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4
"Let me illustrate what this means by an example. In the three
years 1892-3-4 I find that there were 8,523 persons admitted into the
Board's hospitals, among whom the mortality averaged 25.6 per cent., so
that there were 2,181 deaths.
"If the antitoxin treatment had been used at this period it is fair to
assume that the fatality (16.7) which obtained in the years 1895-7 would
also have obtained then, and consequently the number of deaths, instead
of being 2,181, would have been only 1,423. Thus there would have been
a saving of 758 persons from death.
"These are strong arguments in favour of the antitoxin treatment in
hospitals.
"The saving of life would, moreover, have been still greater if only
all the cases were treated by antitoxin at the earliest possible moment of
the attack. This has been clearly proved by the statistics of all hospitals,
home and foreign alike.
"Hence the anxiety of the Metropolitan Asylums Board, that, where
delay arises in the admission of the cases to their hospitals, practitioners
should be in a position to obtain a supply of antitoxin, and therefore the
Board is prepared to supply it.
"A word as to the cases treated at home. These have invariably
shown a lesser fatality than those which are treated in hospital, firstly
because they are, as a rule, of a milder type—only the graver cases going
to hospital—and secondly because they include cases of mistaken
diagnosis.
"Now the home fatality in London in three years (1892-3-4) was
215, 23.7 and 24.5, or an average of 23.2 per cent., whereas in the next
three, or antitoxin, years (1895-6-7) it was 23.3, 2T3 and 201, or an
average of 21.6 per cent. In other words, whereas 232 out of every 1,000
cases died in the former period, 216 died in the latter, indicating a saving
of only 16 lives. The fact is that the treatment is not generally available
for the home patients, and is not pursued. The cause of this is that the
general practitioner is not placed in a similarly fortunate position to the
hospital physician, who has the remedy always at hand.
"I have, therefore, been approached on this matter by Dr. J. G.
Glover, one of the elected representatives of the Medical Profession on
the Medical Council of the United Kingdom, who has suggested that the
Vestry, as the Public Health Authority, might keep a stock of serum at
my office. Also that it should be on sale to any member of the medical
profession who required it for the treatment of Islington patients. He
attributes a great deal of the home mortality which takes place in London
and the country to the difficulty of obtaining supplies of antitoxin.