ANTITOXIN INOCULATION 391 



the exact size of the dose. The two chief points to be borne 

 in mind are early administration (following at once on the 

 bacteriological positive diagnosis), and as large a dose as is 

 practicable.^ 



^ The benefit of antitoxin inoculation is now generally admitted. Its value 

 is clearly demonstrated in the returns of the Metropolitan Asylums Board. In 

 1894, 3042 patients of all ages were treated for diphtheria in the Board's hospitals 

 without antitoxin ; 902 died, yielding a mortality of 29-6 per cent, on aU cases 

 of diphtheria treated. In 1895 the antitoxic serum treatment was inaugurated ; 

 3529 cases of diphtheria were treated and 729 died, yielding a mortality of 22-5 

 per cent. Hence in the first year there was a fall in mortality' of 7-1 per cent. 

 In 1900, 7271 patients suffering from diphtheria were treated with antitoxin in 

 the Board's hospitals ; 936 died, yielding a mortality of 12-8 per cent. That is 

 to say, during six years the mortality has fallen 1 7 per cent., or in other words, 

 more than 1200 lives were saved in London in 1900, which would not have been 

 saved, other things being equal, had the mortality rate been what it was in 1894 

 without antitoxin treatment. In 1902, 7707 cases of diphtheria were treated 

 with antitoxin, and 739 died, yielding a mortality of 1 1-04 per cent, (as compared 

 with 29-6 per cent, in 1894). The value is particularly noticeable among 

 children. Amongst cases in the first year of life the rate has fallen from 6i-8 to 

 37-8 ; in the second year from 63-1 to 35-4 ; in the third year from 55-1 to 26-4 ; 

 in the fourth year from 48-3 to 22-9 ; and in the fifth year from 39-6 to 20-7. 

 At the Metropolitan Asylums Board Brook Hospital in 1901, 723 cases of 

 diphtheria were treated with antitoxin, and 78 died, yielding a mortality per 

 cent, of 10-79. The antitoxin treatment was applied in each of these cases, but 

 in some it was possible to begin on the first day of the disease, in others on the 

 second, and so on. The paramount imp)ortance of administration at the earliest 

 possible moment is seen in the result. The mortality percentage of the first day 

 cases was o-o ; of the second day, 4-1 ; of the third day 11-9; of the fourth day, 

 12-4 ; and of the fifth and subsequent days, i6-6. For five consecutive years 

 there has not been a death at this hospital among the cases that came under 

 treatment on the first day of the disease. Even more striking evidence of 

 exactly the same nature has just been reported in Massachusetts as the result 

 of seven years' experience with antitoxin {see Report of Metropolitan Asylums 

 Board, 1901, 1902). For the most complete account of diphtheria antitoxin and 

 its effects see Report on the Bacteriological Diagnosis and Antitoxic Serum 

 Treatment of cases admitted to the Hospitals of the Metropolitan Asylums 

 Boards 1895-96, by Professor Sims Woodhead, M.D. 



