THE JOURNAL OF THE American Medical Association, A MEDICAL JOURNAL CONTAINING THE OFFICIAL RECORD OF THE PROCEEDINGS OF THE ASSOCIATION, AND THE PAPERS READ AT THE ANNUAL MEDICAL LITERATURE OF THE PERIOD. EDITED FOR THE ASSOCIATION UNDER THE DIRECTION OF THE BOARD OF TRUSTEES, "The American Medical Association, though formally accepting and publishing the reports of the various Standing Committees (and Sections), holds itself wholly irresponsible for the opinions, theories or criticisms therein contained, except otherwise decided by special resolution."-TRANSACTIONS, 1851, 36308 Andrews, Edmund, Chicago, Ill. 7 Andrews, R. R., Cambridge, Mass. Alison, H. E., Fishkill Landing, N. Y. A port, Frank, Minneapolis, Minn. inson, Wm. B., Philadelphia, Pa. Ayres, S. C., Cincinnati, Ohio. Baker, Albert Rufus, Cleveland, Ohio. Bardwell, Eugene O., Emporium, Pa. barker. T. Ridgway, Philadelphia, Pa. Fartholow, Paul, Philadelphia, Pa. Batman, William F., Lebanon, Ind. Batten, John M., Pittsburg, Pa. Barn, William L., Chicago, Ill. Bayard, W., St. Johns, New Brunswick. Beard, R. O., Minneapolis, Minn. Bet, E. Oliver, Washington, D. C. Benjamin, Dowling, Camden, N. J. Benson, John A., Chicago, Ill. Berens, Conrad, Philadelphia, Pa. Bernstein, Edward J., Baltimore, Md. Bishop. Seth Scott, Chicago, Ill. Bistop. Louis Faugères, New York, N. Y. Blech, Gustavus M., Detroit, Mich. Boiton, B. Meade, Philadelphia, Pa. Bracelin, P. M., Chicago, Ill. Bracey, W. F., Ann Arbor, Mich. Brower, Daniel R., Chicago, Ill. Brown, George S., Birmingham, Ala. Brown, G. V. I., Duluth, Minn. Bulkley, L. Duncan, New York, N. Y. Burr, Albert H., Chicago, Ill. Caldwell, W. S., Freeport, Ill. Carstens, J. H., Detroit, Mich. Carter, J. M. G., Waukegan, Ill. Casselberry, W. E., Chicago, Ill. Christison, J. S., Chicago, Ill. Claiborne, J. Herbert, New York, N. Y. Clarke, Augustus P., Cambridge, Mass. Cleaves, Margaret A., New York, N. Y. Clevenger, S. V., Chicago, Ill. Cochran, Jerome, Montgomery, Ala. Cokenower, James W., Des Moines, Iowa. Connor, Leartus, Detroit, Mich. Cornick, Boyd, Knickerbocker, Texas. Corr, A. C., Carlinville, Ill. Coulter, J. Homer, Chicago, Ill. Crothers, T. D., Hartford, Conn. Cutter, Ephraim, New York, N. Y. De Schweinitz, G. E., Philadelphia, Pa. De Vaux, F. H., Valley City, N. D. Dewees, William B., Salina, Kan. Dibrell, J. A., Jr., Little Rock, Ark. Drake, G. W., Chattanooga, Tenn. Drayton, H. S., New York, N. Y. Drewry, William Francis, Petersburg, Va. Dufour, Clarence R., Washington, D. C. Edes, Robert T., Jamaica Plains, N. Y. Ehrmann, Fred. J. E., Chicago, Ill. Ellis, H. Bert, Los Angeles, Cal. English, W. S., Pittsburg, Pa. Epley, Frank W., New Richmond, Ind. Ernst, Harold C., Boston, Mass. Erwin, A. J., Mansfield, Ohio. Everts, O., College Hill, Ohio. Fernandez-Ybarra, A. M., New York, N.Y. Fischer, Louis, New York, N. Y. Fiske, James Porter, New York, N. Y. Fiske, George F., Chicago, Ill. Flood, Everett, Baldwinsville, Mass. Foster, Burnside, St. Paul, Minn. Forbes, W. S., Philadelphia, Pa. Freeman, Leonard, Denver, Colo. Galloway, D. H., Chicago, Ill. Garrison, Harriet E., Dixon, Ill. Gifford, U. Grant, Avondale, Pa. Gilchrist, T. C., Baltimore, Md. Gilpin, Henry B., Baltimore, Md. Goelet, Augustin H., New York, N. Y. Gottheil, William S., New York, N. Y. Hall, J. N., Denver, Colo. Howard, William Lee, Baltimore, Md. Hutchins, M. B., Atlanta, Ga. Ingals, E. Fletcher, Chicago, Ill. McNutt, W. F., San Francisco, Cal. Mylrea, W. H.,. Madison, Wis. Ingraham, Chas. W., Binghamton, N. Y. Overlock, S. Burden, Pomfret, Conn. Jackson, Edward, Philadelphia, Pa. Johnson, Joseph Taber, Washington, Justice, C. R., Poland, Ohio. Kneass, Samuel S., Philadelphia, Pa. Lancaster, R. A., Gainsville, Fla. Paquin, Paul, St. Louis, Mo. Senn, N.; Chicago, Ill. Parker, W. Thornton, Groveland, Mass. Stirling, Alex. W., Atlanta, Ga. Stoakley, Wm. S., Millboro Springs, Va. Sudduth, W. Xavier, Chicago, Ill. Winslow, Charles E., Los Angeles, Cal. ORIGINAL ARTICLES. ORRHOTHERAPY IN DIPHTHERIA.' CHICAGO. No. 1. One thousand antitoxin units is considered the ordinary curative dose, but in severe cases or those not treated until the third day, 1,500 to 2,000 units are often employed, and sometimes these are repeated until altogether from 4,000 to 6,000 units are administered in a single case. The dose considered necessary for As a result of the work of Pasteur and the numer- immunizing a healthy individual is about one-fourth ous investigations which have followed in the same the curative dose. The serum is administered by line, it is now generally believed by bacteriologists hypodermic injections, preferably in some part of the that many diseases, especially those which seldom body where there is an abundance of loose cellular affect individuals more than once, are self-limited by tissue, as at the lower angle of the scapula, in the the formation within the blood of a product capable gluteal region, and upon the abdominal or chest walls. of destroying the toxic material that excites the dis- Dr. Chantemesse (New York Medical Record, 1896) ease, hence called antitoxin. In such diseases if life reports that he has had quite as good results when be prolonged until a sufficient quantity of the anti- administering the antitoxin per rectum as by hypotoxin has been developed the toxic agent is destroyed dermic injections. and recovery follows if no serious complications have It is generally believed that the earlier the injection is made the better the result: still the classification In diseases that can be communicated from man to of cases by days to determine the prognosis and the animals and vice versa, such for example as rabies, size of the dose is at fault for there is much difference anthrax and diphtheria, advantage has been taken of in individuals in the rapidity with which absorption this fact by inoculating animals with the attenuated of toxins takes place and in their resisting power to toxic principle in small but steadily increasing the poison; therefore, in some, injections made the quantities until an antitoxin is developed in the blood fourth or fifth day might be quite as advantageous as in sufficient quantity to render the animal immune to those in others made on the first day, though the the further pernicious effects of the contagium. earlier the remedy is used the better the result that Bebring enunciated the law that blood serum would commonly be expected. The rapidity of the which had in this manner been rendered immune accession, the general condition and the age of the might be transferred to another individual with the patient are of more importance in determining the effect of rendering the latter also immune, no matter use of the serum, its dose, and the prognosis to be how suscepticle he might be to the disease. Further given than is the number of days since the onset of investigations by Kitasato, Aronson, Roux and the disease. Behring have determined what animals have blood Very little interest was manifested in the antitoxin rum that produces the least ill effects when intro- treatment of diphtheria until 1894, after Roux had ced into the human system, and how to render a presented the subject to the International Congress of Sall quantity of blood capable of producing immun- Hygiene at Buda-Pesth with the report of five hunity in a second individual. They have also discovered dred cases treated by this method. Since then many Lethods of preserving the serum and of measuring physicians and the health departments of cities and of its strength and purity. national governments have employed the serum extensively in the treatment of this disease. Although no crucial experiments have been made to determine the value of diphtheria antitoxin yet the statistics obtained. from many sources seem to prove that it is capable of greatly diminishing the mortality of this disease. In Until recently the serum prepared by Aronson, studying the literature of this subject I find the Behring and the New York Health Department was majority of reports have been from many physicians of strength known as from 60 to 150 antitoxin units who have recorded only one or two cases. to the cubic centimeter, the different preparations perusal of these one can not help suspecting that in being numbered 1, 2 and 3. Stronger preparations many instances only the favorable cases have been are now made: No. 4 representing 200 antitoxin units; recorded. The statistics of hospitals are probably No. 5, 300 units, and No. 6, 400 units to the cubic more complete and accurate, but the statistics of centimeter. These are obtained, not by concentration Health Boards although more extensive are likely to of weaker solutions, but directly from the animal that be very inaccurate for many reasons. Las been inoculated. The stronger preparations are In Dr. Foster's report, No. 7, of the accompanying sidered quite as safe and are preferable on account various hospital reports and published records which f their smaller bulk which obviates to a considerable I have obtained (see Table I), it was noted that all Ce the pain caused by the large injections. Diphtheritic poison has been introduced into anials, preferably into the horse, until immunity to its further effects has been obtained. The animal has then been bled, the blood allowed to separate and the seram preserved under the name of antitoxin. errespondence, page 49. From of the cases treated on the first day recovered; of those treated on the second day 9.3 per cent. died; of |