TREATMENT OF DIPHTHERIA 



According to the researches of Doenitz, more recently confirmed and 

 extended by Fritz Meyer, it was established that large amounts of antitoxin 

 can even neutralize toxin already attached to the tissue cells. Men with 

 practical experience like Heubner give 4000 units as the initial dose. In 

 the United States doses as high as 10,000 to 100,000 1. E. have been admin- 

 istered with good results. The view of large dosage is being gradually 

 taken up also in Germany. At any rate it is by far better to give too 

 much than too little. If the first injection does not suffice it should be 

 repeated the next day. The only possible drawback associated with the 

 use of excessive amounts is the possibility of serum sickness, to be men- 

 tioned later. Netter has found that the administration of i gm. of 

 calcium chloride on three successive days prevents serum sickness. 



The serum has as a rule been injected subcutaneously. This method 

 is very practical and as far as anaphylaxis is concerned, is the least 

 dangerous. The disadvantage, however, is that it is very slowly absorbed. 

 Madsen and Hendersen-Smith have shown that but a trace of antitoxin 

 can be found in the blood of the patient four and three-fourth hours after 

 the injection, and only after two to three days can larger amounts be 

 demonstrated. In view of this, Morgenroth recommends the gluteal 

 intramuscular injection, for here a much more rapid absorption follows. 

 In cases of dangerous illness intravenous injection may be undertaken. 

 For this purpose Meyer advises a serum free of carbolic acid, although 

 this is not absolutely necessary. 



The importance of the method of injection is clearly shown by the comparative 

 experiments of Berghaus. In order to save a guinea-pig injected with a definite amount 

 of toxin and followed in i hour by antitoxin, it was necessary to employ: 



0.08 I. E. by intracardial injection (I. E. = antitoxin unit). 

 7.0 I. E. by intraperitoneal injection. 

 40.00 I. E. by subcutaneous injection. 



Thus the curative power was increased 500 fold by placing the antitoxin directly into 

 the circulation. 



