Health, or, How to Live

DIPTHERIA;

ITS CAUSES, TREATMENT, AND CURE. By JAMES C. JACKSON, M. D. HHTL 65.3

The word “diptheria” is derived from two Greek words, signifying a membrane. The same was given by M. Brettonneau to a class of diseases which are characterized by a tendency to the formation of false membranes, and affect the mucous membranes and sometimes the skin. It is not a contagious, nor an infectious disease, but only epidemic. HHTL 65.4

The causes that produce it are of two classes: HHTL 65.5

First, the Predisposing, of those which operate to fit the organism to take on such abnormal conditions as are indicated by the disease. HHTL 65.6

Second, The Proximate, or those which immediately operate to produce these conditions. HHTL 65.7

The predisposing causes are to be found in the general habits of life common to the people of our country. Till attention is called to it, thinking persons are not aware how uniformly and strikingly similar the habits of all children are. As for instance, in the sphere of dietetics, almost all children eat the same kinds of food, prepared in nearly the same ways. HHTL 65.8

Culinary preparations, at the beginning of the autumnal season, and so on through the winter and spring, partake largely of oleaginous materials. Butter is one of these, and is used largely; fat pork is another, and lard another. So also, sugar, or syrup is used largely, and so, as a condiment, is common salt. Now, with grains, vegetables and fruits as a base for our food, with butter and lard intermixed, and flesh-meats, as staple articles of diet, together with narcotic beverages, in more or less use, the condition of the blood, of the fleshy tissues, and of the nervous systems of children are such as greatly to predispose them, under circumstances unfavorable to health, to take on diseases of the mucous membrane. Add to these predisposing influences those which grow out of confinement in school-rooms, where the occupants are compelled for hours to sit upon benches and study, while the air which they breathe is quite impure, or, if not so, is of such a temperature that the stratum in which their feet are bathed, is from five to ten degrees lower than that which envelopes their heads, and you have another predisposing cause to the production of this disease. To this add another in dress, and you have efficient causes enough to predispose the bodies of such persons to take on the disease. HHTL 66.1

Consider with me now the proximate causes. These may be regarded in the main as two; HHTL 66.2

First, Sudden and great changes in the degree of temperature of the atmosphere. HHTL 66.3

Second, Suppression thereby of the circulation of the blood on the external surface of the body, and the forcing of it thereby violently upon the internal skin, or, as it is called, the mucous membrane, thus inducing severe congestion at the throat, in the case of such persons, as by the operation of the predisposing causes before alluded to, have had their vital resistance weakened, and so are specially fitted to take on such congestion. Under the general habits of living, common to our adult and child population, therefore, and the imperfect action of the inherent forces of the living organism in the department of the circulation of the skin, together with the sudden changes of temperature common to our climate, in the autumnal, winter, and spring seasons of the year, are to be found the efficient causes for the existence of this disease. HHTL 66.4

It is a curious fact which statistics most certainly show, that of adult persons or children who take the disease, females as compared with males, in the best ratio, rank as two to three, and in the worst ratio they rank as three to four. Thus, under the most favorable view, two-thirds of the persons attacked are females, and under the most unfavorable view, three-fourths of females. It is easy to account for this from two simple considerations: HHTL 67.1

First, In the case of adult females, women eat nearly as much carbonaceous material for food, as men, yet they live so as to get very much less pure, and very much more impure air than men. As a consequence, their blood becomes less perfectly aerated, or oxygenated, as it is termed. From want of aeration, it becomes foul; its constituents being made up largely of materials which have been separated from the solid tissue, and received into the blood with a view of being passed through the various eliminatory departments, which are the lungs, the bowels, the kidneys, and the skin. Not being carried off as they should be, they become acrid and poisonous. When under sudden changes of the temperature, therefore, the blood is forced from the capillary blood vessels of the skin back upon the capillary vessels of the mucous membrane, the impurities in the blood become a source of irritation and inflammation. HHTL 67.2

In the case of children, the dress of girls may account for the preponderance in numbers of those who take the disease. Has your attention ever been directed to the unhealthy way in which, for the most part, parents dress their girls, especially during the colder seasons of the year? A boy has thick covering for his feet and legs in the shape of high-topped boots, with thick soles, and woolen stockings, and a pair of pantaloons coming over his boots down to the ankle. A girl has a pair of calf-skin bootees, with stockings, a pair of pantalettes coming a little below the knees, together with a short skirt, which serves no other purpose in the world, save to hide her nakedness, but that of so arranging the lower portion of her body as to bathe it continually in air, which, if of low temperature, must necessarily produce constant and uninterrupted chilliness of the surface. As an illustration of the truth of this view, one has but to carry an umbrella over his head when currents of cold air exist, to find how much sooner, with the umbrella, the upper part of the body becomes chilled, than if he did not have it. Now, thus to chill the lower extremities from want of proper clothing, and by means of the ill adaptation of such clothing as the girl wears, is to force circulation to the upper portions of the body, and, when the temperature is cold, to drive the blood from the external surface of the upper extremities to their internal surfaces, thus producing the congestions which are termed diptheritic. HHTL 67.3

What, then, is Diptheria? It is a disease of the mucus membrane of the throat and air passages, caused by their sudden inflammation. So far it is like croup, and stimulates common influenza, as this is often seen in its incipient stages. The points of difference between these diseases and Diptheria are frequently noticeable in their incipient stages, but become more obvious in their advanced stages, through the more complicated conditions in Diptheria, than in croup, influenza or scarlet fever. Persons taken with croup, nine times out of ten show like symptoms; so they do in cases of influenza and scarlet fever. In croup, especially may the disease be said to be local, scarcely dependent upon any general derangement of the organism. Children may be, to all appearance, very healthy, and almost instantaneously show croupy symptoms. Influenza is almost always preceded by headache. In scarlet fever, a child, as a condition precedent to any exhibition of difficulty of the throat, in a majority of instances, shows disturbed condition of digestion. I have never seen one taken down with scarlet fever, who, as a condition precedent to its unmistakable manifestation, did not show more or less irritation of the digestive organs, for some time previous. The complications of Diptheria are as numerous and as variable as the persons attacked by it, and they differ very much by reason of the temperament, age, special condition of sex at the time of being taken down, etc. I have seen persons, both children and adults, attacked with Diptheria, exhibit some or other of the following symptoms: Very sudden vertigo, with blindness; very sudden nausea, with vomiting; very sudden ringing in the ears, with deafness; excessive palpitation of the heart with great faintness; the most violent neuralgic pains in the lower portions of the legs, especially in the heels; sudden and unconquerable desire for stool, with diarrheaic flow; violent pain in the bladder, with great difficulty of making water: irregular, painful and sudden menstruation; chills, as severe as those in the chilled state of fever and ague; great mental irritability, producing mental excitement without cause, in some cases indicating great fearfulness, in others, an audacity unusual, amounting, in a few instances, to temporary aberration of mind, in other cases exhibiting immoderate and excessive laughter; very difficult and painful respiration, in some cases amounting in severity to the worst cases of asthma, — in all such instances, however, these varied symptoms last but a little while, and pass away to be followed by peculiar conditions of inflammation of the throat and air passages, now known to be unmistakable exhibitions of Diptheria. No such varied introductory exhibition of morbid conditions has it been my lot to witness in connection with any other disease. For the most part, the symptoms of any disease are, with slight modifications, the same in all persons. Scarlet fever, croup, bilious colic, fever and ague, typhoid fever, whooping cough, yellow fever, acute dyspepsia, inflammatory rheumatism, inflammation of the bowels, dysentery, and so on, show nearly, in all persons, the same morbid conditions, as to enable physicians of any experience, to determine, almost instantly, when brought within the range of observation, what the matter is with the person or persons affected. HHTL 68.1

But so far as my experience has gone, the introductory stages of Diptheria are quite likely to be different in different persons. Thus, out of the great number of adults whom I have treated, I might specify the following. A German hired girl, at work in my family, was taken with sudden blindness and vertigo, and fell to the floor. In thirty minutes the symptoms of Diptheria were unmistakable. A German hired man, who had not been sick in ten years, to my great dis-service, upon splitting wood, and stooping over to pick up a stick, was taken with such violent congestion of the lungs as with great difficulty to breathe. In half an hour Diptheria was most manifest. A gentleman sustaining intimate business relations to me, and a member of my family, was taken all of a sudden with violent coughing. In a very little time the diptheritic symptoms were in full exhibition. A woman cleaning house for me, was taken with violent pains in her heels, and in a little while showed particular affection of the throat. HHTL 70.1

Children whom I have treated, have been attacked with a great variety of morbid conditions; some complaining of darting sharp pains in the eyes, some of ringing in the ears, some of pains in the bowels, others of chills running up and down their backbones, pains in their legs, and so on. HHTL 70.2

My treatment of this disease began years ago. At the outset I had in my own mind no very clear explanation to offer of the causes of the disease, and therefore I could not satisfy myself as to its nature. I, however, saw the unsuccessful results of the course then pursued by physicians of the Allopathic school, and in view of their want of success, pursued a course of treatment converse to theirs. They seemed desirous to produce relief by increased action of the mucous tissue of the stomach and bowels. Some of them, therefore, gave emetics, but most of them gave cathartics. As most of their patients died, I saw no use in pursuing that course, so I turned my attention to the external skin, and sought to produce changes in the circulation of that structure, hoping thereby to produce the desired end. I know of but few men who have treated so many cases or Diptheria as my associates at Our Home, and myself. We have never yet lost a case. We have been the means of saving many persons who were considered to be in advanced stages of the disease, and many more, who, having taken the disease, passed under our care in its incipient stages, and were saved, though they were members of families wherein from two to five persons had previously died under the drug-medicating plan of treatment. HHTL 70.3

Our success has been so great, while as yet our plan of treatment has been so simple, as really to introduce a decided change in the medical practice in this particular disease, in this locality. I do not know of a physician of any school in the town, who has not practically abandoned the administration of cathartics in cases of Diptheria, and with such modifications of our plan of treatment as his own individuality would naturally prompt him to make, adopted, in fact, our method. The result has been that, whereas great numbers of persons four years ago died of the disease in this town, and whose deaths caused a real panic among the people, the disease has come no more to be feared than any other morbid condition of body common to our people. Owing to our residence here, and as the result of our teachings on the subject of health, or to some silent influence affecting the views of the people of this town, there is much more care given to the conditions of living of children, especially in the cold seasons of the year, than formerly. This of itself, in my judgment, is a very great security, for it stands to reason that if one can manage the predisposing causes, he need not fear the proximate causes of disease. The best course to be pursued in any family, or in any community, in respect to this fearful scourge, is that of prevention, and to look well after the general habits of life is greatly to add to the securities against its appearance. HHTL 71.1

There is one feature connected with its exhibition and progress to which I feel bound to call public attention. It is its greater prevalence in families which are hereditarily scrofulous, and thereby predisposed to diseases of the throat and air passages of the lungs, than in families not thus affected. I have been able by personal advice, and personal examination in this direction, to forewarn parents of the liabilities under which they themselves and their children rested. A scrofulous child, permitted to eat pork, and if a girl, to dress and live as do most children in our society, is predisposed to take on diseases of the air-passages, and when diptheritic conditions of these exist, is as sure almost to die as he or she is to be attacked. Nothing, under such circumstances, saves the child, but the possession on its part of great vitality, and medical administration marked by great judiciousness and care. The public does not know it, but it is none the less a fact, that scrofula has come to be a household disease in the United States. I can pick out a scrofulous man or woman or child just as far as I can see them. Such persons, more likely than not, are high livers, eat gross and high-seasoned foods, and in great quantities, and are therefore liable to take on inflammatory diseases, and to have these located in or about the throat and air passages. HHTL 71.2

To live so as to be able to avoid disease is a very great attainment. That it can be done, and to such degree as to lessen, in a very large measure, the number of persons who are likely to suffer from diptheritic inflammation, is as certain my own mind, as is the existence of the law of gravitation. There is no need, in the first place, of our children, nor of ourselves, having this disease, and in the second place, if, by reason of some carelessness on our part, in the way of simple, uncomplicated exposure, we find ourselves or our children attacked with it, there is no more need of our or their dying with it, than from a common cold in the nose. Two things we only want to know; one is how to live so as to keep our bodies in the best possible relations to life; and second, if from causes that are unhealthful we become sick, and Diptheria is the form of our sickness, to know how to treat it in view of the causes that have produced it. HHTL 72.1

My method of treatment has been as follows: When I repeat that out of the hundreds of cases which have come under my professional handling, I have never yet lost a case. I leave the public to estimate the value of the suggestions I now offer: HHTL 72.2

In all cases, no matter whether the subjects are children or adults, I have uniformly, as the first thing to be done, given a hot bath. Its temperature and duration were regulated by the age, sex, and vitality of the patient, the bath ranging from ninety-eight to one hundred and ten degrees, the person sitting in it from five to thirty minutes, always, however, until profuse sweating was produced. The bath I choose to make in such a way as to render it feasible to be given by any private family. Hence, it has been my practice to give a sitz-bath, for which purpose any washtub will answer by putting a block under the backside so as to tip it forward a little, and filling it as full of water as possible without having it run over when the patient sits down in it, and taking a common keeler, or pail, if the former cannot be had, and fill it up partly full of warm water, for the purpose of immersing the feet, setting it down in front of the sitz-bath. I then place the patient in a sitting posture and wrap a heavy blanket round him in front, bringing it across his shoulders in the rear, and tucking it smoothly down. Then I bind his head in the shape of a wreath or band with a towel wet in cold water, and let him sit till perspiration is induced. If the patient is a child, quite small, the arrangements must be made to suit size and age. In many instances an attendant is directed to kneel down, and lifting up one side of the blanket, dip his or her hand in water and rub the upper portion of the chest of the person. If sweating is not readily induced, some of the water is dipped out, and hotter water poured in until as high temperature is raised as the patient can bear. I have never had a case where the primary symptoms were not mitigated, in some measure, as soon as increased action of the circulation by the skin was manifest. HHTL 73.1

Upon taking the person out, my uniform practice has been to pack him. This, as most of my readers will know, consists of spreading upon a bed two or three woolen blankets, or a woolen blanket and comfortable, the woolen blanket at the top, and over these one or two linen sheets wet in cool water, and left so wet as simply not to drip, and upon coming out having him lie down and be enveloped in this wet sheet from head to foot, with additional cloths laid over the chest, and coming up close round the throat, these being cold or hot, as my own judgment, derived from the sensations of the patient, might dictate. In this envelopment, just taken out of a hot bath, he feels very pleasant bodily sensations. The effect upon the nervous system is decidedly sedative, so much so, as in a majority of instances, to induce sleep. If sleep is induced, I allow the nap to continue undisturbed, even though it be prolonged for three, four, or five hours. If the person does not go to sleep, I generally permit the pack to continue from forty—five minutes to an hour and a half, as the patient’s sensations may indicate. HHTL 73.2

During the period that the patient is in the bath, and while being put in the pack, the room is kept thoroughly warm, but upon being wrapped up in the wet sheet, the windows are opened, and thorough ventilation and lowering of temperature is secured, so that he may be sure to have the coldest air that can be given to him. HHTL 74.1

When ready to come out of the pack, the windows are shut, the temperature of the room raised, and when well warmed, the envelopments are thrown off, the patient lying upon the bed, an attendant proceeds to rub him with dry towels, until all moisture is removed from the body, and then rubs with the dry hand over the entire body until the skin is dry and velvety. HHTL 74.2

I then wrap the patient’s throat and chest in wet bandages. These are made so as to fit the parts well, and are covered by dry ones of the same shape as the wet. Thus enveloped, the patient is placed in bed, with a wet cap upon his head, and hot flat-irons, or a jug of hot water, or hot dry woolen blankets at the feet. An attendant is placed in charge of the room, which, if very much exposed to light, is shaded, and perfect quiet, if possible, thereafter is insured. HHTL 74.3

It gives me pleasure to say that, whether in my own Cure, or at the houses of private families, I have never found this treatment to fail in mitigating the severities of the attack, no matter in what form it has appeared. HHTL 75.1

The course pursued afterward has been nearly as follows. qualified somewhat, as I have before said, with reference to the age, sex, and vital power of the subject: HHTL 75.2

First, having induced, I have sought to keep up thorough circulation on the entire surface. HHTL 75.3

Second, to insure it in plentiful degree at the extremities, my object being two-fold — to relieve the overburdened internal blood-vessels, and especially those of the mucous membrane; and second, to relieve the blood-vessels of the lungs, throat, and head. To do this, frequent application of warm cloths, wet or dry, to the extremities, or rubbing them with the dry warm hand has been practiced. HHTL 75.4

Next, freedom from mental anxiety, to as perfect a degree as possible, and to this end no visitors in the room, and no change of attendants, except such as was originally provided for. The practice of having half a dozen different persons have charge of a patient suffering from diptheritic inflammation, is productive of such mental disturbance as, in many instances, to amount to anxiety of mind, and directly tends to, and not unfrequently produces cerebral congestion. From the family, therefore, two or three persons must be chosen to have the entire care of the case, until all danger is past, and no other members of the family must, on any pretence whatever, enter the room, unless desired to be seen by the patient. HHTL 75.5

Next, comes the giving of food. Whether infant, child, or adult, male or female, I never allow a particle of food to be given, until I am sure that nature has reacted sufficiently to establish healthful circulation, and quite natural conditions of the nervous system. In some instances, I have made my patients go three days, in others four days, without taking a particle of food, permitting them, however, in the meanwhile, to drink freely of soft water. Until one tries it, he is not aware how well a person, whose organism is under inflammatory conditions, will find hunger assuaged by the free use of soft water taken internally. When the collective symptoms indicate such change as to relieve the patient from all danger, food may be given; but this should be of a fluid form, and should not be of a carbonaceous character. HHTL 75.6

Connected with the treatment, the furnishment of pure air is of prime importance. The disease is essentially one derived from imperfect aeration of blood, with imperfect elimination of waste matter. If then, the treatment can be of such a nature as to set the eliminative organs, especially the skin, which is the structure generally at fault, at work, and thus secure the thorough removal of waste materials from the blood, and the solid tissues, while at the same time, the blood is properly aerated, there can be no failure of recovery to the subject. I have no doubt that one of the best things that could be done, in the treatment of this disease, were it readily practicable, would be the inhalation of oxygen gas. In default, however, of means to do this, the next best thing, as a curative, is to secure the free use of pure atmospheric air, which by the way, would be, if freely used, a great preventive. I take it upon me, therefore, always to secure thorough ventilation, even though I have to knock a pane of glass out of the room where the sick person lies or punch a hole through the wall so as to let the air in. The attempt, on the part of doctors and nurses, to have sick persons do well under their treatment in the absence of pure air, is characterized by such folly as to make one wonder why it is so persistently pursued. HHTL 76.1

There are some other points connected with the treatment of Diptheria, to which it may be well for me to allude. One is, that many persons who are killed by the disease, die from suffocation, this resulting from the formation of what the doctors call a “false membrane” in the air passages. This false membrane is formed out of thick mucus, secreted from the mucous glands, and almost immediately thereupon forms into a thick imperfectly organized membraneous shape, filling up the cavities of the air tubes, and thus rendering it impossible for the patients to breathe. The method of treatment, which I have pursued has had the effect, while increasing the flow, to render the expectoration of the mucus perfectly within the control of the patient, and it has been wonderful to myself and to others to observe the quantities that have been thus secreted and coughed up in the course of twelve hours. Some of my patients have raised a quart, others half a gallon; one man in the course of forty-eight hours not less than six quarts of this slippery-elmish substance, and lost nine pounds in weight. The man’s tissues must have been as foul as corruption itself. No other treatment that I have ever been made acquainted with, has seemed to produce this effect, which I consider of great importance. HHTL 76.2

Another consideration worthy of attention, is the danger of relapse. It has been my practice, therefore, to keep my patients free from physical or mental fatigue for some days, and some of them for weeks after all danger seems to have passed away. For many of them, upon convalescence, show nearly the same conditions that persons do who have been taken with congestive chills, or with typhoid fever and recovered. There can be no doubt that in many instances of diptheritic attack, the cerebral disturbance is very great, the brain and lungs, and sometimes the liver and bowels being excessively congested, and that by the rapidity with which these organs have been relieved by the determination of blood to the surface, has recovery to the patient been insured. HHTL 77.1

Thus, have I tried, in common phrase, so that the most unlearned or unlettered person may understand me, to mark out the views which I cherish, and the course I pursue in the treatment of Diptheria. HHTL 77.2

Besides the cases treated personally by myself and associates, Miss Dr. Austin and myself have received hundreds of letters from persons, who, having followed our directions in the main, have succeeded in the recovery of their patients. Some of these patients have been men, others women, others children, and, with slight modifications, they all tell the same story as to the results produced. Whenever my method of treatment has been taken in the early stages, and has been the only treatment pursued, it has been successful. To apply it to scrofulous children in the more advanced stages of the disease, and especially where these have been previously drugged, is to render the probability of success much less than it would otherwise be. But early attention to it, and a persistent following of it, I am satisfied will save a great majority of children who may be so unfortunate as to be attacked. It is far better so to bring up children as to reduce their liabilities to so low a point as practically to amount to nothing, than it is to rear them in such a way as to have them greatly exposed to take disease, and when taken sick, almost sure to die. HHTL 77.3