New-York tribune. [volume] (New York [N.Y.]) 1866-1924, 1896-07-05
WITH THE LARYNX AFFECTED.

WITH THE LARYNX AFFECTED
In the o63 cases therefore. 1863 per cent Of the
whole number. there clinical evidence that the
iarynx was involved and yet recovery took place
without operation II many OF these cases the symp-
toms OF senosis were severe. and yet disappeared
after injection without intubation No one feature
OF the cases OF diphtheria treated by antitoxn
excited more surprise among the physicians who
have reported them than the prompt arrest by
the timely administration of the serum of mem
orane which was rapidly spreading downward be-
ports as IN the rs re 20
90 intubaion, but at my next visit the patient was
nSrience with diphthera have never seen anything
me II before no unprejudiced mind could see
In establishing the value of the serum. nothing
properly administered to check the RAPID spreading
Of membrane downward in the respiratory tract as
physicians who have in reports
o Iurh,ng now to the operative cases we find the
able Operations were done In So cases or in l6
VA SsiH es Wh s
tally OF S's per cent In the above are included
done. with : deaths. In 80 tracheotomy only was
done 5o with - deaths mortality Of b.! per cent
at d the time Of operation or died within tweny-
Quoted there remain 100 cases operated upon by
intubation or tracheotomy, with 81 deaths, a NOR
Of the 2,sls cases not operated upon there were
3l2 deaths. a mortality OF l3 per cent. Deductng
four hours after injection the total mortality of all
non-operative cases was 9l2 per cent
Let us compare the results of intubston in cases
| in which the serum used with those obtained
with this operation before the serum was intro,
ducet OF 5.546 ntubation cases in the practice Of
2i2 physicians. collected by McNaughton and Mad Mad
d be He mCray was s per bs
the general use dn and about New York: at leasO
best results pnbshed Chose Of B fS showed in
| 279 cases mortality of Sic per cent.
RESULTS OF INITIATION.
| Let us put beside the OF McNaughton and
| Maddren the 533 intubatons with antitoxin, with
% per cent mortality. With Browns personal cases
| let compare those Of the fourteen observers who
| have reported the committee ten or more intu-
baton operations in cases injected with serum
These comprise $50 cases. with G1 deaths. -, a
| mortality without the serum is more than twice as
great in the cases in which serum was used
The reports of some individual observers concern
| ing intubation with the serum are Interesting:
Nef. New-York: 2 operations. with = recoyeries
Rosenthal. Philadelphia: is operations, with 10
| recoveries
cries including one aged ten months and one seven
and half months. 40 -
McNaughton. Brooklyn. In my last - operations
q operations. with serum morality S5S per cent.
arS, ~ Without serum GTm morta i 70 per cent last
80, with serum. mortality 1873 per cent
M, But bcSH hes snoKn aO nG
ness the fact that one-half the laryngeal cases
did not require operation at all. Formerly 10 per
cent of the recoveries the record for aryngeal
cases not operated upon surely it does n9th ~
cases of laryngeal dphtheria that has been saved
The great preponderance of intubatlon over tracn-
eotomy operations shows how much more hishy the
profession in this country esteems the FORMER opera
THE KIND OF ANTIToXIN USED.
| They are given in the order of frequency with
| which they have been used. First. the pre-
| XorL ri nf 4.
Behring's; third. Bibiers; fourth. Mulfords; ffth.
| Aronson's sixth. Roux's In addition large num-
Der of reported as having been treated by
the serum PREPARED by the health boards Of different
The LARGEST number Of cases haye been ireas o oy
the serum MP prepaged BY thf EH mea al o6er
| being relatively in small numbers
A SUMMARY OF RESULTS.
l. The report includes returns from els physicians.
! OF this number than COO have pronounced
themselves strongly in favor Of the serum treat
ment the great majority being enthusiastic in its
advocacy.
. The cases included have been drawn from To-
calities widely separated from each other, so that
any peculiarly of local conditions 10 which might
be ascribed the favorable reports must be excluded
turned except those In which the evidence OF diph,
thera was clearly questionable 1t will be noted
thst dombtful cases which recovered have been
Guided. while doubtful cases which were rata! nave
a No new cases of sudden death Immediately after
injection have been returned.
j. The number Of cases injected reasonably early
in which the serum appeared not TO influence me
4 cases of dphtheria compicatinS measles ana 8
MAJ ib csas had passed beyond any reasonable
prospect OF recovery before the serum was used
g. The number OF cases in which the patients ap-
nearca 10 have been made worse by serum was
g. and among these there is only new case IN
which the result may fairly be attributed TO the
: The general mortality in the 5.7s cases reportei
the time of injection dying within twenty-four
hours. ii was SIS per cent. ,.,- so., t., .,a
s. The most striking Improvement was seen IN ' ne
cases injected during the hrst three DAYS or 10
such cases the mortality was - per cent; exling
within twenty-four hours 1t was As per cent.
9 The mortality Of AS cases injected on or AFTER
the fourth day q per cent 49,,
TO- The most convincing argument and 10 the the
able one in favor OF serum therapy is found in the
results obtained in the 2ys laryngea cases unem
place without operation. in large proportion OF 81
which the symptoms Of s,enosls Were srvSt go, I'D
he mortality was 29 per cent. less than half as
great as has ever been reported by any other
' Il The 81 proportion of Of
TO results al published from hospital sources
ITS EFFECT UPON THE HEART
- As against the two three instances In which
tho serum IS believed have acted unfavorably
unon the heart might be cited large number IN
which there was a distinct improvement III lhe
hearts action after the serum was in)ecteo.
-. There is very little. II any. evidence 10 snow
that nephrtis was caused In any case by inc IN
t.ct,on of serum The number OF cases 81 genuine
nenbrJtis is remarkably small. the deaths from
that source numbering 10. ... .,.,,o.,
Ia The of the serum on the nervous III
Is less marked than upon any otheT ar o. w
l.5v. raralytic sequelae being recorded IN W pr
con; ~ inc cases the reports going TO snow maj
Inc nrotection afforded by the serum Is not great
miles, infections are made very early.
The committee feels that this mas been u s,n,s he
.irnctre which has guided il In making up me re-
turne While IL has endeavOred 10 present the Ia
.ua.aIo results with judicial fairness II mas also
tr;ed 10 give equal even greater prominence ~
cases unfavorab.e to anttoxin , l.. Thai, -,
CacN. r,1-,attD 90 les in hehnt OF