London's Pulse: Medical Officer of Health reports 1848-1972

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Fulham 1933

[Report of the Medical Officer of Health for Fulham Borough]

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Behring led to a marked fall in the case mortality
(the number of deaths per 100 cases). Its
introduction revolutionised the treatment of the
disease. The results are rapid and effective.
Unfortunately, however, some cases do not come
under treatment until too late. The longer
anti-toxin treatment is delayed, the less the chance
of the patient's recovery ; for every day's delay
the case mortality rises rapidly. The average case
mortality in Fulham during the ten years prior
to the general introduction of this treatment,
1901, was 17.9. During 1932 the case mortality
in the administrative County of London was
3.77 per cent., while the corresponding figure
for Fulham was 5.65 per cent.
There is no doubt that the main reason for
this decrease in the case mortality is the early
use of diphtheria antitoxin. This can be stated
to be the case even although one knows that
nowadays doctors take swabs of the throats of
cases on the slightest suspicion of diphtheria and
are able to diagnose many more mild cases,
which, previous to the general introduction of
bacteriological examination of swabs, would have
been unrecognised.
Diphtheria antitoxic serum contains the blood
serum of horses into whose withers gradually
increasing doses of diphtheria toxin (a filtrate of
a liquid culture of diphtheria bacilli) have been
injected. Diphtheria toxin is the specific poison
of diphtheria but, being injected in small doses,
it does not cause diphtheria in the horse but
instead stimulates the animal's resistance against
the disease. The horse actively produces antitoxin
as the result of the injections and blood is
drawn from a vein. When the serum of the
blood separates out it is found to contain the
antitoxin. The whole process is complicated as
both the toxin and the antitoxin have to be
standardised and precautions are taken regarding

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