1497THE SERUM TREATMENT OF DIPHTHERIA.

assumption of an increased "power of resistance to diseaseand death " among children; whereas the beneficent dis-

covery of a prophylactic for phthisis or cancer would,on the other hand, apparently justify his most gloomyconclusions as to the supposed decrease of the "powerof resistance" in the age group 0 to 5. Mr. BIDDLE,we feel sure, would admit that there would be nothing"hideously wrong" in an increase of hits "coefficient

of incidence" of child mortality due to the extinction

of phthisis or cancer. It may, moreover, be interesting tohim to know that, if the present excessive rate of mor-

tality among children under the age of five years could

be reduced to a third of its present figure, the coefficient "for this age period would scarcely indicate this startlingdecrease of child mortality, as he suggests, because the

death-rate at all ages would thereby be necessarily reducedto a marked extent.

It is needless, as it is impossible, here to discuss what thedeath-rate of childhood ought to be, certainly much lowerthan it is ; but it would be sheer optimism to expect thatit should not exceed the mean rate of all ages. Neither

need we feel either surprise or despair that sanitary efforthas influenced it less than the death - rate at later age

groups. It is well to bear in mind, however, that, while

according to the latest published English Life Table for

England and Wales (1876-80) the mean rate of mortalityunder five years was 61’0 per 1000, the rate according toDr. FARE’S Healthy District Life Table was only 39 -4, and

according to ANSELL’s Table, based upon upper - class

experience, did not exceed 28-2. Child mortality in Englandand Wales, judged by the Registrar-General’s statistics fora long series of years, is decidedly decreasing, but we donot hesitate to agree with Mr. BIDDLE that there is "some-

thing hideously wrong " in the still terribly excessive wasteof child life in this country.

Annotations.

THE SERUM TREATMENT OF DIPHTHERIA.

"Ne quid nimis."

IT was, perhaps, a little unfortunate that on last Fridayevening there should have been read simultaneously beforetwo of the leading medical societies papers bearing on thesame subject-proof, however, of the lively interest which isawakened in it. Naturally that which attracted the largeraudience was the one which dealt, at the Clinical Society,with the practical results of the antitoxin treatment. But

those who were fortunate to hear the concise and clear

exposition of the scientific side of the antitoxin question as sgiven by Dr. Klein at the Epidemiological Society were alsowell repaid, for this paper may be said to have afforded thebasis upon which this latest addition to therapeutic agentsis founded; whilst the very carefully observed and re-

corded cases of Drs. Washbourn and Goodall and Mr. Cardwere the first fruits in this country of the use of the remedyapplied on a large scale. Dr. Klein’s subject was the

Relation of Bacteria to their Toxines, and he advanced

experimental proofs of the fact that the latter can be

sepaxated from the bodies of the bacteria themselves. By44 antitoxin " is meant the change induced in the blood of ananimal which has passed through an attack of acute infectivedisease, so that this blood becomes capable not only of arrest-

ing the growth of the’specific bacteria, but also’of neutralisingthe toxine they produce. The principle of the use of anti-toxin is the transference to another animal of the immunityacquired by the one whose serum affords this protectivepower. Dr. Klein pointed out that there are three differenttheories of the production of antitoxines : there is the viewof the French school that they are "defensive ferments"produced by the tissues ; the view of the Munich school thatthey are actually related to the toxines themselves ; andthere is, thirdly, the possibility that the bacteria themselvesplay a part in the production of antitoxines. Although,then, there is much scope for conjecture as to the

origin of this antitoxic property of immunised rerum,the fact of its occurrence is sufficiently establishedto justify its being availed of in the treatment ofthose diseases in which it has been discovered ; and to theresults already furnished in France and Germany, whichafford encouraging hopes of its utility in diphtheria, mustnow be added those obtained at Homerton by Drs. Wash-bourn and Goodall and Mr. Card. The discussion upon their

paper is not yet closed. It is to be resumed this (Friday)evening at a special meeting of the Clinical Society. Itwill be preferable, then, to defer any detailed commentaryupon it ; but we may point out that the series of cases

in which the treatment was tried was a consecutive one,that the bacteriological and clinical observations were

most exact, and that whilst the broad conclusion agreeswith the results obtained by others-viz., that the case

mortality was reduced to precisely one-half of that occur-ring in a similar number of consecutive cases prior to theintroduction of this method-there were some points of

difference noted from those of other observers. There isreason to believe that the society will take steps to inquirefully and impartially into the whole subject of this methodof treatment, and we feel sure that this would be a stepuniversally approved. An inquiry such as contemplatedmust perforce be a prolonged one, and must extend over awide area if the conclusions are to be free from fallacies.There is one point in the treatment which shouldbe brought prominently forward. It was urged byM. Roux and has been emphasised by Dr. Kossel-an

abstract of whose recently published essay we give else-where. It is the importance of commencing ’.treatment assoon as a diagnosis is made. It might even be advantageousto commence in all cases suspected to be diphtheritic innature, and not to wait for the bacteriological confirmationof the clinical diagnosis. Moreover, the treatment shouldbe pursued in every case, mild or severe. The former pointis also emphatically insisted on by Dr. Kossel, who goes sofar as to assert that if this be done, and the amount ofantitoxin administered be sufficient, no case of diphtheriaso treated should prove fatal. When we consider the novelty,as well as the necessarily tentative character of the methodat present, it is interesting to find so strikingly concordanta reduction in the case mortality as has been exemplified sofar in Berlin, Paris, and London.

FATAL ACCIDENT WITH A "TOY " PISTOL.

IN the meaning of language there is nothing absolute, butevery word is influenced by the force of its logical relation-ships. We are conscious, nevertheless, of something likedisproportion when speech has little or no regard for these-when, for example, firearms capable of inflicting a fatal

wound are described as "toys." It was a so-called toypistol by which a young girl was accidentally killed a fewdays ago in Clapham. There was, the more the pity,nothing either very strange or novel in the occurrence butthe repetition of a very old blunder - a loaded weapon,supposed to be unloaded, playfully discharged, and withfatal effect. Two lessons, if not more, may be easily read