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The prominent feature in the table is the lessening of the
diphtheria-mortality rate during that period, viz., from 0.35 per
1,000 of the population in 1895 to 0.14 in 1926; or, expressed in
averages, from 0.42 per 1,000 of the population during the five
years 1895 to 1899, as compared with 0.15 during the twenty-seven
years 1900 to 1926, i.e., a reduction of more than 60 per cent. During
the same periods, the diphtheria-incidence rate has practically
remained the same, so that, with an average increasing estimated
population (291,067 in 1895, as compared with 305,273 in 1926),
and despite present and recent improved methods of diagnosis,
with the aid of bacteriology, the saving of deaths has been really
even greater in fact than the figures set out in the statistical table
appear to show. What is the explanation ? The explanation is,
in the opinion of the Medical Officer of Health, to be found in the
two following facts:—
(a) the large numbers of patients removed yearly to the
M.A.B. Hospitals for treatment since 1895;
(b) the use of antitoxin as the sheet-anchor of diphtheria
treatment in such Hospitals since 1900.
The average percentages of patients removed to the M.A.B.
Hospitals are 43.6 during the five years 1895 to 1899, and 88.2
during the twenty-seven years 1900-1926 respectively. 98 per cent,
of the total notified cases in 1926 were removed to Hospital, as
compared with only 28 per cent, in 1895!
Antitoxin was first introduced in 1894, but did not come into
general use until 1900, and into more general use with the introduction
in 1910 of the Antitoxin Order, during the succeeding years
up to date, especially in Hospitals and other Institutions.
The ordinary well-known preventive methods have been in use
during the whole of the 32 years, viz., notification, isolation, disinfection,
etc., supplemented with improved (bacteriological) methods
of diagnosis and more careful examinations of " contacts " during
more recent years. Improved general sanitary conditions must
also be allowed for.
There can be little doubt but that antitoxin, as a chief form
of treatment in diphtheria (in the early stages of the disease) has
been the main factor in reducing the mortality-rate by approximately
60 per cent, during the past 32 years in the Parish and
Borough of Lambeth, and this result has been brought about by
virtue of the M.A.B. official decision to admit practically all cases,
i.e., other than as well as Poor Law cases, and the energy that has