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+The Project Gutenberg EBook of Diphtheria, by Public Health Service
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: Diphtheria
+       how to recognize the disease, how to keep from catching
+       it, how to treat those who do catch it
+
+Author: Public Health Service
+
+Release Date: May 1, 2011 [EBook #36006]
+
+Language: English
+
+Character set encoding: ASCII
+
+*** START OF THIS PROJECT GUTENBERG EBOOK DIPHTHERIA ***
+
+
+
+
+Produced by Bryan Ness, Dianna Adair and the Online
+Distributed Proofreading Team at http://www.pgdp.net (This
+file was produced from images generously made available
+by The Internet Archive/American Libraries.)
+
+
+
+
+
+
+
+
+
+            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]
+
+
+       *       *       *       *       *
+
+
+
+
+
+
+
+
+End of the Project Gutenberg EBook of Diphtheria, by Public Health Service
+
+*** END OF THIS PROJECT GUTENBERG EBOOK DIPHTHERIA ***
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