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41
For one reason or another, antitoxin is not always administered
as early or as generally as it might and should be where houses
fully occupied become infected; and it is no uncommon experience
to find that in cases where there has been illness for several days,
under circumstances strongly suggesting Diphtheria, the precaution of
a prophylactic dose of antitoxin has not been taken. Doubtless, the
question of expense. must often arise, and in order to meet this
many Sanitary Authorities supply, free of charge, a small amount
of antitoxin for occasional use in necessitous cases. The power of
the Sanitary Authority to make this provision, more especially for
its employment from the curative standpoint, has been called in
question, but I do not believe the local authorities have been surcharged
on this account. During the past year, however, the Local
Government Board has placed the matter on a satisfactory basis, by
issuing an Order authorising this provision of antitoxin for both
curative and prophylactic purposes. It is to be hoped that Sanitary
Authorities in the county will avail themselves of this power, for the
prompt administration of the remedy, before patients are removed
to hospital and pending report of the bacteriological examination of
swabs taken from the throats, often goes far in the direction of
preventing a fatal termination to the disease.
Of the cases admitted to the Metropolitan Asylums Board's
Hospitals in 1908, when antitoxin was given on the first day of
illness, only 3.0 per cent. died; when given on the second day, 6.5
per cent. died; on the third day, 10.6 per cent.; on the fourth day,
12.9 per cent; and on the fifth day and later, 14.8 per cent.
Diphtheria has a relatively long epidemic wave lengtli, as
compared with other infectious diseases, so that when an outbreak
of Diphtheria occurs in a community, the disease not uncommonly
remains unduly prevalent for several consecutive years; and it is
remarkable how a small community may be attacked by this disease
for a great many months, while an adjacent community, placed under
almost exactly similar circumstances and quite adjacent to the community
attacked, may escape altogether.