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69
bacillus. The urgency of early diagnosis and treatment is thus
apparent. It is not easy, admittedly, to discriminate between the
early diphtheritic lesion and the numerous forms of tonsillitis met
with in general practice. Nevertheless, it would appear that too
much importance is often attached to bacteriological diagnosis
in cases where, on clinical grounds alone, a diagnosis of diphtheria
would be justified.
Of the cases admitted, the number of deaths was 41, givinga
total death rate, for completed cases (358), of 11.4 per cent.,
compared with 10.6 per cent. for 1933. An analysis of the fatal
cases is as follows
Seventeen cases were hæmorrhagic.
In two cases certificates of death were furnished by medical
practitioners as the patients died a few hours after admission.
In a number of fatal cases, death was determined by some
co-existing condition, but the deaths were attributed to diphtheria
in accordance with the Registrar-General's Classification of
Causes of Death. These cases were as follows:—
1. Nasal diphtheria and broncho-pneumonia.
2. Nasal diphtheria, septicaemia and measles.
3. Diphtheria and retropharyngeal abscess.
4. Nasal diphtheria, broncho-pneumonia and measles.
5. Nasal diphtheria, infective endocarditis and
pneumonia.
Owing to the severity of many of the cases, large doses of
antitoxin were administered, many patients receiving as much as
100,000 units.
Intravenous injection was frequently resorted to.
Tracheotomy was performed in two cases. In the first case,
the laryngeal obstruction was secondary to severe faucial infection.
The patient made a good recovery and left the hospital
in 58 days. In the second case, tracheotomy relieved the obstruction
but the patient died the following day. Post-mortem
examination showed the presence of a broncho-pneumonia
secondary to a foreign body in the larynx.
One unusual case of diphtheria was complicated by an acute
nephritis and urgemic convulsions. The patient, however,
recovered.