DIPHTHERIA 233 



tion that the diphtheria epidemic which was then prevailing was 

 of an unusually mild type. We know as a matter of fact that 

 the "virulence" of a disease undergoes periodic fluctuations, so that 

 there is some reason in such a suggestion. But even so, the low 

 mortality, when treatment was instituted on the first day, which was 

 early noted, should have been sufficient to dispose of this possibility, 

 for up to that time no treatment that had been previously in use 

 could boast of such a result. But aside from this there are many 

 other observations which prove beyond a shadow of a doubt that the 

 low general mortality from diphtheria is really due to the use of 

 antitoxin and not to accidental factors. At the Blegdam Hospital 

 of Copenhagen during an entire year all diphtheria patients admitted 

 on alternate days were thus treated with antitoxin, while those 

 entering on the intervening days were given no serum. The result 

 was the following: 



Of 204 cases without croup treated with serum 5 died, giving a 

 mortality of 2 per cent. 



Of 210 cases without croup treated without serum 14 died, giving 

 a mortality of 7 per cent. 



Of 35 cases with croup treated with serum 3 died, giving a mor- 

 tality of 8 per cent. 



Of 43 cases with croup treated without serum 15 died, giving a 

 mortality of 35 per cent. 



Evidence of the same kind is afforded by the observation that 

 during the year 1894 in Heubner's clinic the mortality had been 

 lowered to 23.08 through the use of antitoxin, while in another 

 hospital in the same city where no antitoxin was as yet available, 

 the death-rate was 43.36 per cent. Korte further reports that in the 

 days preceding the introduction of the serum the death-rate among 

 the tracheotomized children in his clinic was 77.5 and subsequently 

 52.4. Similar figures were obtained by Siegert in his collective 

 report based upon an analysis of 30,369 operated cases of diphtheritic 

 larynx stenosis; of these 17,499 belonged to the pre-serum time 

 and furnished a death-rate of 60.38 per cent., as contrasted with a 

 mortality of 36.32 among 12,870 cases that had been treated with 

 antitoxin. These figures speak for themselves. 



The question, of course, suggests itself, whether it should not be 

 possible to abolish the death-rate from diphtheria altogether, if 

 once all cases could be treated with antitoxin on the first day of the 



