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91
The medical practitioners in the Borough have been circularised
on this matter, and a copy of the following memorandum
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 consisting 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 doses 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 bv
a further dose if no distinct improvement occurs.
Larger initial doses, e.g., from 16,000 to 30,000 units,
are specially required when for any reason the administration
of antitoxin has been delayed until the third or fourth day
from the onset. The need for further administration will be
determined by the progress of the disease, on the lines just
indicated.' "