This last sentence is from Dr. O'Dwyer's note of the case, when by special invitation he discussed the subject at the annual meeting of the British Medical Association, held at Bristol, England, in July, 1894.
Interesting as is the career of Dr. O'Dwyer as an investigator and discoverer in medicine, his character as a man is still more worthy of attention. For nearly thirty-five years he was a member of the staff of the New York Foundling Asylum; during which time he endeared himself to sisters and nurses, to his brother-physicians on the staff and to his little patients. He was eminently conscientious in the fulfilment of his duty, and had a tender sympathy that made him feel every slightest pain of his child-patients almost as personal.
One very stormy evening, in the closing years of his life, after his more than twenty years' service as a member of the asylum staff, a little child fell ill and he was sent for. Though not well himself, the doctor came out into the night and the storm to attend the little patient. As he was leaving the hospital, long after midnight, one of the sisters, who had been longest in the hospital and who knew him very well, said to him:
"But Doctor, why did you come out on such an awful night? The house physician might have gotten on very well without you until morning, even though the little one was much worse than usual."
"Ah, sister," he said, "it was a child suffering, and I couldn't stay home and think that perhaps there was something I might suggest that would relieve that suffering even a little during the night."
It was this beautifully tender sympathy that urged him on against many discouragements to continue his investigations with regard to the possibility of intubation, and finally led him to his brilliant and perfected discovery. Yet it is even more interesting to find that after all these years of labor, just as soon as antitoxin was introduced, and it became clear that a new and great advance in therapeutics had probably been made, O'Dwyer immediately took up the new remedy in order to test fully its possibilities. If antitoxin were to prove the success that was claimed for it abroad, if cases of diphtheria were to recover under its influence as they apparently had done in France and Germany, then the role of intubation would soon be a very small one and O'Dwyer's years of patient investigation would go for very little. Such considerations, however, had no weight with him, and it may be said that during his superintendency at the New York Foundling Asylum antitoxin had for the first time a full, unrestricted opportunity given it to demonstrate its power for good.
Notwithstanding discouragements of many kinds, the test of the efficacy of diphtheria serum was persevered in when others with more apparent reason for interest in it became disheartened and were ready to give it up, if not even actually deprecating its use. The medical profession understands very well now how unfavorable were the conditions under which diphtheria antitoxin was used at first. The original experiments had been made in the laboratory with small animals, and the amount of antitoxin necessary to produce good effects in human beings was not well understood. As [{346}] a distinguished authority in children's diseases, who is himself a great advocate of the efficacy of antitoxin, once said: "It can practically be admitted that when first antitoxin was introduced its use was scarcely more than expectant treatment." That is to say, so little of antitoxic power was contained in the serum injected at first that the children were practically only kept from other and more exhausting forms of treatment, while the physicians awaited the results with nature as the only really active therapeutic agent.
After all, it must not be forgotten that the first doses of antitoxin contained at most 50 to 100 antitoxin units, as we now measure serum efficacy for the treatment of diphtheria. At the present time no one would think of using less than five hundred units as a beginning dose, and those who obtain the best results begin with 1000 to 1500, or in severe cases with 2000 to 3000 units of antitoxic strength. It is almost providential that, notwithstanding this failure to understand the serum properly, the verdict of the profession did not go so generally against antitoxin as to condemn its use hopelessly. It is owing to O'Dwyer and a few other sympathetic souls, who "hoped almost against hope," that finally experience succeeded in demonstrating the true value of diphtheria antitoxin.
There was another difficulty, however, in the way of the adoption of antitoxin that had to be overcome, one that proved no little source of discouragement to many of those who were testing the remedy. The original diphtheria serum employed was not concentrated; so when a sufficient amount of antitoxic units to neutralize the toxins of the disease under treatment was employed, a large quantity of serum had to be injected. Experience shows that the injection of any foreign blood serum into an animal is followed by a certain amount of haemolysis, or blood destruction, and by [{347}] certain cutaneous manifestations, such as urticaria, erythemata, the familiar hives-like eruption and red itchy spots, which prove a great source of annoyance. In very susceptible cases the injection of even a small amount of foreign serum is followed by some fever, by restlessness, and red and swollen joints. In the early days of the employment of diphtheria antitoxin, all of these complications were noted in many cases. They were sufficient to make many who were interested in the demonstration of the value of antitoxin so disappointed and discouraged that they gave up the task. Not so, however, with O'Dwyer, who continued its use, and encouraged others by his example so that in spite of these objections antitoxin obtained a firm foothold.