THE PRINCIPLES OF IMMUNOLOGY 



obstruction are such as to introduce an additional minor element of 

 danger. The accidents following tracheotomy are distinctly more 

 numerous than those following intubation, but neither operation can 

 be regarded as absolutely without risk. It is now well established 

 that the earlier in the course of disease the antitoxin is administered 

 the more favorable is the prognosis. In order to present this 

 graphically, however, we insert the following table taken in large 

 part from Dieudonne and Weichardt : 



The therapeutic efficiency of the antitoxin also varies accord- 

 ing to the method of administration. According to Berghaus, 

 intravenous injections are five hundred times more effective and 

 intraperitoneal are eighty to ninety times more effective than sub- 

 cutaneous injections. In the earlier days of antitoxin treatment the 

 method was almost entirely subcutaneous injection, but subse- 

 quently the intravenous method was employed in severely toxic 

 cases. Injections were given at various intervals, usually a day 

 apart, until the disease showed marked improvement. The studies 

 of Park and his collaborators have modified the treatment consid- 

 erably. Park was able to show that a single dose of antitoxin in 

 sufficient quantity is more effective in neutralizing the circulating 

 toxin than the multiple small doses, largely because of the fact that 

 with subcutaneous and intramuscular injections the absorption is 

 continuous, whereas during the period usually occupied by giving 

 several doses, the absorption occurs for only a short time after each 

 injection. Were it possible to determine for clinical purposes the exact 

 amount of toxin absorption during the disease the dosage of antitoxin 

 could be accurately regulated. Unfortunately, however, different strains 

 of the bacilli vary in capacity for production of toxin and the depth 

 and extent of the local lesion, as well as the nature of the underlying 

 tissues, have some influence upon the rate and amount of absorption. 



