View report page

25
are not strictly comparable because the drainage of every house
where diphtheria has occurred is tested, whereas in house to house
inspection the drainage is not tested unless there is some prima facie
evidence that this is necessary. I consider, however, that the figures
fairly demonstrate that there is no close connection between
diphtheria and domestic drainage defects.
RETURN CASES OF DIPHTHERIA.—In four instances diphtheria
occurred in houses to which patients had returned from hospital
during the previous month. In each instance steps were immediately
taken to test the condition of the discharged patient. In no case
was there any evidence that the discharged patient remained
infectious.

It is noteworthy that none of the cases admitted on the first
day died, and that the mortality of those admitted on the second
day of the disease is small, while there is a considerable rise on the
third day and a still larger on the fourth and fifth days. These are
facts that cannot be too widely known, as they emphasise the well
ascertained fact that almost every case of diphtheria could be saved
if anti-toxin treatment was begun sufficiently early. It is true that
two deaths occurred among children treated on the second day of
the disease, but I am inclined to think that even this number is an
over-statement. Diphtheria is essentially an insidious disease, but,
with greater care on the part of all concerned, the disease could be
recognised at an earlier date. At any rate, there could be no
question that the best results will not be attained at the hospital
until the patients are brought in on the first day of the disease.
Every case of possible diphtheria should therefore be reported without
a moment's delay, and removal to hospital should be encouraged
without the dangerous delay that ensues from waiting for the result
of a bacteriological examination. The latter is unnecessary when
the clinical symptoms are definite.