THE SERUM TREATMENT OF DIPHTHERIA. 521 



ond day of infection have all recovered. While the experiments 

 on animals showed that injections of the serum did not exercise 

 a permanent influence in immunizing the animal, there can be no 

 doubt that such injections would exercise a prophylactic effect if 

 administered to those that have been exposed to diphtheria. 



One of the great obstacles to the general employment of the 

 serum is the cost of its manufacture. In this country from five 

 to ten dollars is asked for a small quantity that sells on the con- 

 tinent of Europe for not more than one fourth of those sums. 

 The British Institute for Preventive Medicine finds that the 

 serum for a single case costs, to be manufactured, from fifteen 

 to twenty-five cents. Public subscriptions have been started in 

 various large cities in the world for the purpose of securing 

 funds to establish and maintain laboratories for the manufacture 

 of the serum. Roux estimated that for a population such as Paris 

 has (two millions and a half) a serum laboratory would require 

 twenty horses, three grooms, two bacteriologists, and two labora- 

 tory assistants, bringing the expenses of maintenance to eight 

 thousand dollars a year, a sum that would be insufficient in this 

 country, where the salaries, etc., would have to be so much higher. 



Prom what has been said it may be deduced that the produc- 

 tion of antitoxine serum is a matter of time, that it must be 

 made with the greatest care, and that each lot must be tested to 

 determine the degree of its antitoxic power. Only by such tests 

 can its efficiency be determined, for there is nothing in the gross 

 appearance of the yellowish fluid to indicate whether it will or 

 will not exercise therapeutic influence. As no other remedy 

 should be employed in conjunction with it, the dire results to the 

 patient of administering a worthless serum may be appreciated. 

 The Board of Health of New York has found specimens of serum, 

 alleged to be antitoxic, exposed for sale, bacteriological tests of 

 which demonstrated its worthlessness. This can only be pre- 

 vented by the enactment of State laws that punish by heavy 

 fine the sale of, or allow the recovery of heavy penalties for the 

 administration of, any antitoxic serum that is not approved by 

 the State Board of Health. The importance of exercising such 

 control is appreciated abroad, where, in France, a bill is in prep- 

 aration for introduction in the Chambers providing that no anti- 

 diphtheritic serum but that prepared under Roux's observation, 

 or tested in his laboratory and found equal in curative influence 

 to that prepared by him, shall be sold or administered. In Italy 

 no antidiphtheritic serum but that prepared by Roux, Behring, 

 or Aronson is admitted into the country. A good antidiphtheritic 

 serum is not only harmless but is a remedial agent ; a poor or 

 spurious serum may be poise nous in itself as well as being worth- 

 less for controlling the disease. 



