1895.] on the Antitoxic Serum Treatment of Diphtheria. 



445 



Table II. 



Metropolitan Asylums Board: Admissions and Case Mortality, 

 Diphtheria, 1888-93. 



Note.— Diphtheria cases have only been admitted into the hospitals since October 23, 1883. 



is given. In order to determine the foundation upon which this 

 certainly very legitimate objection is based, I have taken four series 

 of cases as reported, and have placed them side by side. The per- 

 centages of deaths at certain ages in the London Asylums Board 

 hospitals before the serum treatment are given in Table IV., the 

 percentages of deaths of four observers who have used the serum, 

 in Tables V. and VI. 



It is very important, however, that the period of the disease at 

 which the treatment is commenced should be taken into account, for, 

 as already indicated, experience has taught that the later the stages 

 of the disease at which this serum is injected, the stronger must be 

 the dose given. It is necessary, therefore, to separate the cases in 

 which the treatment is commenced at an early period from those in 

 which it is commenced only when the poison has had time to dis- 

 organise the tissues, and to render them incapable of reacting to the 

 antitoxic serum. 



Table VII., p. 448, given by Kossel, brings out the great import- 

 ance of this element in keejung clown the case mortality. In the first 

 column is given the day of the illness on which antitoxic serum w r as 

 first injected. 



For statistical purposes, too, only those cases which have been 

 bacteriologically examined and found to be due to the action of 

 Loeffler's diphtheria bacillus should be accepted as being cases of 

 true diphtheria. As most of the cases in which the diphtheria 

 bacilli are absent run a much milder course, and are much more 

 amenable to general treatment, and as many of these have been 

 included under diphtheria in the old statistics, such elimination will 

 necessarily make the record tell rather against the antitoxic serum 

 treatment than in its favour. 



From a somewbat extended experience (although condensed into 

 a very short period of time) 1 am satisfied that this question of the 

 Loeffler bacillus is most important, and that every case in which the 

 serum is used should be bacteriologically examined. 



