1895.] on the Antitoxic Serum Treatment of Diphtheria. 449 



and even from none at all, is aware of the fact that albuminuria 

 in children is of comparatively frequent occurrence. It is not 

 striking, therefore, that those who have hitherto paid little attention 

 to this subject should, when they come to make a careful examination 

 of children affected with diphtheria, find a considerable number of 

 cases in which transient albuminuria is a prominent symptom. More 

 than this, however, it has been my duty to examine a large number 

 of cases in which diphtheria has proved fatal, and in these cases 

 there were certain lesions in the kidney, so distinct and so frequently 

 present, that in describing them I used to note simply " diphtheritic 

 condition," and then describe in detail only those features in which 

 the appearances differed from the type that I had in my mind. This 

 will indicate to you that alterations in the internal organs, especially 

 in the kidneys, such as would lead to marked interference with the 

 performance of their proper functions, were present, and had been 

 noted long before the antitoxic serum method of treatment came 

 into use. I may give an example of what, under certain circum- 

 stances, might have been used as a powerful argument against the 

 use of antitoxic serum. In the Deutsche Medizinische Wochenschrift 

 fur December 20 of last year is reported a case of acute hemorrhagic 

 nephritis coming on after the use of Behring's curative serum. The 

 patient recovered. But a similar case of acute hemorrhagic nephritis 

 in diphtheria, in which, however, the curative serum was not used, 

 is reported in the same number of the same journal. The author of 

 the second paper quotes some interesting statistics to show that 

 albuminuria is of frequent occurrence in cases of diphtheria not 

 treated with antitoxic serum. One observer found it in 131 out of 

 279 cases; another in 16 out of 53; another in 60 per cent, of all 

 his cases ; another in 227 out of 470. Suppression of urine has 

 also been ascribed to the action of this agent ; but here again, if a 

 careful search be made of the records of diphtheria cases treated 

 under the old method, it will be found that just as in scarlatina and 

 acute specific infective diseases generally, but especially in those 

 associated with rapidly supervening toxic symptoms, suppression of 

 urine is of common occurrence ; and until we have statistics on these 

 several points, which can be compared with those above mentioned, 

 it will be impossible and unjust to ascribe conditions to the thera- 

 peutic agent which, so far as those best able to judge can see, are to 

 be ascribed to the disease itself. 



It has been held by some that the paralysis which is so common 

 a sequela of diphtheria should disappear entirely under the use of 

 what they are pleased to call a specific cure for the disease. It 

 should be remembered that the antitoxic serum cannot make good 

 any organic damage that has been caused by the action of the toxic 

 products of the diphtheria bacillus. It may stop their action on the 

 tissues, and it may stimulate the tissues to react against the poison, 

 but to the tissues themselves must be left the process of repair ; the 

 vis medicatrix naturae is alone responsible for the making good of 



