62 BACTERIOLOGY. 



(IV.) The uniform improvement in the results of tracheotomy at 

 each separate hospital. 



(V.) The beneficial effect produced on the clinical course of the 

 disease. 



A consideration of the statistical tables and clinical observations, 

 covering a period of 12 months and embracing a large number of cases, 

 in our opinion sufficiently demonstrates the value of antitoxin in the 

 treatment of diphtheria. 



It must be clearly understood, however, that to obtain the largest 

 measure of success with antitoxin it is essential that the patient be 

 brought under its influence at a comparatively early date if possible not 

 later than the second day of disease. From this time onwards the chance 

 of a successful issue will diminish in proportion to the length of time 

 which has elapsed before treatment is commenced. This, though 

 doubtless true of other methods, is of still greater moment in the case 

 of treatment by antitoxin. 



Certain secondary effects not infrequently arise as a direct result of 

 the injection of antitoxin in the form in which it has at present to be 

 administered, and, even assuming that the incidence of the normal com- 

 plications of diphtheria is greater than can be accounted for by the 

 increased number of recoveries, we have no hesitation in expressing the 

 opinion that these drawbacks are insignificant when taken in conjunction 

 with the lessened fatality which has been associated with the use of this 

 remedy. 



We are further of the opinion that in antitoxin serum we possess 

 a remedy of distinctly greater value in the treatment of diphtheria than 

 any other with which we are acquainted. 



On the other hand it has been urged that the decline in the 

 mortality in 1895 in London, which has been attributed entirely 

 to the antitoxin treatment, may possibly be partly due to the pre- 

 valence of a mild type of the disease, and that the fall in the 

 mortality during the seven previous years from 59 per cent, in 

 1888 to 29 per cent, in 1894, continued in 1895. 



It is obvious that the whole subject requires to be very carefully 

 considered, and before any final conclusion can be arrived at as to 

 the therapeutic value of antitoxin, the evidence of others who have 

 had great experience in the treatment of diphtheria by the old and 

 the new methods must be taken into account, and reliable statistics 

 allowed to speak for themselves. 



PREPARATION OF TETANUS ANTITOXIN. 



Antitoxin for use in the serum treatment of tetanus is obtained 

 from the horse. The tetanus bacillus is cultivated in an atmosphere 

 of hydrogen, in flasks specially constructed for the purpose. In 



