constantly diminishing during the three decades mentioned. With this evident increase in diphtheria mortality—an increase that is the more noticeable when the general activity in sanitation during recent years is recalled—the necessity for some remedial agent is apparent. Like epidemics of other infectious diseases, diphtheria epidemics show various characters; sometimes being very mild, sometimes very severe, with a high death-rate. This variation seems to be due to differences in the number and virulence of the bacilli, the result of unknown causes, to the association of other bacteria with the Klebs-Loeffler bacillus, and to unrecognized individual tendencies.
The serum treatment of diphtheria is being generally tried throughout Europe and America, and the evidence seems conclusive that it is of benefit. In a series of almost fifteen hundred cases of diphtheria that has been collated from the reports of a number of observers, treated by antitoxine serum, the mortality averaged 22·99 per cent, the maximum being 44·9, the minimum 5·5 per cent. This in itself is striking, for the usual diphtheria mortality is over 50 per cent. Roux, Martin, and Chaillon reported four hundred and forty-eight cases treated in the Paris Hospital for Children's Diseases, from February 1 to July 24, 1894, with a mortality of 24·33, while during the same time five hundred cases of diphtheria were treated in the usual manner at the Trousseau Hospital in the same city, and the mortality was 63·2 per cent. W. Koerte reported one hundred and twenty-one cases treated in the Berlin Urban Hospital between January 20 and October 27, 1894, with the serum, in which there was a mortality of 33·1 per cent, while of one hundred and six cases treated during a period of that time without the serum—none being obtainable—53·8 per cent died.
The injection, which is administered slowly in quantities of twenty cubic centimetres (a little more than five drachms) beneath the skin of the flank, is not painful; and if it is made antiseptically, no ill effect follows, and the dose is absorbed within an hour. In twenty-four hours a second injection of from ten to twenty cubic centimetres may be given, and the two injections ordinarily suffice to cure. The temperature usually falls after the injection, although in grave cases the fever may persist. The pulse becomes normal more promptly than the temperature.
The general condition remains good, as a rule; and the false membranes usually cease growing after the first injection, becoming detached within seventy-two hours. Roux gave a child a thousandth part of its weight in serum, though in severe cases he increased the quantity to a hundredth part of the weight. The treatment should be instituted as soon as possible after the infection, as those children treated with serum on the first or sec-
