472 Diphtheria 



results. Fever and pain in the joints (serum disease of von 

 Pirquet) also occur, especially if the patients have been pre- 

 viously treated with horse-serum. Serums of high unit 

 strength can be given with the ordinary hypodermic syringe ; 

 those of lower strength, of which a larger quantity is required, 

 must be given with a special "antitoxin syringe." The syr- 

 inge should always be carefully sterilized by boiling, and the 

 packings, etc., found to be in good condition before it is filled 

 with antitoxin. 



Diphtheria paralysis is said to be more frequent after the 

 use of antitoxin than in cases treated without it. In a paper 

 upon this subject I* have shown that this is to be expected, 

 as the palsies usually occur after bad cases of the disease, 

 of which a far greater number recover when antitoxin is used 

 for treatment. The subject has been worked over in an in- 

 teresting manner, from the experimental side, by Rosenau. f 



An interesting collection of statistics upon the antitoxic 

 treatment of diphtheria in the hospitals of the world has 

 been published by Professor Welch, t who, excluding every 

 possible error in the calculations, "shows an apparent re- 

 duction of case-mortality of 55.8 per cent." 



Nothing should so impress the clinician as the necessity 

 of beginning the antitoxin treatment early in the disease. 

 Welch's statistics show that 1115 cases of diphtheria treated 

 in the first three days of the disease yielded a fatality of 

 8.5 per cent., whereas 546 cases in which the antitoxin 

 was first injected after the third day of the disease yielded 

 a fatality of 27.8 per cent. 



On the other hand, it can scarcely be said that any time 

 is too late to begin the serum treatment, for the experiences 

 of Burroughs and McCollum in the Boston City Hospital 

 show that by immediate and repeated administration of 

 very large doses of the serum, apparently hopeless cases 

 far advanced in the disease, may often be saved. 



After the toxin has occasioned destructive organic lesions 

 of the nervous system and in the various organs and tissues 

 of the body, no amount of neutralization can restore the 

 integrity of the parts, and in such cases antitoxin must 

 fail. 



* "Medical Record," New York, 1897. 



t "Bulletin No. 38 of the Hygienic Laboratory, U. S. Public Health 

 and Marine Hospital Service," Washington, D. C., 1907. 



t "Bull, of the Johns Hopkins Hospital," July and Aug., 1895. 



