The treatment of acute failure of the heart / [J.D. Rolleston].

  • Rolleston, John Davy, 1873-1946.
Date:
[1907]
Catalogue details

Licence: In copyright

Credit: The treatment of acute failure of the heart / [J.D. Rolleston]. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    8 had antitoxin been withheld? Surely not. In the pre- antitoxin era,4 even when the cases were brought under treatment at the very onset of the disease, the mortality was never less than 28- 8 per cent., and not infre- quently rose to 50 per cent, or more. Since age is an important factor in the prognosis of diphtheria it is well to say that the majority of my cases were children : 68 were between the ages of 0 and 5 years (14 deaths), 73 between 5 and 10 years (4 deaths), and 28 were 10 years old and over (1 death). The comparatively low death-rate cannot, therefore, be explained by saying that the patients were adults in whom the mortality of diphtheria is notoriously low. Nor can the low mortality be attributed to the mildness of the cases, as will be seen from the following classification: 17 were very severe (10 deaths) ; 51 were severe (9 deaths); among the remainder, which were classified respectively as “ moderately severe” (17 cases), “moderate” (35), “mild” (40), and “very mild” (9), no deaths occurred. These figures also show that a late case is not synonymous with a severe case, every form of the disease being represented. It is important to realise that the evolution of diphtheria may be either rapid and malignant, so that even large doses of antitoxin given on the second day of the disease may not avert a fatal issue—the mortality among my second day cases was 3 * 08 per cent.—or comparatively slow and benign, so that the disease which may have been in progress for a week yields rapidly to a small dose of antitoxin, no subsequent complications ensuing. Though fully substantiating Dr. Bolton’s remarks on the importance of the early administration of antitoxin, I 4Baginsky: Diphtherie, p. 312. Cf. Metropolitan Asylums Board's Reports prior to 1894.