DIPHTHERIA 225 



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. 



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 preceding 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 

 mortality of 36.32 among 12,870 cases that had been treated with 

 antitoxin. These figures speak for themselves. 



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

 possible to abolish the death rate from diphtheria 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 Never- 

 theless 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 anti- 

 toxin intravenously or by using larger doses is now, of course, impos- 

 sible 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 

 15 



