DIPHTHERIA. 229 



the collective investigation with regard to the diphtheria- 

 antitoxin for the period from April, 1895, to March, 

 1896, conducted by Dieudonne in the Imperial Health- 

 office. There were treated with antitoxin in hospitals 

 9581 cases, among which death occurred in 1589 15.5 per 

 cent. If the cases still under treatment at the conclusion 

 of the report be excluded, the proportion of deaths to 

 recoveries was 3 to 16. In the eleven years preceding the 

 introduction of the antitoxin (from 1883 to 1893) the pro- 

 portion of deaths to recoveries averaged 6 to 16. Nearly 

 one-half of the cases included in this study were designated 

 in the reports as severe. The mortality among children 

 under two years old (1189) equaled 39.1 per cent, and 

 that of those subjected to tracheotomy (2744) 32.3 per 

 cent.* 



In the cases submitted to treatment with antitoxin the 

 disease pursued, in general, a milder and more favorable 

 course. Existing manifestations of stenosis improved in a 

 large number of cases, so that tracheotomy was avoided. 

 Serious sequelae with certainty attributable to the antitoxin 

 have thus far not been observed. In rare cases unpleas- 

 ant complications of a transient character occur viz., in- 

 filtration at the point of injection, pains in the joints and ex- 

 tremities, urticaria, exanthemata, possibly also albuminuria. 

 These symptoms are not at all dependent upon the antitoxin 

 itself, but are to be attributed exclusively to the serum of 

 the horse. Like amounts of antitoxic serum induce the 

 same results in this respect, whether they contain a larger 

 or a smaller number of immunity-units. For this reason it 

 is desirable to obtain as highly concentrated an antitoxin 

 as possible in order that as small amounts of serum as pos- 

 sible need be injected. Behring succeeded in preparing an 

 antitoxin- of 1200 times the normal strength, but, unfortu- 

 nately, it was soon found that such highly concentrated 

 solutions could not be preserved for as long a time as less 

 concentrated solutions, and that in the course of time the 

 immunizing activity diminished considerably. 



Behring was, therefore, led to the preservation of serums 

 of greater than 5oo-strength by converting them into a dry 

 form by a special procedure. The dry powder, containing 



* These results have been amply confirmed not only on the Continent of 

 Europe, but also by observations in England and in America, with reference 

 to both nonoperative and operative cases. A. A. E. 



