THERAPEUTIC EFFECTS OF ANTI-SERA 489 



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 instances 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. Another effect of 

 the antitoxic treatment has been that when tracheotomy is 

 necessary the percentage of recoveries is now much higher, being 

 73 per cent instead of 27 per cent in a group of cases collected 

 by the American Pediatric Society. 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 intro- 

 duction of antitoxin. One of the most striking 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 here 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 treat- 

 ment should be commenced whenever the disease is recognised. 

 Behring showed that in cases treated on the first and second 

 days of the disease the mortality was only 7 '3 per -cent, and this 

 has been generally confirmed, whilst after the fifth day it was of 

 little service to apply the treatment. In order to obtain such 

 results it cannot be too strongly insisted mi that attention 

 should be given to the dosage. When bad results are obtained 

 it may be strongly suspected that this precaution has not been 

 observed. In the treatment of acute tetanus by the antitoxin 

 the improvement in results has not been marked, but some 

 chronic cases have been benefited, and as already stated (p. 386) 

 better results are obtained in acute cases if intravenous in- 

 jection be practised. In the case of Yersin's anti-plague serum, 

 though benefit has appeared to follow its use, experience 

 with its effects has been too limited to enable a judgment 

 to be formed. The same may be said to be true of the anti- 

 streptococcic and anti-pneumonic sera, though in the case of the 

 first mentioned numerous cases of apparently successful result 

 have been recorded. With regard to anti-venin, Lamb has shown 

 that, if a cobra with full glands bites a man, many times the 

 minimal lethal dose are probably injected. In cases of slight 

 bite, however, benefit may accrue from the use of the anti- 

 serum. 



