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Chicago returns, which I had the honour to bring under its
notice some time ago, was about 6 per cent. This was on
more than 3,000 cases, all of which had been proved to be
true diphtheria by bacteriological examination, and the same
can by no means be said of the cases notified in Camberwell.
Allowing 25 per cent. deduction (only half that justified by the
figures of this department, and by the result of similar examinations
in the cases notified in Chicago and elsewhere) the case
mortality in Camberwell rises to very nearly 20 per cent.
In other words, had the same results been obtained here as
in Chicago, 120 persons who have died of diphtheria during
the year would now have been alive. Furthermore, not a
single death occurred among more than 300 cases treated
with anti-toxin in Chicago on the first day of the disease.
The reason for the terrible discrepancy in the two
places is probably due to two factors. The most important is
clearly the failure of two-thirds of the medical men of the
Parish to make any use whatever of the means of early
diagnosis, and treatment with the only remedy known to be
effectual, which have been freely provided by the Vestry.
Upon this side of the question there is nothing more to be
said. The Vestry has done all that lies in its power, and lam
unable to suggest any other provision which it can make.
With the other factor, the ignorance or apathy of the general
population, it may be possible to deal to some extent, and I
would suggest that a circular should be widely distributed
throughout the Parish pointing out the importance of neglecting
no cases of sore throat among children, and the fact that there
is a cure available which is practically certain if used at once,
and which is in itself sufficient to cure when properly administered.
It is highly desirable to educate the population, if
possible, up to the point of making them demand the use of
the remedy.
It would also be very desirable to make clear to the
minds of the profession and the public alike the fact that
patients who have had diphtheria may remain in an infectious
state for three months. A great step in advance would be
gained if medical men would send swabs from convalescent
cases at weekly intervals until the bacilli had disappeared.