testimony of others, or by a rational deduction from accepted premises. But our judgment may err in personal experience, or our deductions may be based upon untenable propositions, and the weight of reliable testimony may be meager. Waiving the first two sources as a foundation stone for our judgment, let us conceive of a remedy, or agent, of proposed therapeusis, toward which the eyes of the medical world, were turned, some its friends, some its foes, with a great number of fair-minded judges, who at the assize can deal fairly; and as report after report, article after article, appear, almost weekly, daily, we can form some judgment as to the agent. Such is the case with Serum-Therapy.

With this therapeutical lever I have had no experience, and, therefore, my paper must rest on testimony and rationality combined.

The power of the Blood-Serum-Therapy is the antitoxin, of which it is the carrier. And it might be well just here to ask what is antitoxin? Taking that of diphtheria as typical, from my understanding of the materia medica as it were of the blood-serum agent (digested from Krieger's article), it is simply the inoculation of beef-tea with the bacilli, incubation allowed to take place, toxin formed, animal injected and immunization resulting; blood drawn, coagula formed, serum separated, anti-toxin resulting (after adding a fraction of carbolic acid, or other manipulation), and being injected into mankind (genus-homo), becomes a therapeutical measure of a prophylactic, or curative nature.

Now, what have been laboratory results, upon lower animals, for instance, under strict official surveillance? I quote the following from the New York Therapeutic Review (April, May, June, 1896), verbatim: "REPORT OF THE LABORATORY OF THE NEW YORK PASTEUR INSTITUTE ON ANTITOXINS.

"Experiments recently made with the Antitoxin of Diphtheria, Tetanus and Septicæmia, in the Laboratory of the Pasteur Institute, have given the following results:

"Diphtheria. The injection to guinea-pigs of a quantity of this antitoxin (Gibier's), in the proportion of 1-150.000 of their weight, has enabled them to survive an injection of two drops of the virulent culture of diphtheria bacillus administered 24 hours later. One drop of this culture inoculated to the 'control animals' caused death in 24 hours.

"If the above figures are valued in immunizing units, according to the formula of Spronck, each cubic centimeter of this diphtheria antitoxin (Gibier's), contains 300 units. The horses from which the serum is taken have received during the last twenty months over 5,000 c.c. of diphtheria toxin, each horse receiving an average of two injections weekly.

"Tetanus.-The injection to guinea-pigs of a quantity of this antitoxin in a proportion of 1 to 1,000,000 of their weight, enabled them to

survive a fatal dose of tetanus toxin. The same dose given to the 'control animals' caused death within 48 hours.

"Septicæmia (Erysipelas Streptococcus).-The injection of this antitoxin to rabbits, in a proportion of 1 to 10,000 of their weight, has enabled them to resist a dose of streptococcus culture fatal to 'control animals.'

"A. LETEVE, M.D., Director of the Laboratory of Bacteriology.
"F. T. LABADIE, M.D., Assistant, Hydrophobia Department.
"GEO. G. RAMBAUD, Assistant of Bacteriology.

"E. ESQUERRE, B.S., Assistant of Chemistry.

"J. ESQUERRE, B.A., Assistant of Bacteriology.

"PAUL GIBIER, M.D., President."

ITS EFFICIENCY.

I have compassed the universe, as it were, not to make one proselyte to Serum-Therapy, but to gain light upon the subject, from all climes. Now what are the results from sero-therapeusis? And why not commence at its birthplace-Germany?

Schulze-Berge & Koechl, of New York, have compiled a very elaborate brochure (up to 1894-5), of results from such observers as are now shown. "Statistics in Berlin.-Dr. Behring has recently published a comparison of the results of the treatment of diphtheria in two of the Berlin hospitals. In the Charite, where antitoxin was employed, there were 299 patients, with 53 deaths, or 17 7-10 per cent. In the Bethania Hospital, where antitoxin was excluded, there were 249 patients, with 112 deaths, or 45 per cent."

"Official statistics show that the mortality from diphtheria in the cities of Berlin, Dresden, Leipsic, Munich and Hamburg during the first half of 1895, was conspicuously lower, both absolutely and relatively, than during any year covered by the records, although the whole number of cases of the disease, in the City of Berlin, for instance, was larger, and the proportion of cases received into the hospitals was smaller."

The following are actual results, from individual observers, collected from the brochure (as abstracted):

HUEBNER. “Among the 110 uncomplicated cases treated between the first and third days, there were but six deaths (5 4-10 per cent)." SCHROEDER (City Hospital of Altona).—“Injected 63 cases of diphtheria, 8 of which died (12 69-100 per cent. mortality).

"The mortality of the true diphtheria cases was 10.71 per cent., as opposed to 29.41 per cent. for 1889, the lowest of the seven preceding years."

VIERODT.-"Mortality was then found to be 14 per cent., as against 67 to 37 per cent. in the preceding six years."

LEICHTENSTERN and WENDELSTADT.-"Prior to antitoxin, 309-10 per cent. Subsequently, by use of antitoxin, 'fell to 20 3-10 per cent.' HEIM. "Twenty-two per cent. versus 52 4-10 by other methods." MONTI, of Vienna (British Medical Journal), "Reports that he has treated 25 cases of diphtheria with the antitoxin, with but a single death." UNTERHOLZNER.-"25 8-10 per cent., with versus 66 6-10 per cent. 'without serum.'

SEIZ (Constance).-"Twenty-seven cases treated with antitoxin, with a single death."

GANGHOFNER (in Kaiser Franz Josef Children's Hospital, Prague)."With antitoxin 127-10 per cent.; without, 43 per cent.”

SIEGEL (Olga Hospital, in Stuttgart).-"Prior to use of antitoxin, from 1889 to 1893, 40 1-10 per cent.; and 1894, up to October 4, when the antitoxin was first employed, the mortality reached 50 3-10 per cent; but in 100 cases treated from October 4, 1894, to January 1, 1895, with the antitoxin, the mortality was 12 per cent. and 20 3-10 per cent., respectively."

FURTH (Clinics at Freiburg).-"The opinion is expressed that the antitoxin is a specific in the treatment of diphtheria with which no other therapeutic measure is to be compared."

RUMPE. "Reported the results obtained in the new General Hospital of Hamburg from the employment of Behring's antitoxin in the treatment of diphtheria. The complete statistics for several months showed that there had been 91 cases of diphtheria in the hospital, with II deaths 12 per cent)."

ESCHERICH. "Has treated 51 cases of diphtheria with the antitoxin with 5 deaths (9 5-10 per cent.)."

GOUGUENHEIM (Hospital Lariboisiere).—“Prior to use of antitoxin deaths in adults, 10 37-100 per cent.; children, 57 5-10 per cent. 'Of 77 adults treated with the antitoxin, three died (3 9-10 per cent.), and of 48 children, 9 died (1875-100 per cent.).'"

DREYFUS (Charite Hospital of Lyons).-"With antitoxin, mortality of only 19 29-100 per cent. 'In previous years the mortality of diphtheria has been 50 per cent.'"

LE GENDRE. "Antitoxin in '16 cases diphtheria, with 2 deaths.'" LEBRETON (Hospital des Enfants).-"242 cases of diphtheria, with 28 deaths (11 66-100 per cent.)."

MOISARD. "Reported the employment of the antitoxin during the months of October and November, 1894, in 248 cases of diphtheria, with 34 deaths (1471-100 per cent.)."

WASHBURN, GOODALL and CARD (in London).-"With antitoxin. there were 14 deaths, or 194-10 per cent., the average mortality in the same hospital during 1893, and up to October 22, 1894, was 38 8-10 per

cent. The mortality of the 724 cases immediately preceding the beginning of the antitoxin treatment 38 8-10 per cent. In the opinion of the writers the cases treated with antitoxin were of more than average severity."

ZABOLOTNUI (Podolia, Russia).—"In 109 cases proved bacteriologically to be true diphtheria, injections of anti-diphtheritic serum were employed. The number of deaths was 14. The percentage death rate was, therefore, 12 8-10 per cent. Previously, under the old forms of treatment, the rate had been 48 per cent."

This brochure also says: "Dr. Louis Fisher, of New York, says that before the introduction of this remedy his mortality in diphtheria was about 55 per cent. Since his use of antitoxin his mortality has been reduced to 15 per cent., and he now declares that he would as soon think of treating intermittent fever without quinin, as to treat diphtheria without antitoxin."

Editorial, Journal American Medical Association, April 20, 1895."When Professor Virchow, repudiating the attack of his assistant, Dr. Hansemann, on Behring's theory of the serum treatment of diphtheria, said: 'All theoretical considerations must give way to the brute force of these figures,' referring to the statistics of the treatment in the Kaiser and Kaiserin Friedrich Hospital, of Berlin, the question seemed to be settled as to the general merits of sero-therapy. During a given period 533 cases of diphtheria were treated in this hospital. Of these 303 were treated with serum, with a mortality rate of 13 2-10 per cent.; 230 were treated without serum, with a mortality rate of 47 8-10 per cent. A still more striking exhibit was afforded during June and July, when nearly all cases were treated with the serum, and the mortality rate was 127-10 per cent. 'Suddenly,' says Virchow, "the supply of serum. ceased, as, unfortunately, the very horses from which the serum was taken died. The old methods of treatment had again to be resorted to and the results were: 109 cases, 55 deaths in seven weeks, a mortality rate of 50.46 per cent.'

"A supply of serum was then obtained from another source, and during the next six weeks 81 cases were treated with 12 deaths, a mortality rate of 14.81 per cent. It was the 'brute force of these figures' which Virchow said compelled him to recommend the serum, to attribute to it a brilliant therapeutic virtue;' to contend that, even if disagreeable by-effects were proved to occur occasionally, they were not sufficient to deter him from continuing the treatment."

Copy following from Gaillard's Medical Journal, November, 1895, page 286, as selected from British Medical Journal:

DIPHTHERIA ANTITOXIN.

"Dr. M. Charteris, professor of materia medica and therapeutics, University of Glasgow, said at the last meeting of the British Medical Association:

"I had the opportunities of observing, during the last winter, cases of diphtheria at Belvidere Hospital, which were treated by antitoxin. There seemed to me to be no doubt about its efficacy. The patches of membrane ceased to spread, and shriveled up after the injections. The ashy color of the face was replaced by a healthy hue and the pulse became fuller and stronger.'

Coming to our own State: E. C. Levy, M.D., Richmond, Va., writing under subject of "Serum-Therapy of Diphtheria" (Medical SemiMonthly, May, 1896, and from schedule of his data as member of Medical Society of Virginia), says substantially: "Klebs-Loeffler bacilli excite local trouble, and growing, develop diphtheria toxin, poisoning general system, and probably prove mortal but for a recoil, and 'antitoxin developed,' antagonizing further dire results. The inference is, antitoxin artificially produced and applied has better chance for success.

Copy following from "selections

*

in Gaillard's Medical Journal, June, 1896, page 351. Author, Dr. J. M. French, of Massachusetts. Subject: "A Year of Antitoxin."

"Taking all cases reported together, the practical result of the first year's use of antitoxin, so far as can be judged at the present time, has been to lessen the death rate from diphtheria in cases where it has been used, nearly or quite one-half, thus proving itself beyond all doubt to be the most successful of any known treatment for this dread disease.”

I have corresponded with some in the profession, among the number Dr. Wm. Osler, of Johns Hopkins. The following is his reply:

"Baltimore, May 28, 1896.

"DEAR DR. : You should read Professor Welch's paper on the 'Antitoxin Treatment of Diphtheria.' I will ask him to send it to you. "I have just returned from Montreal at the Pediatric Society. The various members made a report on the serum treatment in private practice, which, in a total of some 5,000 cases gave the most remarkable results, very much superior to anything that has ever been obtained before. "Very Truly Yours, WM. OSLER."

*Where the conditions are favorable.