SERUM TREATMENT OF DIPHTHERIA 713 



ness, occurring at varying times following the administration of anti- 

 toxin. This condition has been shown to be due to certain constituents 

 of horse serum other than the antitoxic antibodies. It is noteworthy 

 that the serum of one horse may cause more serum sickness than that of 

 another; in general, concentrated antitoxins produce fewer cases than 

 do raw serum. 



This condition is characterized by the development of a rash (urti- 

 carial, multiform, or scarlatiniform), mild fever, joint pains, and possi- 

 bly adenitis. The scarlatiniform rash may be extremely difficult to 

 differentiate from that of true scarlatina, especially in the wards of a 

 diphtheria hospital, where outbreaks of scarlet fever are not uncommon. 



This subject has been considered in greater detail in Chapter 

 XXVIII on Anaphylaxis. It may be stated here that while the patient 

 is decidedly uncomfortable, and even quite sick, for several days, serum 

 sickness is not a dangerous condition; the treatment is largely symp- 

 tomatic and palliative. 



Value of Diphtheria Antitoxin. At the present day it seems hardly 

 necessary to introduce elaborate statistics to prove the value of anti- 

 toxin in the prophylaxis and treatment of diphtheria. 



1. It is generally admitted that most of the reduction in the mortality 

 of diphtheria cannot be attributed solely to the use of antitoxin, for 

 unquestionably bacteriologic diagnosis has permitted the inclusion, in 

 our statistics, of a certain number of cases that, twenty years ago, would 

 not have been classed as diphtheria. Generally speaking, however, the 

 mortality of diphtheria, considering all types of infection coming under 

 observation at varying intervals after the disease has developed, is at 

 least five times less under antitoxin treatment than when it is treated without 

 antitoxin. This proportion is true, whether we compare the general 

 mortality before 1896 with the present rate, or whether we take a large 

 city and compare the mortality under both forms of treatment for a 

 single or for several years. For example, in Philadelphia the mortality 

 rates per 100,000 of population for the five years preceding the use of 

 antitoxin were as follows: 



1891..., 127.4 



1892 156.3 



1893 103.9 



1894 122.5 



1895 115.9 



In five years following the general use of antitoxin the mortality 

 rates per 100,000 population were as follows: 



