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disturbance in the very early stage may be actually very much less
in a case of diphtheria, and for that reason, amongst the poorer
classes, there is hesitation in sending for medical assistance until
the illness assumes more formidable proportions, and with every
day that passes without the administration of anti-toxin, the prospects
of a satisfactory termination rapidly diminish. Everything
has been done in this district to facilitate the provision of antitoxin
at the earliest possible moment. Cases supplied with sterile
syringes in alcohol, with 4 vials of anti-toxin (each of 8000 units,)
alcohol, and cotton wool, are kept at the Police Stations at each end
of the district, available at any hour of the day or night.
Personally I am beginning to have grave doubts as to the
wisdom of assisting practitioners by bacteriological diagnosis. I
am convinced that many a case loses its chance through waiting
for the result of a swab. Here we are in the fortunate position
that with our bacteriological laboratory, the result of a swab is in
the possession of the practitioner bv the next morning, so that the
delay in receiving the report is reduced to the minimum possible,
and yet I am still doubtful as to whether it would not be wiser to
discontinue this facility entirely, if that might lead to cases being
determined more on clinical grounds, and the doubtful cases
getting the necessary anti-toxin. Even to-day, it may almost
seem incredible that there should be one moments delay in the administration
of anti-toxin in cases which may be regarded with any
degree of certainty as diphtheria, but yet one still comes across
cases where this delay has occurred.
The investigation with regard to the treatment of diphtheria
has within the last few years made much progress. It was pointed
out by Schick in America that it would be possible as a result of
injecting into the skin a form of diphtheria toxin to produce a
reaction in people who were susceptible to diphtheria.
Unfortunately in the very early days certain experiments were
carried out in some countries, particularly on the Continent, in