EVEN TO-DAY IT TAKES TOLL.

Star (Christchurch), Issue 17865, 5 June 1926, Page 8

EVEN TO-DAY IT TAKES TOLL.

DIPHTHERIA STILL DREADED, THOUGH GERM IS KNOWN. MAY BEGIN WITH TRIVIAL ILLNESS. (Special to the “Star.”) Published under the authority of the Health Department. Even to-day diptheria is justly regarded as ont of the most dreaded diseases of childhood, but in earlier years its appearance in a community brought calamity and terror. Discussion and arguments were waged as to its identity and cause, until in 1883 the special germ of the disease was discovered by Klebs, and in 1884 was grown in culture by Loeffler. When the enemy was thus detected and the plan of campaign revealed it became possible to fight it and nowadays there are few diseases concerning which we know as much as we do of diphtheria, or which we can attempt to prevent and control more hopefully. Yet even to-day diphtheria takes serious toll of a population. Thus in New Zealand for the last five years there have been 10,786 cases of diphtheria with 380 deaths. While diphtheria is present the whole year round, it is more common in winter months. It occurs more frequently among children than among adults, children under five years of age being most readily affected. Each new case of diphtheria is derived from a previous case or from a “diphtheria bacillus carrier”—that is, an apparently well person who harbours the diphtheria germ in his nose, mouth or throat. The infection is caused either by direct contact, as by kissing or being sprayed with moisture thrown out in the act of coughing or sneezing, or indirectly through the agency of various objects which have been contaminated by infected persons.

SYMPTOMS OF THE DISEASE. While diphtheria may affect other regions of the body, the usual sites of the disease are the tonsils and throat, hence the most characteristic symptoms are sore throat accompanied by rapid pulse and fever, and the formation of a membrane spreading over the throat. In the early stages the symptoms resemble those of a common cold and as young children may not complain of sore throat it is necessary to realise that an apparently trivial illness may be the beginning of diphtheria, and no time should be lost in calling medical advice. As the site of the disease is not invariably the throat, it does not necessarily follow that because there is no membrane on the throat there is no diphtheria, and for this reason also medical advice should be obtained in any suspected case. DIPHTHERIA ANTI-TOXIN. There are few diseases, where early treatment is so efficacious and so fraught with hope as in diphtheria. There is no disease also in which early diagnosis and prompt treatment are more essential. We have at hand a powerful antidote in the serum, commonly known as anti-toxin, one of the greatest triumphs of preventive medicine. Were it possible to apply this remedy in sufficient doses and early enough in all cases, mortality from diphtheria would almost vanish. As it is the disease has been robbed of much of its former terror. Given in the early stages of the disease, diphtheria anti-toxin is a powerful weapon in cutting short the disease. Given to contacts, that is to say, people who have been exposed to infection from diphtheria, it affords a temporary protection against it. Unfortunately this protection lasts only for two or three weeks, and leaves the individual at the end of that time as susceptible to the disease as ever. The chief difficulty in the prevention of diphtheria has been the great number of healthy persons who carry bacilli in their throats. In the winter season, it has been found that more than 1 per cent, of our population are diphtheria carriers. It is manifestly impossible to isolate such large numbers, even if it were not utterly hopeless and absurd to attempt ever to examine the entire population in order to detect all carriers. These carriers transmit the disease in spite of all that has been previously done to prevent it and a susceptible person, especially a child, coming into association with a carrier, is likely to fall victim to diphtheria. In view of the fact that children are necessarily exposed to the risk of infection from diphtheria it would obviously be an advantage were there any means of conferring upon them an immunity, that is, a permanent power of resistance to infection. Fortunately, the new means for dealing with the situation is now available. It is now possible to protect a child from diphtheria in the same way as vaccination protects against smallpox. This may be done by giving him an injection of a vaccine (toxin antitoxin) at weekly intervals for three weeks, which confers practically an absolute immunity to diphtheria. Thousands of children every year in England and America receive this treatment with the effect that the incidence of diphtheria is greatly lessened thereby. Preventive treatment for diphtheria by toxin anti-toxin had until the last year has been carried out in only a few selected schools and orphanages in New Zealand. It was felt right, however, that this means of defence should be made more widely available. In certain areas where outbreaks of diphtheria have occurred frequently, therefore, meetings of parents were held last year and addressed by school medical officers on this question. Arrangements were made for children to receive immunisation. No child was given immunisation without the written consent of the parent, treatment being in no way a compulsory one, as it appeared wiser to merely educate the public by administering the benefit of the treatment rather than to antagonise them by enforcing a measure which they did not fully comprehend. Approximately 1100 children were immunised during the period April to December last year. Except for a temporary slight illness, in a few cases treatment was carried out with little inconvenience. A satisfactory feature of the work was requests from several school committees that the children attending their schools should have the benefit of treatment. The necessary material for carrying out immunisation for diphtheria will be supplied free to medical practitioners on application to the Health Department. An important point in considering the preventive treatment for diphtheria by the use of toxin anti-toxin is that the immunity obtained by this method is not conferred immediately, taking about three months to develop. It is not to be regarded, therefore, as an emergency measure for immediate use after exposure to infection. When there is any reason to suspect the presence of diphtheria ) n , e ' k——medical advice must be lmmedi-

ately obtained. This is necessary fbr the sake of the sufferer, as safety is mainly assured by the immediate use of anti-toxin, and it is also necessary for the sake of those brought into contact with the patient, who may be given. an immediate (though temporary) immunity by receiving anti-toxin treatments.