The Birmingham age-herald., 1909-06-06


 ease standing next to scarlet fever and
 measles as a cause of this afhiction. In his discussion of local cases, Dr. Fulton pointed out that disastrous after effects were less common in cases of re- eovery where Flexners serum was em- ployed than where 1t was not In two
 cases total deafness has resulted while a third showed partial deafness in one ear, which has so far persisted. Beyond this. however. the reeoveries have been complete
 In discussing this phase of the treat ment, Dr. Flexner wrote, in his review of
 the first 400 cases:
 "The indications given by the first se- l ries of m-treated cases were to the
 effect that in the great majority of in
 stances recovery from the disease would
 be complete. The facts brought out by the far larger series on which this arti- | cle is based confirm the earlier view. The
 number of complications which arose in l them was small, and the only persistent l defect noted was deafness. This lament
 able condition occurred in a few in stances only. and it was, more often l than not, noted early in the disease be- l fore the serum injections were begun.
 Dr. Flexner also gave figures showing
 the results of the treatment classified 1 by the ages of the patients. Fifty per 1 cent of those under 1 year of age died, | 42 per cent of those between l and 1 years, 23 per cent of those between 2
 and years, Il per cent of those between
 and 10 years. 2S per cent of those be- tween 10 and 20 years, 26 per cent of
 those over 20 years and 46 per cent Of those whose age was not given. The total percentage of deaths was just 20.
 It was observed that there was nor tality among cases over 20 years of age Dr. Flexner expressed the belief that this might be explained by the fact that a larger number of these were treated by scattered physicians who had had no previous experience with the serum.
 This series of 400 cases also showed that the percentage of recoveries was much higher when the serum was ad- mlnistered promptly after the diagnosis. When 1t was used by the third day of the disease, the percentage of deaths was only 165. When it was used between the fourth and seventh day, the per centage was 2S.S, and when 1t was used later than the seventh day the percent age of deaths was 35.
 Practically all of the modern knowl edge of the disease, upon which pr. Flex- ners work was based, dates from 1887, when a German physician discovered the causative agent, an organism existing in the spinal fluid. But though persls- tent efforts were made for 20 years to discover a specific vaccine or serum, and several were tried with varying success, none of them achieved results at all com parable with those of Flexner's serum.
 Following an outbreak at the Newport Training Station three years ago, the army surgeons in charge declared their opinion that the problem will only be solved when an anti--toxin has been sue cesfuly produced" At that time pr. Flexner was just completing the long series of animal experiments which en- abled him to offer the much-sought spe- cifc.
 Of the ravages of the disease, history affords plenty of evidence. There were epidemics of 1t in Europe for centuries, during which time 1t was classed as one of the plagues. medical writer recent ly described four great cycles of 1t dur ing the 18th century in Europe and Ameri- ca one of them occurring during the Civil war when the disease ragged in the Confederate camp at Newbnrn and in the Army of the Potomac.
 Physicians classify the present time as another similar cycle, which began in the late '90s, but which did not be- come serious till 1904 during which year there were more than 5000 deaths in New York city alone Dr. Flexner has raised the question whether the wide distribu- ton of the disease in this country at the present time is the outcome of that epidemic, ar whether it tends to exist and has long existed in a sporadic state. from which severe epldemics occasionally rise.
 In spite of recent additions to knowl- edge of the disease, it is still uncer- tain how it spreads, though it is pretty definitely determined to be distributed by contact and house infection, while it is known that the germs may be present In the nasal muscles of healthy persons, inn plying that the organism of the disease may be transmitted without transmitting the disease.