View report page

99
Antitoxin can be obtained at any time by a medical practitioner
on applying to this department during office hours, and
after office hours to the resident hall porter.
It has been my experience that not only is the mortality
increased by delay in injecting antitoxin but that paralytic and
other complications are far more likely to occur.
A circular memorandum as follows was sent in February,
1922 to the medical practitioners in the borough and a copy is
issued with each dose of antitoxin:—
"The Ministry of Health suggest that Medical Officers
of Health should arrange to send out with each phial of antitoxin
a slip stating that the whole of the contents of each phial
of 8,000 units of antitoxin should be regarded as ordinarily
constituting a single dose for a patient of any age.
The 'Ministry state that 'Experience has shown that for
the purposes of treatment it is seldom safe practice to rely
on any dose which is less than 8,000 units, whatever the age
of the patient may be. The magnitude of the initial dose and
the occasions on which subsequent closes are given must be
determined by close observation of the case, and it is impossible
to lay down a stereotyped procedure. As an
indication it may be stated, especially from the experience of
Metropolitan Asylums Board Hospitals, that when in a case
seen early in the attack an initial dose of 8,000 units (16,000
or more if the case is severe), is followed by definite improvement
at the end of about 12 hours, further administration of
antitoxin is unnecessary. On the other hand, if at the end of
about 12 hours (or sooner in urgent cases), there is no
evidence of improvement, or it is clear that the disease is
advancing, a second dose of similar magnitude should be
given, followed by a further dose if no distinct improvement
occurs.