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37
Sunday she appeared fairly normal, possibly a little listless, which
would be accounted for by the activities of the previous day. On
Monday morning she complained of a sore throat and vomitted, and
a doctor was called in. He examined the throat and took a swab.
Some people might blame him for this, but hav ing had experience
of these graver forms, and that there were at the time none of the
characteristic signs of diphtheria in the throat, we do not think he
was in any way to blame. He was again sent for in the afternoon
and when he arrived between 4 and 5 the picture had entirely
changed. The tonsils and soft palate were swollen, the glands of
the neck swollen, and the child was obviously desperately ill. He
sent her to hospital at once, but on arrival her condition was hopeless,—bull-neck,
foetid breath, profuse nasal discharge, grevish
toxic appearance of throat. She died about 8.30 p.m.
A boy of 16 years, a pupil at a local secondary school, was
admitted to hospital one morning. He was quite definite that his
throat was first sore on the previous afternoon at school. The illness
was thus of less then 24 hours' duration and yet on admission
to hospital a thin membrane extended over the fauces and soft
palate and there was a profuse nasal discharge. The glands in the
neck were also very large. The boy was given 80,000 units of antitoxin
intravenously immediately and the dose was repeated the
same evening. In spite of this he died within 48 hours of the first
onset of sore throat.
Another boy of 15 years was admitted to hospital on the same
night as the previous boy. He had a history of sore throat commencing
that morning. There was a patch of membrane on each tonsil
but no further extension. In view of the fact that he attended the
same school as the previous boy, he was given 56,000 units of antitoxin
intravenously on admission at 10 p.m. The following morning
at 9 a.m. the membrane had spread on to the soft palate and
into the nose, and the glands of the neck were very much swollen.
The dose of antitoxin was repeated and, as the membrane still apappeared
to be extending, that evening another dose of 50,000 units
if antitoxin was given. This boy ultimately recovered.
I have mentioned these cases as examples, but we have had
many others in which the symptoms had advanced almost as rapidly,
and where death had occurred in a few days after admission, in spite
of the intravenous administration of 80,000 and 100,000 units of
antitoxin. In the graver forms of diphtheria, fatality is not going
to be abolished or even greatly reduced by means of antitoxin treatment
alone ; our hope lies in immunization as a means of prevention,
and our experience of immunization since we started in 1932 may be
of interest.