i8 



NATURE 



[November i, 1894 



elements necessary to enable us to form an accurate 

 opinion. The mortality among 3971 children admitted 

 during 1S90-1S94, and who were treated on ordinary 

 lines, i.e. without curative serum, amounted to 51 per 

 cent., the highest mortality being in 1S90, when it reached 

 59 per cent., and the lowest in 1S92, when it fell to 47 

 per cent. On February i, 1S94, Dr. Roux began the 

 inoculations. As soon as a child suffering from diphtheria 

 was admitted into the Hopital des Enfants Malades, it 

 received 20 c.c. of serum subcutaneosly, and if no im- 

 provement took place, 10 c.c. or more were again injected 

 next day. 448 children were thus treated from February 

 I to July 24, 1S94, and 109 died, the mortality being 24-5 

 per cent. At the Hupital Trousseau, on the other hand, 

 520 children were admitted during that period, and 

 treated without the injection of curative serum. Of these 

 316 died, giving a mortality of 60 per cent. This differ- 

 ence is striking enough ; but it is even more marked 

 when we come to analyse the results. In the first place, 

 we must eliminate from Dr. Kou.x's statistics 1 28 cases 

 which were shown by bacteriological examination not to 

 be diphtheria. This mistake is perfectly legitimate, as it 

 has been shown that without a bacteriological examina- 

 tion. It is impossible to make an accurate diagnosis. 

 The injection of the serum in a doubtful case is followed 

 by no harm, and as the result of the bacteriological 

 examination cannot be known for twenty-four hours, the 

 injection of the serum will, at any rate, prevent the child 

 catching the disease from his neighbour. The mortality 

 among such cases we know to be very slight, and in the 

 statistics of previous years, as well as in those of the 

 Hopital Trousseau, these cases are included among the 

 cures, so that the proportion of cures appears to be much 

 higher than it really is. These cases being excluded 

 from Dr. Roux's statistics, there remain 320 children in 

 which the bacteriological examination revealed the pre- 

 sence of the diphtheria-bacillus. Of these 20 died on 

 admission, before any therapeutic measures whatever 

 could be employed. Of the 300 other children 78 died, 

 giving a mortality of 26 per cent. We may further 

 divide these into uncomplicated cases, and those in 

 which tracheotomy had to be performed for laryngeal 

 obstruction. Of the uncomplicated cases, the mortality 

 in Dr. Roux's wards amounted to 12 per cent. ; whilst at 

 the Hopital Trousseau, where no serum was used, the 

 mortality during the same period reached 32 per cent. 

 In the preceding years it was 33 per cent, in the wards 

 in which Dr. Roux carried out his experiments. 



Turning now to the cases in which tracheotony had to 

 be performed, we find that 49 per cent, of Dr. Roux's 

 cases died. At the HTipital Trousseau in the same 

 period 86 per cent, of the tracheotomised children 

 perished. Similar results have been obtained in Ger- 

 many, the mortality in some wards falling as low as 14 

 per cent. I'rof. Ehrlich has shown that the question of 

 time is a most important element, and that the chances 

 of obtaining a cure are infinitely greater when the 

 remedy is applied at an early stage of the disease. The 

 following table, reprinted Irom the Deutsche Medici- 

 nisclic W'ochenschriii. will explain this: 



It will be noticed that the number of cures diminishes 

 according to the length of time which has elapsed since 

 the onset of the disease. 



It appears to me to be difficult to explain away the 

 results obtained in France and Germany by simply say- 

 ing that the epidemic has been a mild one ; for in other 

 hospitals and institutions in which the curative serum 

 has not been used, the mortality has remained the same, 

 or even increased. In fact, it is plain that the serum 

 treatment of diphtheria is now established on a firm 

 basis, and that it is only right that we should at once 

 give the children in this country the benefit of the results 

 of experimental investigation which has been principally 

 carried on abroad. The British Institute of Preventive 

 Medicine is now taking steps to provide the serum at 

 cost price. 



Finally, it is right to draw attention to the fact that 

 although the knowledge of the biology of the diphtheria 

 bacillus, and of the effects of its poison, has been based 

 on the investigations of ditferent observers — French, 

 German, and English — yet the discovery of the curative 

 efl'ect of the serum of immunised animals is the merit of 

 one man only — Prof. Behring, of Berlin. 



M. A. RUFFER. 



NOTES. 

 The Paris Academy of Moral and Political Sciences has 

 bestowed the Audiffret prize of iwelve thous.ind fiancs upon Di 

 Koux for his treatment of diphtheria. 



.\ STATUE of Claude Bernard, the etninent physiologist, was 

 unveiled at Lyons on Sunday last, in the presence of a distin- 

 guished company. 



The Nalicnal Zeitung states that news h.is reached Berlin 

 from the Kilima-Njaro district that the German bolanist, Dr. 

 Lent, and the zoologist. Dr. Krelzschmar, have been killed, 

 with several of their black followers. 



Dalziel'S correspondent at New \otV says that a dispatch 

 received from Buenos Ayres gives particulars of a severe earth- 

 quake, attended by great loss of life, which occurred on Satur- 

 day, October 27, at the town of San Juan de la Fronteza, the 

 capital of the Province of Sm Juan, in the .Argentine Republic. 

 Many of the principal buildings are said to have been destroyed. 

 The shock extended to tlie towns of La Paz, Cordova, and 

 Rosario. The Xew York Hcrahl of Monday published a 

 telegram from Buenos Ayres stating that two thousand persons 

 have perished in the earthquake at La Kioja, and that twenty 

 thousand are homeless. This alarming report has not, however, 

 been confirmed. 



NUMEROUS memoirs have already been based upon the rich 

 collection of Dutch birds brought together by the late Mr. J. P. 

 van Vickevoort Crommelin, of Harlem, and presented, after 

 his death, by his daughter to the Leydcn Museum. Ornitholo- 

 gists will therefore welcome the appearance of a complete 

 catalogue of the collection, which has been compiled by Dr. 

 Jenlink, the director of the museum, and forms the fourteenth 

 volume of the catalogues of the Museum d'histoire naturelle des 

 Pays-has. Nearly three hundred species are in all enumerated, 

 and the majority of these arc represented each by a considerable 

 number of specimens. A separate record is given of every 

 individual, notifying the sex and age, the place and date of 

 capture. An explanation which Dr. Jentink furnishes of the 

 exact locality of all the places mentioned should be of material 

 SCI vice to the student of the geographical distribution of these 

 birds. 



NO. 1305. VOL. 51J 



