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13
In the autumn of 1922 the Ministry of Health issued a memorandum on the
supply and administration of diphtheria antitoxin in which the following paragraph
occurs:—
"It cannot be too strongly emphasised that early administration of antitoxin
not only reduces the mortality from diphtheria, but causes the disease to run
a milder and shorter course; while by lessening the period of the patient's infectivity
to others it reduces the period of occupation of a bed in an isolation
hospital. It is thus an important measure in the interests of economy as well as
of the public health. It should be the aim of every medical practitioner so
soon as on clinical evidence he has diagnosed diphtheria either to have the
patient removed forthwith to an infectious diseases hospital or himself to
administer an adequate dose of antitoxin."
And further:—
"Once the decision is made on clinical grounds that the case is one of
diphtheria, antitoxin should be given forthwith without waiting for the report
of the bacteriological examination."
In June, 1923, a letter was addressed by Dr. Caiger, Chief Medical Officer of the
infectious hospitals service of the Metropolitan Asylums Board, to the Medical
Press, in which, again referring to the paramount importance of giving antitoxin
in the early stages of the disease, it is mentioned that, of 150 cases of diphtheria
which proved fatal in one of the fever hospitals of the Board in 1922, no less than
46 or 30 per cent. died within 24 hours of admission, and 17 more, or 42 per cent.,
within 48 hours. Dr. Caiger says:—
"In view of the almost invariable success of antitoxin, if administered in
the early stage of diphtheria, and the comparative harmlessness of the remedy,
even should its use subsequently prove to have been unnecessary, this record
must be regarded as nothing short of deplorable."
And further:—
"The most frequent source of delay in treatment is the fatal practice of
awaiting the result of bacteriological examination before deciding to give
antitoxin or sending the case into hospital if serum were to be given to
every case of suspected diphtheria at the earliest possible moment before being
sent into hospital, such action on the part of the certifying practitioner would
be warmly welcomed."
The Board recommended on 28th July, 1923, that the Ministry of Health
should consider the question of making it obligatory on the part of local authorities
to keep a stock of diphtheria antitoxin from which medical practitioners could be
supplied on request.
It is the practice in metropolitan boroughs to keep a supply of antitoxin at the
Town Hall. It may be advisable for the authorities concerned to consider the
desirability of utilizing other public places as accessory sources of supply of antitoxin
more especially in those districts in which the Town Hall is not equally
accessible to all parts of the borough.
In considering the reduction in the case-mortality shown to have occurred,
it is of interest to note that, in the autumn of 1910, an order was issued by the Local
Government Board "sanctioning" the provision by sanitary authorities of a
temporary supply of diphtheria antitoxin, and, although no marked reduction in casemortality
is apparent in the figures for 1911, in the two following years a reduction
occurred similar to that above recorded in recent years, but the reduction was not
maintained.
A comparison of the incidence and fatality of diphtheria in the less densely
populated boroughs, which are also largely occupied by the well-to-do class, with the
densely populated and poorer boroughs of London shows that the incidence in the
poorer boroughs among children below five years of age is nearly three times that in
14172 b
Incidence in
relation to
density of
population.