DII'HTHKklA ANTI-TOXIN. 103 



The therapeutic application of diphtheria anti-toxin has given 

 most satisfactory results, and is now recognized and regarded as 

 the specific for diphtheria. The statistics on the death rate from 

 diphtheria have been collected at many different times, and all 

 indicate that, while before diphtheria anti-toxin was used over 

 fifty per cent of the cases resulted fatally, since the application 

 of this method of treatment, the death rate from diphtheria has 

 fallen below twenty per cent, and according to some statistics to 

 five per cent. In Boston the death rate of diphtheria from 1888 

 to 1894 was 43.2 per cent, while from 1895, after which diphtheria 

 anti-toxin was used extensively, to 1904, inclusive, the death 

 rate has fallen to 11.84 per cent. Still better results will prob- 

 ably be, obtained as this method of treatment becomes more uni- 

 versal and is better understood. 



The method of treatment of diphtheria with diphtheria anti- 

 toxin varies. However, some definite principles of treatment 

 have been established. It is very essential that all cases be treated 

 as early as possible. The reasons for this are clear when it is 

 understood that as toxin is liberated by diphtheria bacilli, it tends 

 to combine with the cells of the body. After this union has once 

 taken place the cell is rapidly injured. In order that diphtheria 

 anti-toxin combine with these toxins it is essential that the immune 

 substances be present at the time of the liberation of the toxin. 

 Most statistics show that in ordinary cases of diptheria the death 

 rate is nil when diphtheria anti-toxin is injected on the first day 

 of the disease. Even when treated with diphtheria anti-toxin on 

 the second day, the death rate is below five per cent; however, 

 when specific treatment is not instituted until after the fourth 

 day, twenty per cent of the patients do not recover. 



The dose to be given in the different conditions varies, and 

 no hard and firm rules can be laid down. There are, however, 

 some quite generally accepted rules as to doses. 



The ordinary case of diphtheria, treated on the first day of 

 the disease, receives injections of from two to three thousand 

 units of anti-toxin. When the serum is not given until the second 

 day, usually three to four thousand units are injected. 



In the pharyngeal and laryngeal types of diphtheria larger 

 doses are usually given seldom less than five thousand units. 



