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81
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 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.
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 by a
further dose if no distinct improvement occurs.
Larger initial does, 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.'
In 1920, when the Asylums Board were pressed for accommodation
during the last quarter of the year, medical practitioners were
advised to administer the maximum dose of antitoxin, but even in that
year only 82 bottles of antitoxin of 2,000 units each were requisitioned.
The number of applications for antitoxin last year increased, 239
bottles of antitoxin of 8,000 units each being supplied to medical practitioners,
as compared with 92 the previous year.