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anti-toxin was given within 36 hours of the onset; in spite of this
the patient died. We have been used to a rapid improvement and
recovery when anti-toxin is administered early, especially when the
disease occurs in older children. The early cases in the autumn were
in older children; of the deaths which occurred, 2 were aged 12
years, one 11 years, one 10 years and two 8 years. As previously
stated, most of these were admitted in a comparatively early
stage of the disease. In these older children anti-toxin was given
intravenously and in large doses. There is always a tendency to
blame the therapeutic agent placed in our hands when we are face
to face with an outbreak of Diphtheria, but these details are
mentioned not with the object of finding fault with the anti-toxin,
but to emphasize the difference in the reaction of these cases to
treatment as compared with that observed in the ordinary way. It
cannot be said that these children would be peculiarly liable to a
fatal result if attacked by any serious illness. The children in these
particular schools would compare favourably not only with the
children in the other schools in the district, but with those of any
elementary and secondary school in and around London. We are
forced to the conclusion that in the present instance the type of the
disease was a very virulent one and this virulence was probably
caused by an exaltation of virulence in the germ.
The other factor which might have been operative was a low
communal immunity. In the present century much attention has
been paid to the study of epidemics, and the conditions under which
outbreaks of infectious diseases occur, and in order to appreciate
the importance of certain procedures which have been adopted to
prevent Diphtheria, it is necessary to take a wider view of the subject.
Diphtheria is not a disease of modern times, but until late
in the last century it was confused with other diseases. The
discovery of the Klebs Loeffler bacillus in 1883-84 contributed
towards the correct diagnosis of the disease. Ten years later antitoxin
was discovered and this affected mortality from the disease
to an enormous extent.
From 1895 onwards, the use of anti-toxin became general
and although other factors may have operated, the introduction
of anti-toxin has been one of the principal factors in the reduction
of the fatality. For nearly 30 years there was a continuous decline,
but in the last 10 years the mortality from Diphtheria has been
almost stationary. On account of the smaller population our deathrate
has been different from that of the rest of the kingdom, but the
tendency has been a downward one.