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35
The provision for the sale of Antitoxine at the Vestry Offices
at cost price continues to be much appreciated. The opinion
that the Antitoxine is a valuable curative agent of Diphtheria
is gaining more and more ground each year and the fact may
now be said to be generally accepted by the profession. During
the year 1898, the Clinical Society of London issued a valuable
report upon the subject By comparison of a series of cases
of Diphtheria treated with Antitoxine with another series not so
treated it appears that the use of the serum was marked by a
reduction in the fatality of Diphtheria from 29.6% to 19.5% ; the
reduction was most marked in patients under the age of five years.
The facts certainly now justify the routine employment
of antitoxine. Yet hundreds of poor children in London die
of Diphtheria, who have never had the benefit of this remedy.
The default is sometimes due to the fact that the medical
practitioner is not aware of or convinced as to the value of the
agent, but it is often because of the expense of procuring it.
There can be no gainsaying that the continued prevalence of
this disease is determined to some extent by school attendance.
Apart from statistics, it is a conclusion warranted both by common
sense and experience that the daily aggregation of a large number
of subjects at the most susceptible ages in overcrowded class-rooms,
must, where a disease is concerned which often remains unrecognised,
be responsible for some degree of spread, if the well known behaviour
of the disease within the household continues to hold good.
The Medical Officer of Health (Mr. Shirley Murphy), of the London
County Council, has placed the matter upon a solid statistical
foundation. He has shown that the increase in Diphtheria has mainly
affected the ages 3—10, and that the relative increase of the
mortality at the ages 3—10 commenced with the operations of the
Elementary Education Act of 1870. The effect which the closing
of the schools during vacation periods has in reducing the incidence
of the disease is also susceptible of statistical demonstration.
In view of these facts, and seeing the part schools play in the
dissemination of other infections, the precautions taken in the
interest of the scholars are in my opinion unsatisfactory. The
Medical Officer of Health should be kept promptly posted up as to