The diseases if infancy and childhood; for the use of students and practitioners of medicine / by L. Emmett Holt.

  • Holt, L. Emmett (Luther Emmett), 1855-1924.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: The diseases if infancy and childhood; for the use of students and practitioners of medicine / by L. Emmett Holt. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    Diphtheria is usually followed by a severe and often persistent anaemia which may continue for weeks. Pneumonia, nephritis, and cardiac disease may first show themselves during convalescence, and so be ranked as sequeliB. The most important sequel of diphtheria, however, is multiple neuritis or post-diphtheritic paralysis (page 790). Diagnosis.—The diagnosis of diphtheria rests upon two kinds of evi- dence—clinical and bacteriological. While the bacteriological diagnosis is, on the whole, more exact, it should not be depended upon to the exclu- sion of the clinical diagnosis. The prevailing tendency to disregard the clinical evidences of the disease and rely wholly upon bacteriology, is greatly to be deprecated. These means of diagnosis are not mutually ex- clusive, but complementary. Bacteriology applied to the diagnosis of diphtheria has rendered incalculable service, but it has its limitations. As has well been said by Welch, the mere presence of the diphtheria bacilli in the throat of a patient no more proves that he has diphtheria, than the presence of the pneumococcus in his saliva establishes the fact that he has pneumonia. Again, the case may be one of undoubted diphtheria and yet the bacilli may not be found at the first examination, although they are found at subsequent examinations—a thing which has repeatedly hap- pened in my own experience. The delay thus occasioned in the applica- tion of early treatment is a matter of the greatest importance, especially in connection with serum therapy. Finally, because of the occasional presence in the throat of a non-virulent diphtheria bacillus and of the so-called pseudo-diphtheria bacillus, even a positive report by the bacteriologist may be misleading; but after all this will seldom be the case in actual practice. Wliile in no way detracting from the immense advantage of having bac- teriological assistance in making the diagnosis, I insist that the clinical manifestations of diphtheria must be observed by the physician with the same care as heretofore, particularly since the great body of the profession are as yet compelled by circumstances to rely solely upon a clinical diag- nosis. Every one who has seen much of the two methods of diagnosis studied side by side will, 1 think, admit that in fully four fifths of the cases an accurate clinical diagnosis can be made after twenty-four hours' observation, and in a considerable proportion of these in a shorter time; the remaining one fifth require either a longer period of observation or continue doubtful to the end. The great majority of the cases of this group are of the mildest variety and terminate in recovery. In them an accurate diagnosis is of importance more for the sake of others than for the patient himself. 1. The Clinical Diagnosis.—In arriving at this, there must be con- sidered, first, the patient and his surroundings; secondly, the constitutional or general symptoms; thirdly, the local evidences of disease. The chances of diphtheria are greatly increased if the patient is a child under ten years of age, if his home is in a tenement house or an institution, if he attends