THERAPEUTIC EFFECTS OF ANTI-SERA. 487 



and snake bite. Of the results of such treatment most is 

 known in the case of diphtheria. Here a very great 

 diminution in the mortality has resulted. The diphtheria 

 antitoxine came into general use about October 1894, and 

 the statistics published by Behring towards the end of 

 1895 indicate results which have since been confirmed. 

 In the Berlin Hospitals the average mortality for the years 

 1891-93 was 36.1 per cent, in 1894 it was 21.1 per cent, 

 and in January-July 1895, 14.9 per cent The objection 

 that in some epidemics a very mild type of disease prevails 

 is met by the fact that similar diminutions of mortality have 

 occurred all over the world. Loddo collected the results of 

 7000 cases in Europe, America, Australia, and Japan, in 

 which the mortality was 20 per cent as compared with a 

 former mortality in the same hospitals of 44 per cent. It 

 has also been observed that if during an epidemic the supply 

 of serum fails, the mortality at once rises ; and in two cases 

 recorded it was doubled. It must here be remembered 

 that from the spread of bacteriological knowledge the 

 diagnosis of diphtheria is now much more accurate than 

 formerly. Again, the antitoxic treatment has made trache- 

 otomy less frequently necessary. The American Pediatric 

 Society has collected statistics showing that only 39.2 per 

 cent of laryngeal cases were operated on in 1897 instead 

 of 90 per cent, the calculated previous figure. When 

 tracheotomy is necessary the percentage of recoveries is 

 now much higher, being 73 per cent instead of 27 per 

 cent in the American group of cases. In the London 

 fever hospitals since 1894 the recoveries after tracheotomy 

 have been 56.4 as compared with 32.1 per cent previous 

 to the introduction of antitoxine. One of the most strik- 

 ing results obtained in the same hospitals is a reduction of 

 the death rate in post -scarlatinal diphtheria from 50 per 

 cent to between 4 per cent and 5 per cent. As the 

 disease occurs while the patient is under observation the 

 treatment is nearly always begun on the first day. It is a 

 matter of prime importance that the treatment should be 

 commenced whenever the disease is recognised. Behring 



