New-York tribune. [volume] (New York [N.Y.]) 1866-1924, 1896-07-05
THE USE OF ANTITOXIN.
,r.rs1rcs OF RESULTS OBTAINED IN
PRIVATE PRACTICE

MORTALITY IN DIPHTHERIA CASES WHERE IT
WAS USED IN TIME LESS THAN NINE PER
rrxr-FAvoRABLE REPORT OF A COMMIT
TEE OF THE PEDIATRIc SOCIETY.
The following report of the Pediatric Society
m the use Of antitoxin in private practice was
wade at the last annual meeting of the society IN
Montreal The committee sent out lo."oo blanks
and collected data regarding 5000 cases in pri-
vate practice in which antitoxin was used
The result Of the investigation was report IA
xorable to the remedy II is in part as follows:
This subject was chosen by the officers OF the So
ca,y for its eighth annual meeting with the behef
,,at large amount Of valuable experience not
otherwise available might in this way be reached
and collated. 1t also believed that more trust
worthy estimate OF the value OF the serum treat
mont of dphtheria might thus be obtained than by
statistics taken from hospital practice Ihere are
o-, fcO large hospitals In America that receive dlph-
iberia patients and the conditions under whch pa
tents are admitted 10 hospitals and the surround
,ne. while there are so different from those Of pr
vate practice that the measure OF success IN Hos-
pltal cannot be taken as an INDEX OF 'he re
suits which been obtained upon this SIDE Oh 'he
Atlantic With the treatment.
IN order therefore TO obtain an expression OF
n,nson from American physicians to the serum
treatment after what had been. with most o. 'hen
,,s,r first wears experience. circular letter was
orepared and issued by the committee early IN April
This was distributed through the members OF the
society as widely could be done during the time
allowed An attempt made 10 reach az many
ohvsicians as possible who had had experience win
the remedy
WIDE USE OF THE SERUM
The first surprise of the committee was in learn
fig how very widely the serum treatment hao Dee"
EMPLOYED especially in the Eastern and midwest
~-r States With more time. the number OF cases
collected might easily have been doubled and per
haps trebled but enough reports have come IN 10
enable one 10 see what opinion was held on May !,
1896 by American physicians who have used TINS
remedy
The circular letter asked for Information upon
,he following points Age previous condition. AURA
zion O, disease when the first injection was made
the number Of injections the extent OF me mem
brane-tonsils. nose. pharynx and larynx' "he'her
or no, the diagnosis confirmed by culture CONF
nlscations or sequelae. viz. pneumonia nephritls'
sepss PARALYSIS the result. and remarks, n1ciuu'hg
peber treatment employed. the preparation OF anti
toxin used and general impression drawn from the
cases.
rsans with 362s cases OF these pa cases have been
.xcl,6ad from our statistical tables. These We're
cases In which the disease was said to nave peeh
confined TO the ;onsils and the diagnosis ho' CON-
frrnei BY culture and therefore open 10 queSuoi''
A few cases were reported in such doubtful terms
as to leave the diagnosis uncertain. Inc "suie7
herewith given are therefore made up from cases
in which the diagnosis was confirmed oy cu'tuie
(embra c!ng about twO-thrds OF the wnole NUMBER
and others giving pretty clear evidence OF
either in the fact that they had been contractor
from other undoubted cases, or where the mem
trane had invaded other parts besides the tons'is'
much as the palate. pharynx. nose or larFhN IL Is
possible that among the latter we have admitted
some streptococcus cases. but the number Of such
Is certainly very small.
OVER 5000 CASES.
rnars ar. left then Of these 1884 for an
aIvsis These have been observed In the prac'ce Vi
C,s physicians from ia cities and towns IN fifteen
different States. the District OF OoiufhDi1 anu 'i7
Dominion Of Canada
In the general opinion Of the reporters the type
Of dphtheria during the past year has not dlnered
materially from that in previous years so mat
4. has been average diphthera which has been
treated II there is any difference in the severity
Of the cases included these reports from those OF
average dlphtheria, # Is that they embrace
rather larger proportion OF very bad cases tnah
are usually brought together in statistics Inc
cases according TO the extent or the membrane
are grouped as follows: 593 the tonsils alone were
involved In 1891 the tonsils and pharynX the ton
sis and nose, the pharynx and nose OF all three
were affected In 1256 the larynx was affected
either alone or with the tonsils pharynx and nose
one or all In many instances the statement IS
made By the reporters that the serum was re-
sorted only when the condition OF the patient had
become aarmirg ly under ordinary methouS OF
treatment This is shown by the unusually large
number OF cases in which injections were made late
In the disease Again. many physicians being as
yet in dread Of the unfavorable effects OF the
serum. have hestated 10 use II in mia cases ana
Rave giver 1t only in those which from the onset
gave evidence Of being OF severe type. Inc OK
pense OF the serum has unquestionabiy deferred
many from employing IN mid These factS
II is believed. will more than outweigh the bias OF
any anttoxn enthusiasts by including many lnlia
cases which would have recovered under any treat
nent. II Will however. be remembered that ton
siar cases no. confirmed by culture have not been
Included.
NETWORK CASES.
Only TWO rerorts embracing series Of over 100
cases have been received most Of the observers
having sent IN from five to twenty cases aithough
clere are many reports of single cases particularly
Of single fatal
In addition to this aterial which has come in re-
vonse 10 the circular there have been placed al te
disposal Of the committee by the courtesy of Dr. H.
NJ Biggs 942 cases treated in their homes IN 'he
tenenents Of New York OF these $50 were injected
BY the corps of inspector, Of the NeW.lork Heanh
and Sc others were treated BY RhyTc asrd i fn
the first group the diagnosis OF dphthera was con-
frmei by culture IN every case. ana IN an OF
rested upon extensive membranous deposits or
kryngea invasion. The cases Of TIE Ee"- d, OK
Health Board OF more than ordinarily severe ft
type. 40 or more than % per cent OF ~ 80 -
reportei being in bad CONDITION al ne t ee moi OF
injection: 10 mild cases the ilsISc'VV VIZ ~
often called Further, an unusually !arge nurii .s
6r them s per een9 s were a OF e cases
only the tonsils affected: in 400 me tohsls
ell three; in 2si the arynx was invaded either with
or without disease OF the tonsils nose or l,h1rInA
Through the courtesy of DR.. Biggs the committee
able to include also partial report upon ~
cases from Chicago treated In Their POTTS a l41
nnent II was the custom In Chicago to send an
inspector In every rra r. was refised
By the parents These cases were thereore trsads1
much earlier. and the results we're correspoii1'hgy
obtained