242 PASSIVE IMMUNIZATION 



spending to the first day we have an average of 4.8 per cent. Further 

 argument than this should be unnecessary to convince anyone 

 that in the use of antitoxin we now have a weapon in the face of 

 which diphtheria has indeed lost its terrors, and that a physician 

 who refuses to avail himself of its use is indeed unfitted to practise his 

 profession. 



Later 



No. of Mortality First Second Third Fourth Fifth Sixth than 

 Author. cases, per cent. day. day. day. day. day. day. sixth. 



Welch .... 1489 14.2 2.3 8.1 13.5 19.0 29.3 34.1 33.7 

 Hilbert .... 2428 18.3 2.2 7.6 17.1 23.8 33.9 34.1 38.2 

 Collective report of 



American Pediatric 



Society .... 5794 12.3 4.9 7.4 8.8 20.7 35.3 

 Austrian collective 



report .... 1103 12.6 8.0 6.6 9.8 25.5 28.8 30.7 21.0 

 German collective 



report .... 9581 15.5 6.6 8.3 12.9 17.0 23.2 ... 26.9 



In the earlier days of the use of antitoxin the question was asked 

 whether the lower mortality could not be explained on the assump- 

 tion that the diphtheria epidemic which was then prevailing was 

 of an unusually mild type. We know as a matter of fact that the 

 "virulence" of a disease undergoes periodic fluctuations, so that 

 there is some reason in such a suggestion. But even so, the low 

 mortality, when treatment was instituted on the first day, which was 

 early noted, should have been sufficient to dispose of this possibility, 

 for up to that time no treatment that had been previously in use 

 could boast of such a result. But aside from this there are many 

 other observations which prove beyond a shadow of a doubt that 

 the low general mortality from diphtheria is really due to the use of 

 antitoxin and not to accidental factors. At the Blegdam Hospital of 

 Copenhagen during an entire year all diphtheria patients admitted 

 on alternate days were thus treated with antitoxin, while those 

 entering on the intervening days were given no serum. The result 

 was the following: 



Of 204 cases without croup treated with serum 5 died, giving a 

 mortality of 2 per cent. 



Of 210 cases without croup treated without serum 14 died, giving 

 a mortality of 7 per cent. 



Of 35 cases with croup treated with serum 3 died, giving a mor- 

 tality of 8 per cent. 



