ΤΟ

ROBERT ABBE, M.D., of New York.

ELLICE M. ALGER, M. D., of New York.
CHARLES W. ALLEN, M. D., of New York.
HENRY B. ANDERSON, M.D., of Toronto, Can.
W. L. ARMSTRONG, M.D., of New York.
ALBERT S. ASHMEAD, M. D., of New York.
JOHN ASHURST, Jr., M. D., of Philadelphia.
L. GRANT BALDWIN, M. D., of Brooklyn, N. Y.
JAMES BECKETT, M. D., of Chicago.

JOHN W. BELL, M.D., of Minneapolis, Minn.
E. OLIVER BELT, M. D., of Washington, D. C.
A. L. BENEDICT, M. D., of Buffalo, N. Y.
H. M. BIGGS, M.D., of New York.
EUGENE BOISE, M.D., of Grand Rapids, Mich.
E. D. BONDURANT, M. D., of Tuskaloosa, Ala.
JOHN W. BRANNAN, M. D., of New York.
A. T. BRISTOw, M. D., of Brooklyn, N. Y.
CHARLES W. BURR, M.D., of Philadelphia.
HENRY T. BYFORD, M. D., of Chicago.
RICHARD C. CABOT, M. D., of Boston.
J. M. G. CARTER, M. D., of Waukegan, Ill.
CHARLES CARY, M. D., of Buffalo, N. Y.
F. O. CHAMBERLAIN, M. D., of Paris, France.
WALTER B. CHASE, M. D., of Brooklyn, N. Y.
THOMAS ASH CLAYTOR, M. D., of Washington, D. C.
SOLOMON SOLIS-COHEN, M. D., of Philadelphia.
A. B. COOKE, M. D., of Nashville, Tenn.
L. C. DANA, M. D., of New York.

J. HERBERT DAREY, M. D., of Norwood, Iowa.
JOSEPH B. DELEE, M.D., of Chicago.
G. E. DE SCHWEINITZ, M. D., of Philadelphia.
THEODORE DILLER, M. D., of Pittsburg, Pa.
W. T. DODGE, M. D., of Big Rapids, Mich.
MAX EINHORN, M. D., of New York.
J. W. ELLIOT, M. D., of Boston.

HENRY L. ELSNER, M. D., of Syracuse, N. Y.
W. T. ENGLISH, M. D, of Pittsburg, Pa.
AUGUSTUS A. ESHNER, M. D., of Philadelphia.
J. T. ESKRIDGE, M. D., of Denver, Col.
T. C. EVANS, M. D., of Louisville, Ky.
W. KNOWLES EVANS, M. D., of Chester, Pa.
W. H. FAULDS, M. D., of Luzerne, Pa.
ALBERT WARREN FERRIS, M. D., of New York.
E. M. FOOTE, M. D., of New York.
PROFESSOR MICHAEL FOSTER, M. D., of England.
MATTHIAS L. FOSTER, M. D., of New York.
GEORGE R. FOWLER, M. D., of Brooklyn, N. Y.
MELVIN M. FRANKLIN, M. D., of Philadelphia.
PERCY H. FRIDENBERG, M. D., of New York.

EDWARD FRIDenberg, M. D., of New York.
SAMUEL H. FRIEND, M.D., of Milwaukee, Wis.
J. HENRY FRUITNIGHT, M. D., of New York.
EUGENE FULLER, M. D., of New York.
J. MCFADDEN GASTON, M. D., of Atlanta, Ga.
LANDON CARTER Gray, M.D., of New York.
ROBERT H. Greene, M.D., of New York.
J. P. CROZER GRIFFITH, M. D., of Philadelphia.
FORDYCE GRINNELL, M. D., of Pasadena, Cal.
ARTHUR R. GUERARD, M. D., of New York.
FRANK C. HAMMOND, M. D., of Philadelphia.
JAMES B. HERRICK, M. D., of Chicago.
J. W. HICKMAN, M. D., of Tacoma, Wash.
L. EMMETT HOLT, M. D., of New York.
ELMER GRANT HORTON, B.S., of Philadelphia.
A. S. HOTALING, M. D., of Baltimore, Md.
THOMAS HUBBARD, M. D., of Toledo, O.
E. FLETCHER INGALS, M. D., of Chicago.
GEORGE THOMAS JACKSON, M. D., of New York.
J. M. KAUMHEIMER, M.D., of Milwaukee, Wis.
A. O. J. KELLY, M. D., of Philadelphia.
JAMES KERR, M. D., of Washington, D. C.
FREDERICK KRAUSS, M. D., of Philadelphia.
O. A. LACRONE, M. D., of Kalamazoo, Mich.
A. H. LEVINGS, M. D., of Milwaukee, Wis.
DANIEL LEWIS, M. D., of New York.

R. E. LEWIS, M. D., of Macomb, Ill.
CHARLES E. LOCKWOOD, M. D., of New York.
WILLIAM T. LUSK, M. D., of New York.
MORRIS MANGES, M. D., of New York.
THOMAS H. MANLEY, M. D., of New York.
F. W. MARLOW, M. D., of Syracuse, N. Y.
G. BETTON MASSEY, M. D., of Philadelphia.
CHARLES MCBURNEY, M. D., of New York.
ALEXANDER MCPHEDRAN, M. D., of Toronto, Can.
GEORGE W. MILES, M. D., of Oneida, N. Y.
DOUGLAS W. MONTGOMERY, M. D., of San Francisco,
Cal.

M. G. MOORE, M.D., of Vincennes, Ind.

J. B. NICHOLS, M. D., of Washington, D. C.
W. P. NORTHRUP, M. D., of New York.
ROSWELL PARK, M. D., of Buffalo, N. Y.
FREDERICK A. PACKARD, M. D., of Philadelphia.
CLAYTON PARKHILL, M. D., of Denver, Col.
ARTHUR J. PATEK, M. D., of Milwaukee, Wis.
I. B. PERKINS, M. D., of Denver, Col.
GEO. M. PLEAVER, M. D., of Bristol, Tenn.
CURRAN POPE, M. D., of Louisville, Ky.
CHARLES A. POWERS, M. D., of Denver, Col.

WILLIAM BROADDUS PRITCHARD, M. D., of New York.
W. R. PRYOR, M. D., of New York.
WALTER L. PYLE, M. D., of Washington, D. C.
MAURICE H. RICHARDSON, M.D., of Boston.
J. C. ROCKAFELLOW, M. D., of Philadelphia.
FREDERICK W. ROBBINS, M. D., of Detroit, Mich.
J. M. ROBINSON, M. D., of Duluth, Minn.
E. J. A. ROGERS, M. D., of Denver, Col.
JOHN RUHRAH, M. D., of Baltimore, Md.
ALBERT SCHOFIELD, M. D., of England.
RALPH W. SEISS, M. D., of Philadelphia.
C. D. SIMMONS, M.D., of Dutch Town, La.
A. ALEXANDER SMITH, M. D., of New York.
A. LAPTHORN SMITH, M. D., of Montreal, Can.
J. LEWIS SMITH, M. D., of New York.

RALPH R. SPENCER, M. D., of Grand Rapids, Mich.
C. D. SPIVAK, M.D., of Denver, Col.

CH. WARDELL STILES, Ph. D., of Washington, D. C. LEWIS A. STIMSON, M. D., of New York.

W. H. THOMSON, M. D., of New York.
HENRY E. TULEY, M. D., of Louisville, Ky.
AP. MORGAN VANCE, M.D., of Louisville, Ky.
A. VANDER VEER, M. D., of Albany, N. Y.
C. S. VAN RIPER, M. D., of Paterson, N. J.
H. D. WALKER, M. D., of Franklinville, N. Y.
J. J. WALSH, M.D., of Philadelphia.
FREDERICK S. WARTHIN, M. D., of Ann Arbor, Mich.
T. J. WATKINS, M. D., of Chicago.

J. HOWELL WAY, M.D., of Waynesville, N. C.
WALTER A. WELLS, M. D., of Washington, D. C.
G. M. WELLS, M. D., of Fort Mason, Cal.
R. M. WHITEFOOT, M. D., of Bozeman, Mon.
HERBERT B. WHITNEY, M. D., of Denver, Col.
ROYAL WHITMAN, M. D., of New York.
U. O. B. WINGATE, M.D., of Milwaukee, Wis.
WOLRAD WINTERBERG, M. D., of San Francisco, Cal.
JOHN A. WYETH, M. D., of New York.

NORMAN C. YARIAN, M. D., of Cleveland, O.

VOL. LXIX.

ORIGINAL ARTICLES.

THE REPORT OF THE AMERICAN PEDIATRIC
SOCIETY'S COLLECTIVE INVESTI-
GATION INTO THE USE OF AN-
TITOXIN IN THE TREAT-
MENT OF DIPHTHERIA

IN PRIVATE PRACTICE.'

THIS subject was chosen by the officers of the Society for its eighth annual meeting, with the belief that a large amount of valuable experience not otherwise available, might in this way be reached and collated. It was also believed that a more trustworthy estimate of the value of the serum treatment of diphtheria might thus be obtained than by statistics taken from hospital practice. There are very few hospitals in America that receive diphtheria patients, and the conditions under which patients are admitted to hospitals and the surroundings while there, are so different from those of private practice, that the measure of success in hospital cases cannot be taken as an index of the results which have been obtained upon this side of the Atlantic with the new treat

ment.

In order, therefore, to obtain an expression of opinion from American physicians as to the serum treatment, after what had been, with most of them, their first year's experience, a circular letter was prepared and issued by the Committee early in April. This was distributed through the members of the Society as widely as could be done during the time allowed. An attempt was made to reach as many physicians as possible who had had experience with the remedy.

The first surprise of the Committee was in learning how very widely the serum treatment had been employed, especially in the Eastern and mid-Western States. With more time, the number of cases collected might easily have been doubled and perhaps trebled; but enough reports have come in to enable one to see what opinion was held on the 1st of May, 1896, by American physicians who have used this remedy.

The circular letter asked for information upon the following points: Age; previous condition;

1 Reported at the Eighth Annual Meeting held at Montreal, Canada, May 26, 1896.

No. 1.

duration of disease when the first injection was made; the number of injections; the extent of the membrane-tonsils, nose, pharynx, and larynx; whether or not the diagnosis was confirmed by culture; complications or sequelæ, viz., pneumonia, nephritis, sepsis, paralysis; the result; and remarks, including other treatment employed, the preparation of antitoxin used, and general impression drawn from the cases.

Reports were returned from 615 different physicians, with 3628 cases. Of these, 244 cases have been excluded from our statistical tables. These were cases in which the disease was said to have been confined to the tonsils and the diagnosis not confirmed by culture, and therefore open to question. A few cases were reported in such doubtful terms as to leave the diagnosis uncertain. The figures herewith given are therefore made up from cases in which the diagnosis was confirmed by culture (embracing about two-thirds of the whole. number) and others giving pretty clear evidence of diphtheria, either in the fact that they had been contracted from other undoubted cases, or where the membrane had invaded other parts besides the tonsils, such as the palate, pharynx, nose, or larynx. It is possible that among the latter we have admitted some streptococcus cases, but the number of such is certainly very small.

There are left then of these cases, 3384 for analysis. These have been observed in the practice of 613 physicians from 114 cities and towns, in 15 different States, the District of Columbia, and the Dominion of Canada.

In the general opinion of the reporters the type of diphtheria during the past year has not differed materially from that seen in previous years, so that it has been average diphtheria which has been treated. If there is any difference in the severity of the cases included in these reports from those of average diphtheria, it is that they embrace a rather larger proportion of very bad cases than are usually brought together in statistics. The cases, according to the extent of the membrane, are grouped as follows: In 593 the tonsils alone were involved. In 1397 the tonsils and pharynx, the tonsils and nose, the pharynx and nose, or all three were affected. In 1256 cases the larynx was affected either alone or with the tonsils, pharynx, and nose, one or all. In many instances