ghly established as any other fact in medicine. The mass of
figures from all parts of the world in support of its value has become
so overwhelming that it is neither possible nor necessary to specify
them in detail. The series of Bayeaux, covering two hundred and thirty
thousand cases of diphtheria, chiefly from hospitals and hence of the
severest type, showing that the death-rate had been reduced from over
_fifty-five_ per cent to below _sixteen_ per cent already, and that this
decrease was still continuing, will serve as a fair sample.

Three-quarters of even this sixteen per cent mortality is due to delay
in the administration of the antitoxin, as is vividly shown in thousands
of cases now on record, classified according to the day of the disease
on which the antitoxin was given, of which MacCombie's "Report of the
London Asylums Board" is a fair type. Of one hundred and eighty-seven
cases treated the first day of the disease, none died; of eleven hundred
and eighty-six injected on the second day of the disease, four and a
half per cent died; of twelve hundred and thirty-three not treated until
the third day of the disease, eleven per cent died; of nine hundred and
sixty-three cases escaping treatment until the fourth day, seventeen per
cent died; while of twelve hundred and sixty not seen until the fifth
day, twenty per cent died. In other words, the chances for cure by the
antitoxin are in precise proportion to the earliness with which it is
administered, and are over four times as great during the first two days
of the disease as they are after the fourth day. One "stick" in time
saves five.

This brings us sharply to the fact that the most important factor in the
cure of diphtheria, just as in the case of tuberculosis, is early
recognition. How can this be secured? Here again the bacteriologist
comes to our relief, and we needed his aid badly. The symptoms of a mild
case of diphtheria for the first two, or even three, days are very much
like those of an ordinary sore throat. As a rule, even the well-known
membrane does not appear in sufficient amounts to be recognizable by the
naked eye until the middle of the second, or sometimes even of the
third, day. By any ordinary means, then, of diagnosis, we would often be
in doubt as to whether a case were diphtheria or not, until it was both
well advanced and had had time to infect other members of the family.
With the help of the laboratory, however, we have a prompt,