DIPHTHERIA 243 



Of 43 cases with croup treated without serum 15 died, giving a 

 mortality of 35 per cent. 



Evidence of the same kind is afforded by the observation that 

 during the year 1894 in Heubner's clinic the mortality had been 

 lowered to 23.08 through the use of antitoxin, while in another hospital 

 in the same city, where no antitoxin was as yet available, the death 

 rate was 43.36 per cent. Korte further reports that in the days pre- 

 ceding the introduction of the serum the death rate among the 

 tracheotomized children in his clinic was 77.5 and subsequently 

 52.4. Similar figures were obtained by Siegert in his collective 

 report based upon an analysis of 30,369 operated cases of diphtheritic 

 larynx stenosis; of these 17,499 belonged to the preserum time and 

 furnished a death rate of 60.38 per cent., as contrasted with a mor- 

 tality of 36.32 among 12,870 cases that had been treated with anti- 

 toxin. These figures speak for themselves. 



The question, of course, suggests itself, whether it should not be 

 possible to abolish the death rate from diphtherial altogether, if 

 once all cases could be treated with antitoxin on the first day of the 

 disease. As a matter of fact there are physicians who have not a 

 single death to record among just such cases, even though their 

 experience is based upon a fairly large number of observations. 

 Nevertheless, there are instances where the injections have been 

 started in time and in which death nevertheless occurred (see table 

 above). Whether any of these could have been saved by injecting 

 the antitoxin intravenously or by using larger doses is now, of course, 

 impossible to say, but the possibility unquestionably exists. But 

 even so we should remember that our serum is after all purely anti- 

 toxic in character, and that unless the body can successfully destroy 

 the infecting organisms the battle may yet be lost, and it is this 

 factor which may be responsible for the number of deaths that yet 

 occur, even though the antitoxin be used at the very start. To 

 overcome this possible obstacle to a zero mortality it would be 

 tempting to fuse a corresponding vaccine simultaneously with the 

 antitoxin. This has indeed been advocated by several investigators 

 and deserves serious consideration. Petruschky records that he 

 has succeeded in freeing bacillus carriers in this way of their 

 dangerous guests. 



