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46
The table on the succeeding page demonstrates what need not
be further laboured :—the progressive diminution of cases of the
grave infectious diseases in the district during the last decade, in
spite of the urbanization of the locality, the increased facility of
communication, and the growth of the population : that on the page
following affords some estimate of the work of the Isolation
Hospital, so far as it may be judged by the case mortality.
The improvement in the results of the treatment of scarlet
fever I attribute mainly to the routine use of salicylates, and to the
recognition of the frequent coincidence of diphtheria as a secondary
or symbiotic infection, before admission, in many cases commonly
put down as septic scarlet fever.
The very low case mortality from diphtheria shewn in 1901 is
explained by the fact that in the early part of that year a number
of cases were admitted, very properly no doubt, but of a very mild
type. The cases tabulated for later years are cases passing both
clinical and bacteriological investigation.
The relative infrequency of diphtheria now-a-days is unfortunately
a cause of hesitancy on the part of many medical men in
dealing with the disease. A child is seen with croupy symptoms.
The medical man in attendance recognises the danger, administers
antitoxin, and within a few hours the child is apparently well again.
The doctor, whose promptness has probably saved the child's life,
bears the odium of being labelled an alarmist, and earns the
undying hostility of the child's parents.
In another case the medical man, less decisive in his methods,
waits till death is impending before making a diagnosis. There are
a few hours of confusion and anxiety, much futile administration of
remedies, and perhaps death-bed tracheotomy. The relatives are
quite happy, and complacently assure each other that "everything
has been done."