London's Pulse: Medical Officer of Health reports 1848-1972

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West Ham 1934

[Report of the Medical Officer of Health for West Ham]

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The number of cases, notified as diphtheria, which were
admitted during the year was 902. The diagnosis was amended
after admission in 125 of these cases, or 13.86 per cent. of the
admissions. One hundred and thirty-one patients were in residence
at the beginning of the year, and the total number under
treatment was 908. Of these, 718 were discharged, 37 died, and
153 remained under treatment at the end of the year. The average
duration of residence of all the cases was 52.67 days.
Corrected Diagnosis:—The 125 cases which proved to be
wrongly diagnosed were found after admission to be suffering
from the following complaints:—Measles 5, broncho-pneumonia
11, bronchitis 1, tonsillitis 67, laryngitis 4, meningitis 2, no
disease 4, stomatitis 1, Vincent's angina 3, debility 1, septicaemia
2, convulsions 1, parotitis ,1, quirrsy 2, septic rash 1, alveolar
abscess 1, gingivitis 1, rheumatism 2, rhinitis 2, pharyngitis 1,
Ludwig's angfina 1, scarlet fever 11.

The cases which were discharged or died are classified as follows:—

Type of Disease.Number of Cases.% of Total Cases.DeathsFatality Rate.
Nasal only12917.0910.77

The faucial cases are again classified according to severity,
as follows:—
Mild 186 or 34.45 per cent.
Moderate 218 or 40.37 „ „
Severe 136 or 25.18 „ „
Paralysis: Post diphtheritic occurred in 72 of the above cases.
It was mild in 44 cases and severe in 28 cases.
Laryngeal diphtheria: 50 cases were admitted as laryngeal
diphtheria, but 22 of these proved to be wrongly diagnosed. Of
the 28 true cases, 18 required operative interference, 3 were relieved
by aspiration, and 15 required tracheotomy; 4 of the
latter proved fatal, one of them had severe faucial involvement,
one was complicated by measles, and the other two developed
Treatment: The amount of antitoxin administered to the mild
cases averaged 13,000 units, and the amount given to the moderate
cases averaged 29,000 units. It was all given by intramuscular
injection to both types of cases. To the severe cases the antitoxin
was given partly by intravenous and partly by intramuscular
injection. The dosage varied from 48,000 units to 312,000 units,