326 SURGERY 



Thus it is evident that the use of antitoxin, the employment of 

 antiseptic surgery, the administration of certain anodynes and the 

 enforcement of quiet to avoid reflex disturbances, comprise a plan 

 of treatment which will offer brilliant results in the cure of this 

 terrible malady. The success of this treatment in tetanus alone is 

 a monument of the progress which surgery has made during the 

 past quarter of a century. 



The antitoxin treatment of diphtheria affords the most forcible 

 illustration of the value of serum therapy in the treatment of in- 

 fectious diseases. This disease does not, strictly speaking, belong 

 exclusively to surgery; but it affords an opportunity to show the 

 results of the use of antitoxin, and it often happens that the dis- 

 ease may require surgery for its relief. From the statistics of the 

 Health Board of New York City prior to January 1, 1895, the 

 mortality was as high as 64 %, and in 1902, as a result of the use 

 of antitoxin, mortality was reduced to 9.5%. From a period of 

 5 years, from 1888 to 1894, the mortality was from 64% to 44%, 

 and the following 4 years, from 1895 to 1898, the mortality dropped 

 to 12%. In 1902 the mortality was reduced to 10.9 %. In another 

 series the cases were also not selected. They were collected from 

 hospitals, asylums, private residences, and many of them were 

 moribund at the time of the use of the antitoxin, and the mortal- 

 ity was less than 8 %, as contrasted with 64 % to 44-% 20 years 

 ago, or before antitoxin was employed. In 1903 the improvement 

 was still greater, since in 1208 cases of diphtheria only 72 died, 

 thus giving a mortality of only 5.9 %. If the 26 moribund cases 

 were deducted, the mortality is only 3.8 %. There remains no longer 

 any doubt as to the value of serum therapy in this disease, and if 

 these results can be taken as prophetic of the result of serum therapy 

 in other infective diseases a new era has dawned upon the civil- 

 ized world. Billings has called attention to one fact, and that is 

 the necessity of the early administration of the antitoxin, since 

 in 1702 cases injected on the first day, only 85 patients died in- 

 cluding the moribund cases; the mortality was only 4.9 %. Finally, 

 in 1610 cases collected from 12 physicians in private practice, 

 and not including the moribund cases seen in consultation, there 

 were 24 deaths, or a mortality of only 1.5%. An antitoxin has 

 been made by Calmette, who worked in the Pasteur Institute, to 

 prevent death after the bites of venomous serpents. This anti- 

 toxin has already afforded immunity to thousands of persons who 

 had been poisoned by the bite of venomous reptiles in India and 

 Australia. 



The antitoxin treatment of snake-bite was discovered by Vital, 

 of Brazil. He made some extensive experiments with antitoxin 

 at the institute over which he had charge. This serum was better 



