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Diphtheria.
Very little change has occurred in either the incidence or
fatality of this disease. Though the admissions were somewhat
lower than in the previous year, the deaths numbered 33 as compared
with 29 in 1928.
It has now become a firmly established practice among the
majority of medical practitioners to swab every suspicious throat
and wait for a bacteriological report before notifying the case or
administering antitoxin. This is to be regretted, not only on
account of the delay in giving antitoxin, but because the bacteriological
reports are not always reliable, and do not justify the
faith placed in them by practitioners and the general public. Not
infrequently the swab has proved negative in cases which have
been suffering from virulent diphtheria. Two such cases, one of
which proved fatal, occurred during the year. The following are
brief details of the fatal case:—
A practitioner was called on a Tuesday to see a boy aged 7
years suffering from sore throat. He thought the condition very
suspicious of diphtheria, and took a swab. He intended to visit
the patient on the following day, but just as he was setting out on
his rounds he received a report that the swab was negative, and
then decided that a second visit was unnecessary. He did not see
the patient again until the following Friday, when he received an
urgent message from the parents stating the boy was worse. On
this visit the doctor found the whole of the fauces covered with
thick membrane, and the patient in acute distress from laryngeal
obstruction. He was admitted immediately to hospital, where
tracheotomy was performed, but he died 3 days later.
Much better results would, I think, be obtained if practitioners
relied entirely on their clinical diagnosis, and in doubtful cases
either administered antitoxin or sent the patient into hospital.
106 cases were in residence at the end of 1928. 830 cases,
notified as diphtheria were admitted during 1929, and 741 of these
proved to be suffering from the disease, making a total of 847
cases under treatment. Of these, 723 were discharged recovered,
33 died, and 91 remained under treatment at the end of the year.
Of the cases discharged, 51 suffered from paralysis which was of
a mild character in 29 cases, and severe in 22; cases.
85 of the cases were notified as laryngeal diphtheria, and 67
of these proved to be rightly diagnosed. Tracheotomy was performed
in 31 of these cases,' and 10 of them proved fatal, giving a
fatality rate of 32.25 per cent. of the cases operated on which compares
with 12.3 per cent. in the previous year. The average age
of all the cases was 3 years, and the amount of antitoxin administered
to them averaged 24,000 units.
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