"It must be clearly understood, however, that to obtain the largest measure of success with antitoxin it is essential that the patient be brought under its influence at a comparatively early date—if possible, not later than the second day of disease. From this time onwards, the chance of a successful issue will diminish in proportion to the length of time which has elapsed before the treatment is commenced. This, though doubtless true of other methods, is of still greater moment in the case of treatment by antitoxin.
"Certain secondary effects not unfrequently arise as a direct result of the injection of antitoxin in the form in which it has at present to be administered, and even assuming that the incidence of the normal complications of diphtheria is greater than can be accounted for by the increased number of recoveries, we have no hesitation in expressing the opinion that these drawbacks are insignificant when taken in conjunction with the lessened fatality which has been associated with the use of this remedy.
"We are further of the opinion that in antitoxic serum we possess a remedy of distinctly greater value in the treatment of diphtheria than any other with which we are acquainted."
Now let us take the whole record of all the hospitals together. The disease was first admitted in 1888; this year is therefore to be reckoned as incomplete.
| Year. | Percentage Mortality. | Year. | Percentage Mortality. |
|---|---|---|---|
| 1888 | 59.35 | 1897 | 17.69 |
| 1889 | 40.74 | 1898 | 15.37 |
| 1890 | 33.55 | 1899 | 13.95 |
| 1891 | 30.63 | 1900 | 12.27 |
| 1892 | 29.35 | 1901 | 11.15 |
| 1893 | 30.42 | 1902 | 11.04 |
| 1894 | 29.29 | 1903 | 9.69 |
| 1895, first antitoxin year | 22.85 | 1904 | 10.08 |
| 1896 | 21.20 | 1905 | 8.3 |
These results, of course, are but one instance of what has happened, since 1895, in every country all over the civilised world. Securus judicat orbis terrarum. We have Siegert's tables (1900), based on no less than 40,038 cases admitted in nine years to sixty-nine hospitals in Germany, Austria, Switzerland, and Paris. He divides these nine years into a "pre-serum period," an "introduction year," and a "serum period." In the pre-serum period the general mortality was 41.5, and the mortality of cases requiring operation was 60; in the serum period, the general mortality was 16.5, and the mortality of cases requiring operation was 37.5.
Any bad results that have been recorded from the use of the antitoxin are so rare, in comparison with the hundreds of thousands of injections made, that they do not come to be considered here. And, even though a few have occurred, we may be sure that some of them were due, not to the antitoxin, but to the natural course of the disease.[23] The lesser drawbacks, the occurrence of joint pains and of rashes, are transient and in no way serious.
It has been supposed, and said, that the use of the antitoxin increases the complications of the disease. On this point, the best authority is Professor Woodhead's monumental Report (1901), dealing with the Metropolitan Asylums Board cases for 1895 and 1896. He sums up the matter thus:—
"The free use of antitoxin does not raise the percentage of cases of albuminuria. As regards vomiting, the statistics give little information, as vomiting is usually met with only in the very severe cases. This also holds good of anuria. The number of cases of adenitis appears to be distinctly reduced by the use of antitoxin, as the percentage of cases falls as the injections of antitoxin are pushed. The use of antitoxin has also had a perceptible effect in diminishing the cases of nephritis, and it certainly has not aggravated the kidney complications of diphtheria. There can be no doubt that in cases treated with antitoxin there is a greater percentage of cases in which joint-pains occur than in cases not so treated; these, however, are transitory, and are probably the result of some slight change in the blood set up by the action of the serum itself, and not by the antitoxic substance in the serum. The number of primary abscesses has undoubtedly been reduced by the use of antitoxin. It may also be accepted that antitoxic serum has some effect in temporarily raising the temperature, but only during the periods of joint-pains and serum rashes; all these, however, are of comparatively slight importance as compared with the effect the antitoxin has in diminishing the percentage mortality and alleviating the more severe symptoms.