Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
[Report of the Medical Officer of Health for London County Council]
The following table shows the main complications which occurred in the 826 cases of clinical diphtheria admitted during the year:—
|Cases admitted||Myocarditis.||Palatal paresis.||Pharyngeal paresis.||Diaphragmatic paresis.||Ciliary paresis.||Strabismus.||Faucial paresis.||Percentage of complications to admissions.|
|1st half of year||371||25 (10 died)||18||-||1||2||3||1||12.0|
|2nd half of year||455||47 (14 died)||27||2||-||1||3||1||17.7|
Dr. Banks states that it is thus apparent that the cause of the increased crude
mortality rate for the year (4 per cent.) is a greater proportion of severe toxic cases,
and that results of treatment of these cases has actually improved. The combined
groups A and B which represent the dangerously toxic cases have risen from 10.1
per cent, to 14.1 per cent, of the total, and the mortality rate of these groups
combined has fallen from 28 per cent, to 26.5 per cent. Laboratory evidence shows
that the increase in the severe cases was associated with the prevalence of the
"gravis" strain of C. diphtheria during the latter part of the year. It is satisfactory
to note that the increased prevalence of severe cases and the accompanying
larger number of deaths were not associated with any increase in the mortality rate
of these cases. Dr. Banks can only attribute this result to the intensive use of
intravenous antitoxin which, with one or two notable exceptions, has proved to
be reasonably satisfactory for the "gravis" type of case in the London district.
The medical superintendent of the Brook hospital (Dr. Armstrong) has reported
The type of case admitted has remained severe although the fatality rate (3.02 per cent.)
is a little lower than last year when it was 4.0 per cent. In no less than 24 of the fatal cases,
toxic myocarditis following faucial diphtheria was the determining cause of death; 5 deaths
occurred as a result of laryngeal diphtheria and one as a result of measles complicated by bronchopneumonia
Of 136 cases of bacteriological diphtheria under treatment during the year, 2 died, one aa
the result of scalds received before admission and the other from Neimann-Picks disease.
In the hope of reducing the fatality rate of faucial diphtheria, many more cases than before
have been given intravenous antitoxin and glucose on admission. Towards the end of the year,
however, a very serious type of toxic faucial diphtheria began to show itself, against which even
the most intensive intravenous therapy seemed to be of no avail. Even when admitted at a
comparatively early stage of their illness, some of these cases failed to show any real response
to treatment and rapidly progressed to a fatal issue. The day of disease on which the 24 fatal
cases of faucial diphtheria came under treatment is shown below:—
4 came under treatment on 2nd day of disease.
4 „ „ 3rd „ „
10 „ „ 4th „ „
4 „ 5th „ „
1 „ „ 6th „ „
1 „ „ 8th „ „
6 of these cases died within 24 hours of admission.
11 „ „ during first week in hospital.
7 „ „ during second week in hospital.
The following table shows the main complications which occurred in the 826 cases of clinical
diphtheria admitted during the year:—
1st half of
2nd half of