9. Even when used in large doses, no serious ill effects have followed the injection of antitoxin."
The foregoing reports belong to ancient history. Let us leave them, and study the record of the hospitals of the Metropolitan Asylums Board. They serve a city of 121 square miles, and 4-1/2 millions of inhabitants.
The use of the antitoxin in the hospitals of the Metropolitan Asylums Board began in 1895. It had been used in 1894 on a few cases only, during the latter part of the year, and had been procured with much difficulty from various sources, chiefly from the Institute of Preventive Medicine. On 9th November 1894, the Board applied to the Laboratories' Committee of the Royal Colleges of Physicians and of Surgeons, asking them to undertake the supply. Arrangements were made for this purpose; and the sum of £1000 was given by the Goldsmiths' Company. Dr. Sims Woodhead, then Director of the Laboratories of the Conjoint Colleges, now Professor of Pathology at Cambridge, was put in charge of the bacteriological work and the preparation of the serum, with a host of expert colleagues: the administration of the treatment was the work of the medical officers of the hospitals of the Metropolitan Asylums Board. The experiences of 1895 are given in the following passages from the joint report to the Board from the medical superintendents:—
"The period covered by the report extends from 1st January 1895 to 31st December of the same year. During this time—with the exception of an interval of three months at the Eastern Hospital, when its use was suspended; of three months at the Fountain, and to a considerable extent throughout the year at the South-Eastern Hospital, when all cases were consecutively treated, irrespective of their severity—the serum was administered only to cases which at the time of admission were severe, or which threatened to become so. In a certain number, the patients being moribund at the time of their arrival, and beyond the reach of any treatment, no antitoxin was given. No change has taken place during the year in the local treatment of the cases, nor has there been any new factor in the treatment other than the injection of antitoxin.
"It must be clearly understood that, with the exceptions previously stated, it has been the practice at each of the hospitals to administer serum to those cases only in which the symptoms on admission were sufficiently pronounced to give rise to anxiety, the mild cases not receiving any.
"No less than 46.4 per cent. of the antitoxin cases were under five years of age, against 32.5 per cent. in the non-antitoxin group; and only 16.1 per cent. in the former class were over ten years of age, against 33.8 per cent. in the latter. The high fatality of diphtheria in the earlier years of life is notorious.
"It is obvious, therefore, that to compare the mortality of those treated with antitoxin with that of those which during the same period were not so treated, would be to institute a comparison between the severe cases and those of which a large proportion were mild. This would clearly be misleading.
"The only method by which an accurate estimate can be obtained as to the merits of any particular form of treatment, is by comparing a series of cases in which the remedy has been employed with another series not so treated, but which are similar, so far as can be, in other respects. This, in the present instance, is impossible; but, having regard to the fact that 61.8 of the 1895 cases were treated with serum, an approximately accurate conclusion can be drawn by contrasting all cases of diphtheria completed during 1895, the antitoxin period, with all cases completed during 1894.
"The year 1894 has been selected for the purpose of comparison, not only because it is the year immediately preceding the antitoxin period, but because the average severity of the cases has been, in our opinion, about equal. Moreover, the death-rate in 1894 was slightly lower than it had been in any previous year.