520 THE POPULAR SCIENCE MONTHLY. 



constantly diminishing during the three decades mentioned. 

 With this evident increase in diphtheria mortality an increase 

 that is the more noticeable when the general activity in sanita- 

 tion during recent years is recalled the necessity for some reme- 

 dial agent is apparent. Like epidemics of other infectious dis- 

 eases, diphtheria epidemics show various characters ; sometimes 

 being very mild, sometimes very severe, with a high death-rate. 

 This variation seems to be due to differences in the number and 

 virulence of the bacilli, the result of unknown causes, to the asso- 

 ciation of other bacteria with the Klebs-Loeffler bacillus, and to 

 unrecognized individual tendencies. 



The serum treatment of diphtheria is being generally tried 

 throughout Europe and America, and the evidence seems con- 

 clusive that it is of benefit. In a series of almost fifteen hundred 

 cases of diphtheria that has been collated from the reports of a 

 number of observers, treated by antitoxine serum, the mortality 

 averaged 2299 per cent, the maximum being 44"9, the minimum 

 5*5 per cent. This in itself is striking, for the usual diphtheria 

 mortality is over 50 per cent. Roux, Martin, and Chaillon re- 

 ported four hundrsd and forty-eight cases treated in the Paris 

 Hospital for Children's Diseases, from February 1 to July 24, 

 1894, with a mortality of 24'3o, while during the same time five 

 hundred cases of diphtheria were treated in the usual manner at 

 the Trousseau Hospital in the same city, and the mortality was 

 63*2 per cent. W. Koerte reported one hundred and twenty-one 

 cases treated in the Berlin Urban Hospital between January 20 

 and October 27, 1894, with the serum, in which there was a mor- 

 tality of ;)3"1 per cent, while of one hundred and six cases treated 

 during a period of that time without the serum none being ob- 

 tainable 53"8 per cent died. 



The injection, which is administered slowly in quantities of 

 twenty cubic centimetres (a little more than five drachms) beneath 

 the skin of the flank, is not painful ; and if it is made antisep- 

 tically, no ill effect follows, and the dose is absorbed within an 

 hour. In twenty-four hours a second injection of from ten to 

 twenty cubic centimetres may be given, and the two injections 

 ordinarily suffice to cure. The temperature usually falls after 

 the injection, although in grave cases the fever may persist. The 

 pulse becomes normal more promptly than the temperature. 



The general condition remains good, as a rule ; and the false 

 membranes usually cease growing after the first injection, becom- 

 ing detached within seventy-two hours. Roux gave a child a 

 thousandth part of its weight in serum, though in severe cases 

 he increased the quantity to a hundredth part of the weight. 

 The treatment should be instituted as soon as possible after the 

 infection, as those children treated with serum on the first or sec- 



