DIPHTHERIA

Evening Post, Volume CVII, Issue 104, 3 May 1924, Page 13

DIPHTHERIA

"ASSASSIN OF CHILDREN"

ITS PREVENTION AND CURE

POSITION IN NEW ZEALAND.

Medical authorities in their work on diphtheria have found that not a single death from, this disease need, occur: (1) If every child bo protected against diphtheria by the proper, administration of toxin-antitoxin on its first birthday ;{Z) if the doctor is called in early when a child is sick; (3) if the diagnosis, is .made early; (4) if a sufficient .amount of antitoxin is administered early. ■■.-..■■ During the five-yearly period 1919-23 a total of 12,492 cases of diphtheria corresponding to an average annual rate of 20.59 per 10,C00 of the mean population, were reported to the New Zealand Health Department. For the same period the. deaths totalled • E05,: equal to an average annual rate :of 0.83 per 10,CCO of the, mean population. . " Little' progress has been made in the last twenty years until quite recently to control this' disease. The death rate from diphtheria for the quinquennium 1896-1900 was 0.78; in other words, the disease is apparently more fatal to-day than it was twenty years ago, notwithstanding" recent' discoveries of medical science.... ' Diphtheria, is, !in the main, a disease of. childhood. This fact is brought out clearly, in the table below, which' sets out the notifications and deaths by ago periods for the; years 1920-22:-^-DIPHTHERIA IN NEW ZEALAND. Total Notifications and Deaths by Age ■Groups fof Period 1920-22. 4 /."

If .it be- remembered . that the rige group 5-15 comprises the. .school population, and tl la (, children aged 0-5 who contract -diphtheria are frequently infected by brothers or sisters •of schooL age, it is at once obvious that the 'school is the key of .'the situation. . ': ■• - , •: ■;- The next table is of-considerable interest, as showing the number and percentage of cases of: diphtheria 'treated in , public hospitals during the period 1917-22.:—. , . : ..:;-;:. , : - \,. ' Total Notifications and Proportions ''.■ Thereof Treated "in Public' Hospitals "■. for Period 1917-22..-:. ■■ ■

.-■ -The. various figures quoted are sufficient to show the importance of" diphtheria both as a .cause of mortality and morbidity. -The/amount of sickness and suffering caused by this disease is, in the mass, enormous. ' ITie interference with school .; attendance is a"t times considerable. , The economic loss, also is most serious, as can be shown by a simple calculiitioh, the average duration, of stay inhospitals; of .such cases andthe aveiage cost-of. maintenance while in hospital being known.. . .■.■■■ . " .

"The iverage- duration: of stay, in hospital -of diphtheria leases- is tout .weeks. The averaged cost of maintenance is. £2 per week. The. cost of treatment in hospital ;of diphtheria cases, for,; the. period 1917-22 inclusive'-was 'therefore £2 multiplied by 15,541 multiplied by four equals £124,328, or/an average figure of £20-721 i-er annum.- . • . : ■'-■

BLACK ENEMY OF CHILDHOOD

."Not so. many years .ago," writes; an American authority,'■"diphtheria, was the black enemy of childhood. All over the world it . claimed.. a •frightful toll. And the tragedy was that three-quarters of its victims were'-^little tots under six— hai-dly more than" babies. Swiftly it struck; with deadly result—-without'warn-ing-f-andl there was no sure way to combat it. Then came anti-toxin. Children—who., received this; treatment at once enjoyed ■ a better chance in their struggle for '■•.life:. The diphtheria death rate, was .'lowered. But anti-toxin1- is effective only after diphtheria develops.; It checks, the progress of the disease, bufi' it does notgive Tasting protection.

TRIUMPH OF MEDICAL SCIENCE

Now. comes.a great 'triumph of medical science—the ,-preveni.ion of diphtheria. To-day, eminent, specialists state positively: and denfmitely that through modern preventive treatment diphtheria can be. stamped out..- Some .children are able, to resist, the- germs of diphtheria. Others are hot. The' wonderful discovery of Dr.. Schick, of, Vienna,, is now being used to show which, children need protection—which are -. susceptible and which are not. The Schick test '^consists, in giving, the child a tiny injection in the skin of the arm. If, alter a few days, a red spot appears, where the injection ; was made, the child is sub-: :ceptible. If no spot appears, the child ■is immune^ . . '.-' .■■■'■ < -

■ Children.who show by the Schick test that they are liable to diphtheria can be given at the toxin-antitoxin preventive treatment. This treatment.consists ;ot three injections of. toxin-anti-toxin, one each week for'three weeks.

The Sphick. test,does not make the child >immune,-but authorities agree that the toxin-antitoxin does.; Experience shows that .both test and treatment are 'painless and harmless. ■ '■:.■.. ...

WHAT IS DIPHTHERIA?

.: .Diphtheria is the: foremost fatal disease in children from three to five years of age. V Diphtheria is \a ■ highly contagious or catching disease, and is caused by a germ.; It-is spread by contact with a person' who,: has virulent diphtheria germs in his noseoi- throat. -

/'. DIPHTHERIA CARRIERS. There is another class of people known as carriers. They are persons who are immune to.their own germs, but if the' germs are passed on to. another person who has little, or no resistance,, the person in contact may collect the germs arid contract the disease. The diphtheria carrier is the most fruitful, source ot spreading diphtheria., In groups of children, such as in schools where there have been no cases of recent diphtheria, it is found that two out of every 100 children, have, diphtheria germs in the throat and may run as high as ten out of every ICO in groups where there have been recent cases of diphtheria. As in diph-" thena, diphtheria carriers are diagnosed by' nose and throat cultures. ° ' OTHER SOURCES .OF INFECTION. Diphtheria may also be spread- by mzlk, if same is not pasteurised. Someone who harbours x virulent type of these germs may contaminate the milk by the spray from his nose or throat, or with his hands or fingers soiled' with secre: tions from nose or mouth. Occasionally ■ tl:o germs may attach themselves to clothing, bedding, eating utensil 3 etc., and thus tie cairied on to a susceptible pei-auii and cause, a case of diphtheria. ■ . . " . . r TREATMENT. : . : ' Prior to "1886, when a sickness was diagnosed .as diphtheria, it usually meant

death. In 1896 antitoxin as a cure for diphtheria was introduced. Tt was one of the most remarkable discoveries in medicine. As soon as diphtheria antitoxin became generally accepted and used as the proper treatment for diphtheria, the death rate began to fall, and has remained low as compared with the period prior to 1896. ... -.. „'. To-day it is known that there is but one curative treatment for diphtheria, and that is antitoxin. Not only is the antitoxin of importance, but also the time of administration' and the amount given affects .immediately the result. It has been shown that if antitoxin is administered early, that is, within the first twelve hours, and in sufficient dosage, there will not be one death from diphtheria.

Diphtheria antitoxin is also of value in protecting persons exposed to active cases of diphtheria. Its action ' is' immediate. Diphtheria antitoxin is not harmful or injurious in any way:

IMMUNITY AGAINST DIPHTHERIA,

Greater than the discovery of antitoxin are the methods provided by medicinal science to protect the young and old against the ravages of diphtheria by means of diphtheria toxin-antitoxin immunisation. Toxin-antitoxin is' a serum composed, of diphtheria poison . almost neutralised by diphtheria antitoxin, arid is capable of stimulating the production of more antitoxin. Its results fill one of the most brilliant pages of medical history. The method is safe, sure, and simple. It is an absolute .protection against diphtheria provided that •: it is administered until'a negative Schick test is. produced.1' The duration of the'protection against diphtheria is for not less than six years and probably for life. Toxin-antitoxin should be given to every susceptible child from one to twelve years of age. ; ;■•'■■.' ■ : .

iving toxin-antitoxin to school chilCi2ii not only acts to prevent their'contracting diphtheria, but also lessens the. exposure of. children, of^pre-school age to active cases of diphtheria in their families. In America the work of diphtheria immunisation) in. schools is restricted to the children in the kindergarten and .first grade classes. Only, children are given this protective treatment whose parents consent, i " ' ' : . . ■■-, V'I ..SUMMARY. :. ■'.: . 1. Diphtheria: is preventable. ,'. 2. Air children under 14 years of age should be teste^ for susceptibility to diphtheria. ■ ... , '. ■ '..:■" •■ 3. Have your children, of the ages, of from.one to! 14. years who show suscep tibility, to. diphtheria iirimunised against diphtheria. : , ' : . ■ . ; . . 4. Toxin-antitoxin is the 100 per cent: preventive of diphtheria. ... , ■" ' STEPS': ;IN NEW ZEALAND. . -.' The New Zealand Department of Health has been keeping in close touch with these' latest developments, and has indeed made trial of the methods outlined above. The earliest adoption of those methods in New Zealand, so far as is known, were in 1919, when the Health Department immunised in this way the residents of an institutional school in which diphtheria had been ,endomic for some .time. Since then, the method has been used for' the immunisation of one school in a suburb of Dunedin. and two schools, in Hamilton. The results' have in each case been most' encouraging. The Health Department is desirous of pressing on with this phase of its work, and hopes in .the near future to be able to offer to the school population' in all parts of the Dominion this method of protection against a most formidable disease. -. "■'.. _ ■■' ■-.-■■' ';■'.' ■' .'■ '■'■■ ■

O-.S -. Cases 1744, deaths 137. 5-10. ....;....... Cases 2310, deaths 88. iO-I5 ..,........:; Cases 1028, deaths 19. L5and over ... Cases 1960, deaths 25.

..-.•■■• . Cases .-.-V Cases : . Year. not.fied. .. , treated. rercentagc. ,917 .',... 5,458 ' 4,122 . 75.5 L918 ..... ''5,539 ' . 4;430 ' EO.O : L919 ....." 3,499 .■■;■■ 2,221-:-, 63.5, 1920 :....: 2,442 ■ 1,669 ,921 ..•■• 2,611 1,722 ■■' 66.0 l922 ;....: : ; 1,989 -.., 1,377 ■- 69.2 ■Totals ill,538v : ■15,541:' 70.4