104 VACCINE AND SERUM THERAPY. 



When the disease comes under observation late or is very 

 severe twenty thousand to one hundred thousand units may be 

 necessary. Evidence has been obtained that toxin may be taken 

 from the cells with which it has combined when very large doses 

 of anti-toxin are injected. No case of diphtheria should be re- 

 garded as being too severe or too far advanced to be treated by 

 diphtheria anti-toxin, but in such cases large doses should be given, 

 as small doses are of no avail, because they do not neutralize all 

 the toxin present. The age of the patient, unless very young, 

 should have no influence on the amount of anti-toxin injected. 



Diphtheria anti-toxin, as any other therapeutic agent, should 

 be given in sufficient quantities to accomplish the full therapeutic 

 action. To determine this the effects of diphtheria anti-toxin 

 must be recognized. The results of injections of sufficient amounts 

 of anti-toxin are: general improvement of the patient's condi- 

 tion, reduction of fever, improvement of the pulse, but most 

 noticeable of all is the shriveling of the membrane, decrease of 

 discharge, and less fetid odor of the breath. When these effects 

 do not appear from six to eight hours after injection, more diph- 

 theria anti-toxin should be injected. Re-injections usually are 

 larger than first injections, and are indicated at any time when 

 the patient's condition becomes more grave, or when improve- 

 ment does not come in six to eight hours after injection. At 

 times diphtheria anti-toxin does not give satisfactory results in 

 the treatment of diphtheria. In most of these cases, however, the 

 treatment is begun too late or there is infection with other organ- 

 isms. Of these organisms streptococci are most important and 

 are responsible for many of the fatal cases of diphtheria. Such 

 cases are at times treated with both diphtheria anti-toxin and 

 anti-streptococci serum. 



Various attempts have been made to administer diphtheria 

 anti -toxin by the mouth. The work of McClintock and King on 

 this method has already been referred to. Before oral adminis- 

 tration of diphtheria anti-toxin can be generally employed, more 

 experimentation will be necessary. 



The' use of dried diphtheria anti-toxic globulins, which are 

 dissolved in salt solution before injection, is relatively recent. 

 If the results obtained by their use are as favorable as has been 

 reported, it may be expected that they will be readily taken up 



