DIPHTHERIA 223 



have of late hesitated to use antitoxin as promptly as has generally 

 been urged. Should such symptoms develop, it is recommended 

 to administer atropin and adrenalin hypodermically and to resort 

 to artificial respiration. It should be borne in mind, however, that 

 actual disaster is an extreme rarity, when compared with the innumer- 

 able instances in which antitoxin is used without any untoward 

 results, and that the danger which the unprotected patient incurs 

 from the diphtheria is infinitely larger than that which would likely 

 follow the use of the serum. Unless, therefore, it is known before- 

 hand that the patient is hypersensitive to such an extreme degree, 

 there should be no hesitancy on the part of the physician to use the 

 serum. 



It would, of course, be ideal if some method could be worked 

 out which would enable us definitely to establish the existence of 

 abnormal hypersensitiveness before the injection, but as yet no 

 such method exists. In some instances where alarming symptoms 

 followed the injection of the horse serum a history was obtained 

 that the patients had been subject to asthmatic attacks, and in 

 some of these such attacks were brought on when the individuals 

 came into close contact with horses. It would accordingly be well 

 to inquire into this point before the injection is given, and possibly 

 to rule out from the treatment all those in which a distinct history 

 of asthma is obtained. In such cases antitoxin derived from some 

 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 where horse 

 serum has been used not long before, and where 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 develop- 

 ment cannot be regarded as a contraindication to the use of the 

 serum, and that not a single case has been reported where 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. 



