DIPHTHERIA 241 



other animal than the horse could probably be used with impunity, 

 and it is urgently to be hoped that ere long the manufacturers will 

 place such material upon the market. 



This could then also be employed in those cases in which horse 

 serum has been used not long before, and in which we would hence 

 have reason to expect the development of a sharp attack of serum 

 sickness. The nature of the latter we have already discussed before 

 (Chapter XI); suffice it to say at this place that its development 

 cannot be regarded as a centra-indication to the use of the serum, 

 and that not a single case has been reported in which the serum 

 sickness in itself has endangered the life of the patient or caused 

 any permanent damage to the individual. That it is undesirable, of 

 course, stands to reason, and as the liability to the disease increases 

 to a certain extent with the amount of the serum employed, it 

 follows that sera of high potency in small bulk are generally to 

 be preferred to larger quantities of serum of low antitoxic content. 

 As the blood of adults, moreover, has been found to contain not 

 inconsiderable amounts of natural diphtheria antitoxin, the use of 

 horse antitoxin is less urgent in these for prophylactic purposes than 

 in children and can indeed often be neglected. 



The Avoidance of Anaphylaxis by the Production of Antianaphylaxis. 

 Of late the suggestion has been offered that it may be possible to 

 produce a state of antianaphylaxis (which see) by injecting the 

 patient with a small quantity (0.5 c.c.) of antitoxin (sc., horse serum) 

 a few hours before the principal injection is made, and that any 

 dangers arising from anaphylaxis may thus be minimized or alto- 

 gether eliminated. This should be borne in mind if serum treatment 

 is necessitated in a patient who has been previously injected with 

 horse serum. That antianaphylaxis may indeed develop in a very 

 short time following the introduction of serum is undoubted, and 

 Friedberger has lately devised an apparatus by means of which an 

 intravenous injection of serum may be given so slowly that anti- 

 anaphylaxis has an opportunity to develop during the administration. 



Results. If now we come to study the effect which the treat- 

 ment of diphtheria with antitoxin has had upon the mortality of the 

 disease, it is apparent from a survey of the accompanying table that 

 the lowest death rate will be obtained if the injections can be given 

 on the first day, and that the mortality percentage increases for 

 every day that the treatment is delayed. Taking the results corre- 

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