This vast collection of cases is of special interest, because they
occurred in private practice. In most of them the nature of the
disease was proved by bacteriological examination; in the rest, the
clinical evidence was decisive: "It is possible that among the latter
we have admitted some streptococcus cases, but the number of such is
certainly very small." All other doubtful cases, 244 in number, were
excluded.
Three thousand three hundred and eighty-four cases were reported by
613 physicians from 114 cities and towns, in 15 different States, the
District of Columbia, and the Dominion of Canada. To these 3384 cases
were added 942 cases from tenement-houses in New York, and 1468 cases
from tenement-houses in Chicago. The New York and Chicago cases were,
most of them, treated by a corps of inspectors of the Health Board of
the city; and the municipal surveillance was very strict at Chicago:--
"There are very few hospitals in America that receive diphtheria
patients.... It was the custom in Chicago to send an inspector
to every tenement-house case reported, and to administer the
serum unless it was refused by the parents. These cases were
therefore treated much earlier, and the results were
correspondingly better than were obtained in New York, although
the serum used was the same in both cities, viz., that of the
New York Health Board."
The sum total of results was 5794 cases, with 713 deaths = 12.3 per
cent., including every case returned; but 218 were moribund at the
time of injection, or died within twenty-four hours of the first
injection. "Should these be excluded, there would remain 5576 cases in
which the serum may be said to have had a chance, with a mortality of
8.8 per cent.
Of 996 cases injected
on the first day of the disease, 49 died = 4.9%
" 1616 " on the second " 120 " = 7.4"
" 1508 " on the third " 134 " = 8.8"
" 758 " on the fourth " 147 " = 20.7"
" 690 " on or after the fifth " 244 " = 35.3"
And in 232 cases, where the day of injection was unknown, there were
19 deaths = 8.2 per cent.
"No one feature of the cases of diphtheria treated by antitoxin has
excited more surprise among the physicians who have reported them than
the prompt arrest, by the timely administration of the serum, of
membrane which was rapidly spreading downward below the larynx. Such
expressions abound in the reports as 'wonderful,' 'marvellous,' 'in
all my experience with diphtheria, have never seen anything like it
before,' etc.
Public-domain text, read in full here on John Shaqi.
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