Value of Anti-Diphtheritic Serum Treatment

Abstract

THE autumn issue of the Fight against Disease (22, No. 4), the quarterly journal of the Research Defence Society, contains an article by Sir Leonard Rogers showing the reduction in the suffering and the deaths of children from diphtheria during the last forty years consequent upon the use of anti-diphtheritic serum treatment. He points out that the case mortality, the most scientific test of the value of treatment, from diphtheria in the hospitals of the Metropolitan Asylums Board, has steadily fallen every year from a percentage of 30-4 in 1890-93 before serum was used, to 9-0 in 1905, 7-4 in 1910, and less than 4-0 in 1933, following the treatment of the disease with the serum. More striking still is the fall in mortality for laryngeal cases, from 62 per cent in 1894 to 11-7 in 1910. The value of the serum treatment is even more conclusively shown by its remarkable efficacy in the early stages of the disease, as compared with its comparative failure when given after the fourth day of the disease, when the toxaemia of the disease is fully developed, in accordance with what animal experiments had indicated would be the case. The case mortality per cent when treatment is commenced on the first day of the disease is only 1-6, on the second day it is 7-9, and on the third 17-2. As Sir Charles Martin has pointed out, “If the antitoxin (serum) were a remedy of no value, whether it was administered on the first or on the fifth day of the disease would be immaterial”. Clinical evidence is no less conclusive: many doctors still living can testify to the horrors of diphtheria in young children in the pre-serum days. This is now all changed, and the young diphtheria patient if treated early with serum will rarely succumb. Sir Leonard Rogers estimates that had the pre-serum mortality from diphtheria continued since 1911, there would have been 250,000 more deaths from diphtheria than were actually recorded.