Lab. No. of the Antitoxin...............

Day and hour of inoculation............................

Dose employed in c. c...

Day of the disease.........

Was Tracheotomy or Intubation employed?............

State on the following pages the general condition of the patient 24 hours after the inoculation; the effect, if any, on the temperature, pulse, respiration and membrane.

Please notify the laboratory when the patient recovers or dies.

From March to December 31, 730 bottles, each containing 10 c.c. of serum, having a strength of 1,000 antitoxic units or over, have been supplied to the Municipal Hospital.

To physicians applying for the antitoxin or requesting that it be injected, 170 bottles, containing the same quantity and of the same strength as that mentioned above, have been supplied.

Results of the Use of Diphtheria Antitoxin Supplied to Physicians.

Of the 170 bottles thus sent out, 137 were for use in cases of disease; whereas 33 were for persons who had been in contact with cases of disease and where its use was simply as a protection.

We received reports of the results of the use of antitoxin from only 76 cases out of the 137 in which it was used. The reports show that 57 cases recovered and 19 died, giving a death rate of 25 per cent.

By means of weekly reports of deaths from diphtheria, obtained from the Registration Division of the Bureau of Health, we were able to ascertain the termination in 47 more cases. However, while applications were made for antitoxin to be used in these cases, we have no other evidence that it was actually used. Including these latter cases in the total we find the mortality to be 27.6 per cent.

It has been universally conceded by the supporters of

the antitoxin treatment of diphtheria, that in order to obtain the best results it should be first used before the fifth day of the disease. When the antitoxin is injected on or after the fifth day the results are no better than where it is not used at all.

The average day of disease, on which the injection was given, in the 76 cases reported to us, was 3.8 day. Of these 56 were injected before the fifth day, and the death rate was 16.6 per cent. Among the remaining 20 cases injected after the fourth day the death rate was 50 per

cent.

It could hardly be expected of antitoxin that it restore a dying patient. Of the 19 fatal cases out of 76, from which reports were received, 6 died from 3 to 24 hours of the first injection.

It is reasonable to expect it to be necessary in some cases to give a second or third dose in case the first did not produce the desired results. Therefore, while unknown factors prevent a positive statement, it is not improbable that the results would have been more favorable, if six cases receiving one dose of antitoxin and dying from 5 to 11 days later, had received several more injections.

If from the 19 fatal cases we deduct the cases where antitoxin was not used until the fifth, or a later day, of the disease or where the patient was moribund at the time of injection, or where the patient was allowed to linger for over 5 days after the first dose without any further use of the remedy, we find but four (4) cases where the antitoxin was apparently given a fair trial and failed, or a mortality of only 5.2 per cent.

Thirty-three healthy persons received injections of our antitoxin on account of having been in contact with cases of diphtheria. We received reports from 10 of these cases, none of whom contracted the disease.

Decisive deductions as to the value of the antitoxin treatment of diphtheria cannot properly be made from the above statistics, for the reason that we have not at our command for comparison the results of a similar series of cases treated without antitoxin, and also because the number of cases included in the analysis is not of itself large enough for that purpose.

However, the above statistics are in perfect accord with those compiled by others, from larger series of cases, and who had accurate and complete histories of the patients, on which to base their conclusions.

Respectfully submitted,

HERBERT D. PEASE,

First Assistant.

ANNUAL REPORT

OF THE

CHIEF INSPECTOR OF MILK

For the year 1896.

DIVISION OF MILK INSPECTION.

Room 513 City Hall.

Philadelphia, January 15, 1897.

To the President and Members

of the Board of Health.

GENTLEMEN -The past year is no exception to the rule of diligent systematic inspection of milk. During the year the number of inspections aggregated thirty-two thousand five hundred and seventy-seven (32,577), and the number of quarts inspected, four hundred and four thou sand nine hundred and seventy (404,970). Of these twelve thousand nine hundred and forty-seven (12,947) quarts or 3.20 per centum were condemned for adulteration with water; two thousand four hundred and fourteen (2,414) quarts or 0.60 per centum were skimmed ; and forty-nine (49) quarts or 0.01 per centum were colored. The monthly average of condemnations is shown to be 3.96 per centum of the whole quantity inspected.

The estimated quantity annually consumed being 110,000,000 quarts, it will be seen that 0.37 of one per centum of the supply only was examined, being the quantity found in the shops and wagons of dealers. This may seem com

paratively a small proportion of the whole, nevertheless, it represents the quantity being sold or offered for sale to consumers on the periodical visitations and examinations of the inspectors of the four districts into which the City is divided.

The territory embraced in each of these districts is so large that however energetic the inspectors may be they are unable to go over them in less than five to six weeks. The districts comprise as follows:

First District. All that portion of the City south of Market street, from the Delaware river to the County line.

Second District.-North from Market street to Girard avenue, and from the Delaware river to the County line.

Third District.-North from Girard avenue to Lehigh avenue, and from Delaware river to the Schuylkill river. Fourth District.-All north of Lehigh avenue to the County line.

The inspection includes the condition of the cows, in relation to health, stabling, food, cleanliness, preparation of the milk for use-in a word a strict enforcement of the regulations for the government of places in the City and County of Philadelphia, where cows are kept for the sale of their milk.

These regulations are printed on paste-board and, conveniently arranged for hanging conspicuously in the house or barn, have been distributed to each and every milk producer in the County of Philadelphia.

An entry of the date of service is made by the district inspector in a book kept for the purpose, so that a denial of such service by the proprietor is readily corrected.

With few exceptions the regulations have produced a very decided improvement in the treatment of cows and greater care in the preparation of milk for use within the City and County of Philadelphia.