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8
the patients attacked removed at once to hospital. Closing
the schools would have made a panic in the neighbourhood,
which, as is well known, has the effect of increasing an outbreak.
It would have thrown 900 or 1,000 children suddenly
out of school. Mixing, as they certainly would have done,
with one another in their own homes, and crowding into one
another's small rooms, would have brought them into far
closer contact than was the case when they were at school
under supervision. This would, in my opinion, have materially
increased instead of lessening the outbreak. If the
schools could have been closed and the children prevented
from mixing with one another, then the closing of the schools
would have been necessary; but this is impossible.
The mortality caused by this outbreak was 28 up to the
end of October, viz.,—2 in August, 7 in September, and 19
in October. The fact is of interest that 50 per cent, of the
attacks which began between September 17 and September
30 were fatal, while, on the other hand, of those attacked
earlier and also later than these dates, only 13 percent, died.
The explanation of this mortality is, I think, entirely
that during the period between September 17 and 28 it was
impossible, in most instances, to remove the cases till late
in the disease, and they therefore did not get the benefit
of treatment by antitoxin till too late. The value of this
remedy was also Droved in the Hither-green Hospital.
Nearly all the cases first removed there died; but after antitoxin
treatment had been instituted there was not one death.
The extreme value of this treatment is now so well established
that whenever the Asylums Board- are unable to take
in a case of diphtheria, owing to want of space, the medical
man in charge of the case can obtain antitoxin from them
free of charge. Finding, however, that a serious delay
occurred in many cases, the Board of Works have allowed
me to provide a supply of antitoxin at their office, and also
a syringe, I have written to all the medical men in the
District acquainting them with this fact. The great point
in the antitoxin treatment is, that it should be employed
early in the case, and by keeping a supply at the Board's
Office all delay will be avoided.