The diagnosis and management of doubtful cases of diphtheria : being an address delivered before the Medical Officers of Schools Association on November 26th, 1903 / by F. Foord Caiger ; issued by the Medical Officers of Schools Association.

  • Caiger, F. Foord.
Date:
1904
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Licence: In copyright

Credit: The diagnosis and management of doubtful cases of diphtheria : being an address delivered before the Medical Officers of Schools Association on November 26th, 1903 / by F. Foord Caiger ; issued by the Medical Officers of Schools Association. Source: Wellcome Collection.

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    is likely to be more severe in follicular tonsillitis than in a case of diphtheria sufficiently mild as to be mistaken for it. Rhinor- rhoea is relatively uncommon in follicular tonsillitis, and the same may be said of albuminuria, which is a frequent symptom in diphtheria. The occurrence of hoarseness, stridor, or a croupy cough is very suggestive, while the advent of paralysis or cardiac disturbance at a later date is, of course, confirmatory of diph- theria. By a careful consideration of all the foregoing points a satisfactory diagnosis can often be arrived at. With respect to those cases in which no abnormality can be detected beyond the presence of a mucous rhinorrhoea, it is usually quite impos¬ sible to differentiate diphtheritic rhinitis from a simple nasal catarrh. Careful inspection of the anterior nasal fossae through the external nares may reveal the presence of membrane, either on the septum or floor or the inferior turbinate, but in the majority of cases no exudation whatever is visible, even though the discharge may be teeming with diphtheria bacilli. The white appearance presented by a patch of Schneiderian mucus is a pDssible source of error, as it is very likely to be mistaken for an exudation, unless due care be exercised in the examination. Some degree of redness, and occasionally an impetiginous exco¬ riation of the skin immediately within the nostrils may often be detected. This, when present, is strongly suggestive of diphtheria. It is dependent upon the irritant character of the discharge, a quality also shared by the rhinorrhoea, which so often follows scarlet fever in young children. Having now referred to the chief evidences on which we have to rely in the diagnosis of doubtful cases of diphtheria, it remains to say a few words about the preventive measures which should be undertaken with the object of checking the spread of the disease. On becoming aware of a case of diphtheria among the members of a community living together in the close association which is incidental to school life, I think all must be agreed as to the ad¬ visability of immediately adopting the following precautions. (1) Isolate the patient. (2) Disinfect everything which he is likely to have worn, touched, or handled, and also the room in which he has been sleeping immediately before the attack. (•>) Examine the throats and nasal passages of all persons with whom he has been in especially close contact, such examination, if possible (and in a school it always should be possible) to include a bacteriological examination. (4) Isolate, or at any rate exclude, all “ contacts ” who are found to harbour even doubtful diph¬ theria bacilli on their mucous membranes and all (even though a bacteriological exaimination proves negative) who present any suspicious appearance of the throat or nasal fossse. (5) Search for any other possible source of infection besides a previous cass