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"operation having been doubtless imperative in every case, my own
"experience has been that Antitoxin alone will obviate the necessity
"for operativ e measures in the majority of cases.
"Patients with laryngeal symptoms are continually being
"admitted here, often with a message from the certifying doctor
"that an operation is urgently required; yet, in the course of a few
"hours, with only Antitoxin to help them, they are on the high
"road to recovery. Seldom a week passes that we do not get one
"or more laryngeal cases of diphtheria, which looks as if they could
"go from bad to worse only. The child is cyanosed, all the extra"ordinary
lespiratory muscles are in full use, the breathing is
"stridulous, and the cough is croupy. On looking at the throat and
"nose, no signs of Diphtheria are to be found, perhaps only blue,
"swollen tonsils; and the diagnosis is to ail intents and purposes
"made by the administration of Antitoxin and the observation of its
"action, while it is confirmed later on by the microscope. The child is
"immediately put into a steam tent, and a large dose of Antitoxin is
"given,—say, 10,000 or 12,000 units. Usually sleep supervenes in
"the course of half-an hour, and gradually the acute dyspnoea gives
"over, the cyanosis fades to a natural colour, and in six hours or
"less, the child is out of immediate danger. Such cases in pre-anti"toxin
days must either have been operated on or must have died.
"If they are operated on now, and get Antitoxin, they stand
"a very good chance of recovery ; but if they get Antitoxin
"alone, they have at least in my opinion, a still better chance.
"One must never forget that the conditions calling for tracheotomy
"imply grave poisoning of the system, and that to super"impose
a serious operation on such a state of affairs, is to add
"still another obstacle to recovery. Of course, I am not discussing
"such cases as are absolutely demanding operation to avert impend"ing
death. These must be operated on, on the spot, with or
"without preparation of the patient or his surroundings. During
"the past two years we have had very many severe cases, out of all
"proportion to those which have been mild or moderately severe,
"and I am certain, if tracheotomy had been done as frequently as
"apparently was necessary, that our mortality would have been very
"much greater.
"From the above remarks it is fairly evident that I place a firm
"belief in the efficacy of Antitoxin, and I have striven year by year
"to make it plain to the medical men who send us cases for
"treatment and isolation, that this institution should be regarded, so
"far as diphtheria is concerned, mainly as an isolation hospital, and
"that the treatment should be begun before the patient is sent in.
"Were this done in all cases, I believe our death-rate would fall to
"2 per cent., or 3 per cent., or even less. Our mortality is far too
"great, and I maintain that it is entirely due to the delay inadminis-