LARYNGEAL DIPHTHERIA, Formerly Called Membranous Croup

Category: Infectious Diseases

Diphtheria in
the larynx may occur alone or with the pharyngeal kind, and was formerly
called "Membranous Croup." After several days of hoarseness and coughing
the breathing suddenly becomes hard, generally at night, and it is at
first in paroxysms, but later it is constant. The space above the breast
bone (sternum) is depressed and there is a drawing in of the spaces
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. Antitoxin 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.

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
antitoxin, 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 glass 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 glasses, 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. Antitoxin 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, albumin water, broths, eggs given every two
hours. Some doctors give stimulants with the food.

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.

Next: ACUTE TONSILITIS. (Follicular Inflammation of the Tonsils). Causes
Previous: PHARYNGEAL DIPHTHERIA

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LARYNGEAL DIPHTHERIA, Formerly Called Membranous Croup