[Report 1920] / Medical Officer of Health, Birmingham.

  • Birmingham (England). Council.
Date:
1920
Catalogue details

Licence: Attribution 4.0 International (CC BY 4.0)

Credit: [Report 1920] / Medical Officer of Health, Birmingham. Source: Wellcome Collection.

    22/74 (page 16)
    The percentage of the mortality among patients treated in hospital compared with those treated at home is indicated in the following table ;— Mortality per 100 Cases. City Hospitals. At home or elsewhere. 1905 10.6 17.0 1906 11.1 11.6 1907 10.6 9.6 1908 12.7 13.4 1909 12.0 14.6 1910 10.6 12.9 1911 11.5 10.2 1912 10.2 12.3 1913 16.0 16.3 1914 14.1 13.6 1915 11.1 10.9 1916 8.4 16.7 1917 12.8 17.8 1918 16.0 19.9 1919 10.7 15.0 1920 11.1 12.2 The results of hospital treatment are more satisfactory than they appear to be, because it is almost universally the custom to send severe cases into hospital, while a good many of the mild cases are left at home. There can be no doubt that sufficient use is not yet being made of the laboratory as an aid to the diagnosis of suspicious throat illnesses in children. Only 2,716 swabs were examined either as an aid to diagnosis or as a test of freedom from infection during the whole of the year, the cost of examination being £663 10s. Od. Another ever-present difficulty is that mothers do not call in a doctor sufficiently early in cases of Diphtheria, or the doctor when he is called in does not make up his mind as to the diagnosis soon enough for anti-toxin to be of its greatest use. During the year under review the first case of death from Anaphylaxis Shock after the use of Diphtheria anti-toxin occurred. Anti-toxin has been given freely at all our hospitals during the past fifteen years, and probably no less than 30,000 cases have been treated with anti-toxin without serious result. In the case of the death which occurred on November 27th the patient was a healthy girl of sixteen years of age, who died within fifteen minutes of the dose of anti-toxin being adminis- tered. Before the anti-toxin was given careful enquiries were made from her and her parents as to whether she had previously had anti-toxin. Below is quoted a paragraph from the writings of the late Professor Sir William Osier on the value of anti-toxin and of large doses of it:— “ Dosage.—This is one of the most important questions relating to the use of anti- toxin. J. H. McCollom, of the Boston City Hospital, who probably had a richer experience with the disease than any man in the United States, insisted that the guiding practice in the use of the anti-toxin is to give it until the characteristic effects are produced, whether 4:,00(> or 70,000 units be required for this result. He very rightly said that in the case of a patient ill with Diphtheria there is no way of estimating the quantity of toxin generated by the membrane, and therefore one must administer the agent until the characteristic effect is produced, viz., the shrivelling of the membrane, the diminution of the nasal discharge, the correction of the fetid odour, and a general improvement in the condition of the patient.. No case, he says, in the acute stage should be considered hopeless. When one sees a patient in whom the intubation tube has been repeatedly clogged, when the hopeless condition of the patient changes for the better after the administration of 50,000 units, one cannot help but be convinced of the importance of giving large doses of anti-toxin in the very severe and apparently hopeless cases. In the majority of instances these large doses are not required, particularly if the patients are seen early in the attack, 4,000 to 6,000 units being enough to produce the characteristic effect on the membrane. The initial doses in ordinary cases should be from 3,000 to 10,000 units, and the result must determine the frequency of repetition. In severe cases and in laryngeal diphtheria the first dose should be from 10,000 to 15,000 units, repeated in six hours. The danger is in giving too small and not too lajge a dose.”