THERAPEUTIC EFFECTS OF ANTI-SERA 547 



which the mortality was 20 per cent, as compared with a former 

 mortality in the same hospitals of 44 per cent. It has also been 

 observed that if during an epidemic the supply of serum fails, 

 thr mortality at once rises; and in two instances recorded it 

 was doubled. It must here be ivmt-inbered that from the 

 spread <>f bacteriological knowledge the diagnosis of diphtheria 

 is now much more accurate than formerly. Another effect of 

 the antitoxic treatment has been that when tracheotomy is 

 necessary the percentage of recoveries is now much higher, being 

 73 per cent, instead of 27 per cent, in a group of cases collected 

 by the American Pediatric Society. In the London fever 

 hospitals, since 1894 the recoveries after tracheotomy have been 

 56 - 4 as compared . with 32*1 per cent, previous to the intro- 

 duction of antitoxin. One of the most striking results obtained 

 in the same hospitals is a reduction of the death-rate in post- 

 scarlatinal diphtheria from 50 per cent, to between 4 per cent, 

 and 5 per cent. As the disease here occurs while the patient is 

 under observation, the treatment is nearly always begun on the 

 first day. It is a matter of prime importance that the treat- 

 ment should be commenced whenever the disease is recognised. 

 1 >fh ring showed that in cases treated on the first and second 

 days of the disease the mortality was only 7 '3 per cent., and this 

 has been generally confirmed, whilst after the fifth day it was of 

 little service to apply the treatment. In order to obtain such 

 results, it cannot be too strongly insisted on that attention 

 should be given to the dosage. When bad results are obtained, 

 it may be strongly suspected that this precaution has not been 

 observed. In the treatment of acute tetanus by the antitoxin 

 the improvement in results has not been marked, but some 

 chronic cases have been benefited, and, as already stated (p. 431) 

 better results are obtained in acute cases if intravenous in- 

 jection be practised. In the case of Yersin's anti-plague serum, 

 though some benefit has appeared to follow its use, this has 

 been of quite a limited nature. The same may be said to be 

 true of the anti-streptococcic and anti-pneumonic sera, though 

 in the case of the first mentioned numerous cases of apparently 

 successful result have been recorded. With regard to anti- 

 venin, Lamb has shown that, if a cobra with full glands bites a 

 man, many times the minimal lethal dose are probably injected. 

 In cases of slight bite, however, benefit may accrue from the use 

 of the anti-serum. 



As has been shown above, antibacterial sera require for their 

 bactericidal action a sufficiency of complement, and as this 

 diminishes in amount when a serum is kept, the unsatisfactory 



