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28
Considering the countless ages which have passed since life has
existed, and since Diphtheria has probably made its appearance,
what sort of gradually acquired inherited racial immunity would
that be which showed no effect for hundreds or thousands of
generations, and then sprang up armed in the present one?
It is possible that the lower fatality and decreased mortality
are due, not to the mildness of the type, but to the improvement in
the methods of treatment and diagnosis. The discovery of
Antitoxin and the appreciation of the importance of its early use
have revolutionised the treatment of the disease. The treatment,
under certain conditions, can be more effectually carried out in a
hospital, inasmuch as the liability of secondary infection is
lessened, and the nursing is of a more skilled character, but the
reduced fatality is not entirely due to hospital isolation.
Another important factor is the improved means of diagnosis.
The bacteriological examination not only enables an earlier
diagnosis to be made, but many cases are now diagnosed as
Diphtheria which formerly passed as "sore throat" or tonsilitis.
For instance, last year, 160 children suffering from sore throat
were sent from the schools for examination, and in 33 of them the
Diphtheria bacillus was found. In the majority of these, the
clinical signs in the throat would not have enabled anyone to
diagnose Diphtheria, and in many of the other cases notified during
the year, the diagnosis was made only after a bacteriological
examination.
The facilities for the bacteriological examination of the
throat are being more and more appreciated by doctors, and last
year 207 swabs were sent by medical practitioners for examination;
72 of these were positive and 135 were negative.
This examination affects the case fatality in two ways; an
increased number of cases are notified, and specific treatment is
earlier carried out.
The age-incidence and the ward distribution of the disease
are given on a subsequent page, and from that it will be observed
that the proportion of children of school age is higher than it has
been for some years. The percentage of school children to the
total notified was 56.4, as compared with 49 in 1912.