Diphtheria Antitoxin 473 



The occurrence of tetanus following the employment of 

 serum drawn from a horse suffering from tetanus was ob- 

 served in a number of cases in St. Louis. In rare cases 

 in which local and metastatic abscesses have been observed, 

 the condition is probably correctly attributable to infection 

 from the patient's skin or from the syringe. 



I have found that the serums are by no means regular 

 in the rapidity of deterioration, so that no very old serum 

 should be used. 



Freezing is without effect upon the serum and ordinary 

 temperature changes are harmless to it. The antitoxic 

 power is destroyed at 60 C., the point at which the serum 

 coagulates. The antitoxin is precipitated with the globulins.* 



The serums from different horses probably vary much 

 in both their irritant and globulicidal .properties, so that 

 mixed serums from a number of horses may be preferable to 

 that from a single horse. 



A very interesting paper by Parkf shows the effect of the 

 introduction of antitoxin upon the death-rate from diphtheria 

 and the advantages of its employment. From it the follow- 

 ing table is taken: 



" Combined statistics of deaths and death-rates from diphtheria and 

 croup in New York, Brooklyn, Boston, Pittsburgh, Philadelphia, Berlin, 

 Cologne, Breslau, Dresden, Hamburg, Konigsberg, Munich, Vienna, 

 Soudan, Liverpool, Glasgow, Paris, and Frankfort: 



Year . population . Deathsjromdiphtheria Deaths,per 



1890 .16,526,135 H,059 66.9 



1891 17,689,146 12,389 70 



1892 18,330,787 14,200 77.5 



1893 18,467,970 15,726 80.4 



1894 19.033,902 15,125 79-9 



i95J 19,143,188 10,657 55.6 



1896 19,489,682 9,651 49.5 



1897 19,800,629 8,942 45.2 



1898 20,037,918 7,170 35.7 



1899 20,358,837 7,256 35.6 



1900 20,764,614 6,791 32.7 



1901 20,874,572 6,104 29.2 



1902 21,552,398 5,630 26.1 



1903 .21,865,299 5,117 23.4 



1904 22,532,848 4,917 21.8 



1905 22,790,000 4,323 19.0 



* See paper by J. P. Atkinson, ''Journal of Experimental Medicine," 

 Sept. and Nov., 1899, vol. iv, Nos. 5 and 6. 



t" Journal of the Amer. Med. Assoc.," Feb. 17, 1912, LVIII, No. 7, 

 P- 453- 



J Introduction of antitoxin treatment. 



