The Health bulletin [serial] - University of North Carolina at Chapel Hill

:
May, 1927 The Health Bulletin 19
sorption of toxin from the larynx is
very slow and incomplete. Many feel
that less is absorbed in laryngeal than
in nasal diphtheria, which is. of course,
a verj' benign form of the disease.
Therefore antitoxin in laryngeal diphtheria,
not associated with pharyngeal
diphtheria, is given largely for the
local effects. Its action on the local
condition is slow and not spectacular.
Except when given very early, not
much change in symptoms can be expected
under 18-24 hours.
Laryngeal diphtheria frequently occurs
without membrane on the throat.
Throat cultures will be negative in at
least 50 per cent of cases of laryngeal
diphtheria without visible pharyngeal
membrane. The outstanding points
about laryngeal diphtheria are : its progressive
character without improvement
in the daytime ; loss of voice and
fairly early definite dyspnea—all of
the.se things being in contrast to spasmodic
croup and acute catarrhal laryngitis.
Any case of laryngitis or croup that
shows little tendency to improvement
in the daytime, that is associated with
loss of voice or difficulty in breathing
is a potential case of laryngeal diphtheria
and should be watched most
carefully and antitoxin administered if
there is any progressive character to
the symptoms.
The parents of all children should
know the outstanding points about this
condition, and many lives will be saved
if parents will have medical supervision
for these cases early. Where the
difficulty in breathing has become
marked, the child should be placed
where there is someone who can introduce
a tube into the larynx if necessary,
for this is a life saving measure
and without it many will die before
the effect of antitoxin can relieve the
obstruction.
Any persistent, excoriating nasal discharge
should suggest to the physician
that he is dealing with a case of nasal
diphtheria, and this will almost certainly
be the case if at any time the
discharge is tinged with blood. Nasal
diphtheria is almost always unaccompanied
by any constitutional symptoms
and is therefore usually overlooked.
The condition is important largely because
a large percentage of the cases
of clinical diphtheria we see contracted
the disease from this type of unrecognized
carrier.
Summary
(1) Diphtheria can and should be
stamped out by the use of toxin antitoxin.
(2) Antitoxin cannot undo damage
that has been done by toxin absorbed
before it was given, and should therefore
be given without delay,
intramuscularly,
and all in one dose.
(3) Laryngeal diphtheria is a progressive
laryngitis and frequently occurs
without visible membrane, and a
negative culture means very little.
(4) If nasal diphtheria were recognized
more generally we could remove
one of the most important foci of diphtheritic
infection.