatment.--Put the patient to bed alone in a pleasant room, comfortably warm; for this disease is recorded as contagious in this form. Cold applied externally around the sore spot is good. Use an ice bag if you have it; or wring cloths out of cold water and put just under the jaw and a flannel over that, bound around the neck. It must be changed often to keep cold.
2. Smartweed.--Cloths wrung out of smartweed tea are very good when applied under the jaw.
3. Salt Pork.--Salt pork, well salted and peppered, sewn to a cloth and applied on both sides, if both are diseased, directly to the lumps is very good. These can be kept on indefinitely. I have used them.
4. Liniment.--A strong blistering liniment applied externally where the lumps are is also good. These applications tend to withdraw some of the blood from the sore tonsils, and of course, that relieves them. There are many such that can be used. Poultices should not be applied for this form as they tend to hasten formation of pus.
5. Internally.--Dip your clean moistened finger tip into dry bicarbonate of soda (baking soda), rub this gently on the sore tonsil and repeat it every hour. You can also put one teaspoonful of it in one-half gla.s.s of very hot water and gargle if you do not use it locally.
6. Hot Water.--Gargling frequently with very hot water is splendid. If you wish you can use one teaspoonful of some antiseptic, like listerine, in it.
7. Thyme.--You can make a tea of the common garden thyme and gargle or rinse your mouth and throat with it every half to one hour. This is not only healing and soothing, but it is also antiseptic. This is a const.i.tuent of many of the antiseptic preparations.
8. Steaming With Compound Tincture of Benzoin.--Tincture of benzoin is splendid. Put one tablespoonful in a quart of hot water and inhale the steam. Put a sheet over your head and pitcher; or put it in a kettle, and roll white writing paper into a funnel, tie one part over the spout and put the other end in your mouth if possible; or you can inhale simple steam in the same way. I know this is excellent and often recommended; everyone has it, and it costs literally nothing, except to heat the water.
9. For the Pain.--Dissolve two drams of chloral hydrate in an ounce of water, use a camel's hair pencil if you have it, or a soft piece of cloth tied on a smooth stick, and apply directly to the diseased parts. This is for older persons, relieves the pain very much. There are many other simple remedies that can be used in this way.
[190 MOTHERS' REMEDIES]
10. MEDICINES. Parke, Davis & Co., Anti-Tonsilitis Tablet No. 645 is very good. This can be bought at any drug store. For a child give one-half a tablet every two hours for four doses, then every three hours. An adult can take one to two every one to three hours according to the severity of the case.
11. Aspirin.--Aspirin is another good remedy; five grains every four hours for an adult; but used only under doctor's directions.
12. Dr. Hare of Philadelphia, uses 1/200 grain mercurius biniodide (pink powder) every four to six hours to abort tonsilitis. I would recommend the following:--Give one-tenth drop dose of a good tincture of aconite and 1/200 grain of the mercury biniodide (one to two tablets a dose) every hour, alternately, one of them one hour and the next, etc. If there is much deposit I would put ten tablets of mercury protoiodide (one-tenth of a grain in a tablet) in one-half gla.s.s of water and give two teaspoonfuls every hour until the bowels move freely, then every three to four hours.
The aconite can be used if there is much fever, with hot, dry skin, alternately everyone-half hour. I prefer the pink powder when there is no deposit or membrane. These I have used for years, and know them to be excellent. For children the dose is about one-half. After twelve hours the remedies should be given only every three to four hours.
QUINSY. (Suppurative Tonsilitis).--In from two to four days the enlarged gland becomes softer and finally may break, sometimes in the pharynx; the breaking gives the patient great relief. Suffocation has sometimes followed the rupture of a large abscess and the entrance of the pus into the larynx. This form of tonsilitis was formerly called quinsy. By this term now is meant an abscess around the tonsils, (Peri-tonsilar abscess).
The structures are very much swollen.
Causes are somewhat similar to what has produced the regular tonsilitis.
It may follow exposure to cold and wet, and is very liable to recur. It is most common between fourteen and twenty-five years. The inflammation here is more deeply seated. It involves the main tissue of the tonsil and tends to go on to suppuration.
Symptoms.--The general disturbance is very great. The fever goes to 104 or 105 degrees; the pulse 110 to 120. Delirium at night is not uncommon. The weakness may be extreme. The throat is dry and sore, hurts terribly to swallow, this being the first thing of which the patient complains. Both tonsils may be involved. They become large, firm to the touch, dusky red and swollen, and the surrounding parts are also much swollen. The swelling may be so great that the tonsils may touch each other or one tonsil may push the uvula aside and almost touch the other tonsil. There is much saliva. The glands of the neck enlarge, the lower jaw is almost immovable and sometimes it is almost impossible to open the mouth at all.
QUINSY. Mothers' Remedies. 1. Willow Gargle for.--"Steep p.u.s.s.y willow and gargle throat with it. This remedy if taken in time, will cure quinsy and it will not return."
[INFECTIOUS DISEASES 191]