Appendix to Third report of the Commissioners : minutes of evidence, April to July, 1907.
- Great Britain. Royal Commission on Vivisection (1906)
- Date:
- 1907
Licence: Public Domain Mark
Credit: Appendix to Third report of the Commissioners : minutes of evidence, April to July, 1907. Source: Wellcome Collection.
224/272 page 218
![Martin, M.B., D.SC., F.R.S. 10 July 1907. 218 11730. You go on to distinguish between diphtheria and the laryngeal cases which, you say, are in the nature of diphtheria. Will you tell the Commission what is the effect of the serum treatment upon the mortality of laryngeal cases ?—In a certain proportion f cases the local inflammation of diphtheria, which commonly commences in the throat or nose, extends to the larynx and trachea. This extension increases the gravity of the case, both owing to the larger surface involved, and to the frequent interference with the entrance of air through the narrow orifice in the larynx. To prevent suffocation laryngeal cases com- monly require tracheotomy or intubation. The mortality of laryngeal cases has always been much higher than the mortality of those in which the local manifestation of the disease was confined to the nose or throat. In testing the effect of antitoxic treatment upon laryngeal diphtheria there is therefore no ques- tion of the inclusion of an unusual proportion of mild cases, so that the mortality of laryngeal cases before or after the introduction of the treatment may safely be compared, and any improvement in the death rate placed to the credit of the antitoxin. Statistics of cases of diphtheria requiring tracheotomy or intuba- tion have, in recent years, been carefully kept by most hospitals. In 8,927 cases collected by Goodall (“British Medical Journal,’ 1899, volume i., page 197), from hospital records in different countries before 1894, the mortality was 71.6 per cent. With the intro- duction..of antitoxin there was’ a marked fall in the mortality of cases of diphtheria requiring tracheotomy. In a series of 2,374 cases collected by the same author from similar sources, but in which jantitoxin was employed, the mortality was 36.6, or approximately one-half, The same order of improvement occurred in all the principal hospitals of Europe and America: in which antitoxin was administered. With the object. of coming to a conclusion regarding the curative value’ of diphtheria antitoxin, the German Health Office: (Arbeiten aus dem Kaiserlichen Gesundheitsamte, 1897, - 254) obtained returns of diphtheria cases from all the hospitals in the Empire from April, 1895, to March, - 1898. Amongst these were 2,041 cases in children up to five years of age,:in which tracheotomy had to be. resorted to. Of these 778 died; a mortality of 33.6. ver cent. The German health authorities compare this mortality with that of tracheotomy cases in chil- dren’s hospitals in Germany, previous to the intro- duction of antitoxin, which, according to the statistics of Baginsky, Hirsch, Herz, Glaser, and Feer, varied from 58.4 to 86 per cent., depending upon the age of the children. 11731. Are these cases in the report of the German. Health Office cases in which antitoxin had been used ? —In the first series of cases antitoxin was used with a mortality of 33 per cent. 7s 11732. When you say returns of diphtheria cases from all the hospitals, does that imply that they were: diphtheria cases which had been treated in all eases: with antitoxin ?— Yes, the treatment was general im hospitals in Germany within those years. 11733. Then you give some results obtained by the, antitoxin treatment in’ tables, showing the influence of early or late administration of antitoxin upon the case mortality from diphtheria ?—Data regarding this. question have been collected. by numerous authorities. and the total figures amount to upwards of 20,000 cases. hich the Total |Percentage) 7... : , . : Aft Author. of of Total Day ine : ‘Nay, yg pe j gitar Sixth | Cases. | Mortality. | : y- y ay: Day. Titit police tf) wack: eel eee Tuateal Sree ape dae Rae Ia S He ay! ner Welchvit St} 2f 1 aerups 10. 1,189 14:2 23 |. 8 135 | 19:0 | 293 | 341 | 33-7 Hilbert - - - - - ~ | 2,428 18°3 22 76 hy os 23-8 , 33°9 341 382 Collective Investigation of | the | 5,794 12°3 ag | 74 | 88 | 2070] 36g eo LG American Paediatric Society 3 5 oe Collective Investigation in Austrian | 1,103 12°6 8:0 6°6 9°8 25'5 28°8 30-7 | 210 «> Sanitary Department tie” = sip | pathy Glee SOE Bn Collective Investigation of the Imperial | 9,581 Lp ae 1. 6:6 8°3 12-9 17°0 93: F De so Bag German Health Office P . . d e ical Treatment began. Lancet, 1903.) Day of the Disease on which Treatment Commenced. ‘1897. First’ - - - - - - - 0 Second - - - : aan 5°4 Third : - - - - . 115 Fourth - - - - - 19-0 Fifth - - - - : - 21°0 Mortality per cent 1898 1899. | 1901. 1902. 0 0 ‘a 0 0 0 5-0 3°8 36 fe 46 14:3 12:2 6-7 11-9 10°5 181 20°0 14-9 12-4 19°8 22°5 20-4 21-2, | 166 19-4 Eight thousand and three cases Department between 1895 and 1905. cago Health Day of Disease - - . - Ist. 2nd. 3rd., oy athe ‘Later. Number of Cases [ Ea Sees 4. | 608 | 2,063 | 2,802 | 1,496 | 1,034 Cases of Mortality per ent. - - | 32 | 1°66 | 364 11°03 21:08 | .](https://iiif.wellcomecollection.org/image/b32182181_0224.jp2/full/800%2C/0/default.jpg)
