(From The Abolitionist)
IN any discussion on the question of whether animal experimentation should be allowed, it is not before its upholders will mention the discovery of diphtheria antitoxin as a brilliant achievement of modern science which was dependent on animal research.
In view of this, and the generally held medical opinion that diphtheria antitoxin has saved thousands of lives, it is interesting to study the average number of deaths from the principal infectious diseases in this country in decennia from 1871-1880 onwards, and in 1933. These figures, taken from the Reports of the Ministry of Health, are as follows:
DEATHS FROM PRINCIPAL INFECTIOUS DISEASES
Scarlet Diphtheria-
Typhoid Smallpox Fever. Measles.
1871-1880 7,842 5,742 17,423 2,943 9,195
1881-1890 5,401 1,228 9,177 4,473 12,107
1891-1900 5,340 406 4,829 8,067 12,684
1901-1910 3,097 429 3,608 6,092 10,548
1911-1920 1,278 14 1,706 5,058 9,868
1921-1930 428 25 885 3,270 4,241
1933 222 2 729 2,646 1,937
It will be seen from this table that the deaths from typhoid fever, small pox and scarlet fever have dwindled in the last sixty years until in 1933 they have caused only 953 deaths between them, whilst the number of deaths from measles has fallen by nearly 80 per cent. It is interesting, too, to note the very low, almost negligible, number of deaths from smallpox, keeping pace with the increasing disuse of vaccination.
For none of these diseases is there a regularly practised or advocated specific treatment: for diphtheria alone is a specific treatment invariably practised, and that is the only disease which shows no reduction in the mortality. The average number of deaths in the ten years, 1871-1880, was 2,943; whereas in the last period given in the table (1921-1930) the number was 3,270. Although the total of 2,646 for 1933 is below that average, it is 307 more than in 1932, showing that the death-rate is rising again.
An article on the decline of the death-rate in measles appeared in the Daily Telegraph from a medical correspondent last year, and commenting on this the writer says:
“There is little doubt that the principal factors in this reduction have been –
A general increase in the standard of living;
Better domestic conditions;
A more instructed attitude in care and nursing;
and
Improved hospital facilities.
Indeed, among the more prosperous sections of the community, measles is very rarely fatal or even serious. It is chiefly among children living in overcrowded and less sanitary conditions that fatalities occur”.
Now, precisely the same arguments apply to diphtheria as apply to measles, only with more force, because removal to hospital is much more commonly, indeed almost invariably, practised in diphtheria.
In view of the great reduction in the death-rates from other infectious diseases, and in particular from scarlet fever, which is of all diseases the most nearly akin to diphtheria, it is only reasonable to suppose that there would in any case have been a reduction in the death-rate from diphtheria.
What evidence is there from these figures, that antitoxin has saved any lives at all? Clean drains, better domestic conditions, and so forth are allowed to be the cause of the improvement in scarlet fever, typhoid and measles. Yet the close connection between dirty drains and diphtheria has been observed for a century. Has not increased cleanliness therefore played its part in the reduction of the death-rate from diphtheria?.
That these facts are becoming more widely recognized in the medical profession is evident from different sources. Dr. Cobbett, in a letter to the British Medical Journal in July, 1933, expressed “his disappointment that diphtheria antitoxin had had such a small effect in lowering the death-rate from diphtheria in the last forty years.” And Dr. Wilson, of Wakefield, writing in the same Journal the following week, reminded his readers that diphtheria was declining in mortality before the introduction of antitoxin.
It is becoming usual now to speak of two types of diphtheria bacillus, “gravis” and mitis”, depending on the degree of toxicity shown in the patient, but investigations do not show any quantitative or qualitative differences in the type of toxin produced. The distinction is only made because it is now admitted that a large number of cases are resistant to antitoxin, and these are thought to be due to an infection of the gravis” strain.
Writing in the current number of The Practitioner, Dr. Gunn, Deputy Medical Superintendent, Infectious Diseases Service, London County Council, says: “Diphtheria is commonly pointed out as the classical lethal disease in which serum therapy finds its most brilliant application. It is still widely believed that practically every patient with faucial diphtheria can be saved from death by administration of appropriate doses of antitoxin, and that the present mortality rate of four to six per cent. is entirely due to the laryngeal form of the disease.
Nothing could be farther from the truth. Nearly all diphtheria fatalities follow toxic, late or neglected faucial infections. Not all severe cases are late, nor are late cases necessarily severe; it is not rare to see a relatively early case-second or third day-in which membrane continues to spread in spite of huge doses of serum, even given intravenously”.
It is the severe type of case that antitoxin was previously supposed to have saved, and the picture that is usually drawn of children choking and dying is characteristic of that type. Yet it is in this type that it is becoming increasingly evident that antitoxin is useless. The mild case of diphtheria would recover whatever treatment were carried out.
In the previous century, when the type of case was generally much more severe, when diagnosis depended on clinical grounds alone, not on bacteriological methods with the admitted frequency of error, with crowded houses, poorer physique and less efficient methods of isolation and hospital treatment, still the majority of cases recovered. With improved sanitation, better physique, and a more instructed attitude in nursing, it is reasonable to believe that without antitoxin at all the figures would have been at least as good as they are to-day.
Indeed, it is impossible to think that the injection of enormous quantities of foreign serum into a system depleted by sickness can have been unattended by grave immediate and remote effects on the general health and resistance of the patient, usually a child. The poor figures in diphtheria mortality represent the Nemesis of a system of treatment essentially cruel.
