INDICATIONS OF SERUM INJECTIONS. 05 



of diphtheria anti-toxin. The heart paralysis which develops 

 in some cases is probably only observed because by the use of 

 diphtheria anti-toxin the patient remains alive long enough so 

 that the heart paralysis may be observed. The action of diph- 

 theria toxin on the heart and other organs has been known for 

 some time and in serum laboratories it is not an unusual occurence 

 to have an apparently well horse, which is undergoing immuni- 

 zation to the diphtheria bacillus and its toxin, die very suddenly 

 after exercise. Post diphtheritic paralyses have been observed 

 long before the introduction of the use of diphtheria anti-toxin, 

 and to attribute this condition to anti-toxic serum is to attrib- 

 ute a symptom to a remedy, where the symptom is really one 

 found in the disease treated by the remedy, diphtheria anti-toxin. 

 In all cases treated with immune serum the patient ought to be 

 kept quiet for some time after injection of serum, even though 

 he has apparently recovered from the disease. 



Following the good results obtained in the treatment of 

 diphtheria by diphtheria anti-toxin and the protection against 

 the disease conferred by the so-called immunizing dose of 

 diphtheria anti-toxin, the serum has been used very extensively. 

 In many cases, undoubtedly, serum has been used without proper 

 indications. Many physicians have used diphtheria anti-toxin 

 even though the diagnosis of diphtheria was not definitely made, 

 because it was assumed that no harm could come from the use of 

 the serum while great benefits might result if the condition were 

 one of diphtheria. Some physicians have injected the immuniz- 

 ing dose fully as indiscriminately ; whole families, attending physi- 

 cian and nurses have received immunizing doses of diphtheria 

 anti-toxin. The indications for protective and curative injec- 

 tions of immune serum ought to rest on a better foundation. 

 This is especially true because hypersusceptibility to serum, or 

 serum disease, is more frequent following re-injections of serum. 

 It is evident that serum ought only to be injected into the indi- 

 vidual when certain indications are present. 



Specific treatment with immune serum is only indicated when 

 the diagnosis, and, in certain cases, the etiological factor has been 

 determined. It frequently happens that a bacterialogical diag- 

 nosis cannot be made immediately. Under such conditions the 

 clinician is warranted in using specific serum if there is such 



