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is given the first day the disease is manifest, and that if the treatment be
delayed until the second day, the patients in nearly all cases will be saved,
while even on the third day most children will recover, but that if not given
before the fourth day there will be many deaths. After the fourth day antitoxin
does little or no good.
They also assert that when antitoxin is given the first day, 2,000 units
generally suffice for a dose ; that on the third day 5,000 units are required
and that on and after the fourth day 10,000 units are rarely of any service.
A further fact has also come to my knowledge. It appears that in April
of the present year, the Health Authorities of Newcastle-on-Tyne, on the
advice of their Medical Officer of Health, Dr. H. E. Armstrong, resolved on
public grounds to supply antitoxin free of charge to all the medical practitioners
in their city, in order to avoid the least possible delay in its administration
to suspected cases of Diphtheria. This arrangement was to last for six
months. On the completion of that period, Dr. Armstrong reported that the
experiment had proved highly satisfactory; that the medical men had taken
very full advantage of the offer, and that almost all cases, except those which
had been removed to hospital before the private practitioner could re-visit,
were inoculated with the serum before removal.
The method of distribution was as follows:—Each general practitioner on
request receives two or three phials, according to his requirements, and
immediately on his sending an inoculated case to hospital, or on his request,
a further supply is forwarded.
The Medical Officer of Health communicated personally with those
practitioners who at first neglected to apply for the antitoxin, all of whom
at once acted on his suggestions.
Although the period under report is too short to allow any definite
conclusions to be arrived at, nevertheless, the mortality among the hospital cases
was 1.2 per cent. lower than during the preceding 12 months, and the proportion
of cases requiring tracheotomy was less than half that of the preceding year.
As regards cost, two-thirds of the persons inoculated were sent to
hospital, so saving expenditure of antitoxin there, while of the remaining third
a considerable proportion were not patients, but receiver1 the remedy as
a preventative.
The scheme appears to have succeeeded so well in promoting an early
and general use of antitoxin in Newcastle that the Sanitary Committee have
now decided that the free use of the serum to all the medical practitioners is
to be continued in that city.
This statement, which appeared in one of the health Journals,* has been
confirmed by a letter to myself from Dr. Armstrong.
Here, then, are examples which the British people might well follow,
because without doubt the result must be that Diphtheria will be practically
expunged as a fatal disease from our registers.
* The " Medical Officer," Nov. 17, 1910.