TREATMENT

The sovereign remedy for diphtheria is antitoxin. If given early and in sufficient amount practically every case could be cured. Diphtheria antitoxin was first used in Berlin in 1891. It came into general use about 1894. Like most new remedies it met much opposition at first but is now recognized throughout the civilized world as the one essential means of cure. Cases given antitoxin on the first day practically always recover, only a little over 1 per cent die. Each day of delay is shown in the results. When given the second day, a little over 3 per cent die; the third day, over 6 per cent die; the fourth day, nearly 11 per cent, the fifth day, 15 per cent. In hospitals where many cases come late under treatment, about 10 per cent of the cases of diphtheria now die. This is in marked contrast to the 50 to 80 per cent of deaths in preantitoxin days. The patients who receive antitoxin early not only have greater chance of recovery but they get well promptly after a very brief illness, while those that come late under treatment, even if they recover, do so after a tedious illness and protracted period of convalescence.

The important things in treating diphtheria with antitoxin are early administration and sufficient amounts. The earlier given the smaller the dose required. The doctor from experience is able to estimate the dose needed in each case. A moderate dose is 5 to 10 thousand units, a full dose is from 20 to 30 thousand units. A small fire may be extinguished by a little water, but when it has spread much more is needed. The damage done by the diphtheria poisons before antitoxin is given cannot be undone by any amount of antitoxin. Antitoxin only prevents further injury. If sufficient injury to the heart and kidneys has occurred death will follow. Lost time cannot be regained. The antitoxin must be injected with a hypodermic needle. It cannot be given by mouth as it is destroyed and rendered useless in the stomach.

A few hours after enough antitoxin to control the disease has been given marked improvement occurs. The restlessness subsides, the swelling begins to grow less and the membrane separates at the edges and begins to peel off, the color reappears in the pasty cheeks, the pale lips become red again, and the child which has been blue and struggling for breath falls into quiet sleep. The change in a short time is one of the most remarkable observed in sick persons.

Local treatment is of little value. We no longer gargle, spray and swab the throat. We only try to keep the mouth and throat as clean as we can with cleansing washes but this is not done with the idea of influencing the disease.

If the obstruction to breathing from diphtheria in the larynx becomes extreme this must be relieved by making an opening in the windpipe or by passing a small rigid tube into the larynx through the mouth.

If antitoxin has been given late the complications which have developed must receive appropriate treatment. The duration of confinement to bed will depend on the time antitoxin was given. If given early the patient may be up in a few days. Serious damage to the heart and kidneys may require confinement to bed for several weeks. When there are heart disturbances perfect quiet in a horizontal position is imperative. Even rising to a sitting position or moderate exertion may be quickly fatal. Such accidents are most apt to occur about the 5th to the 14th day. Recovery from the paralysis is usually complete, but may require several weeks or months. These paralyses may continue to extend for two months, and during this time the weakened muscles must not be used. If unable to swallow the patient must be fed with a rubber tube through the nose or mouth.