60 BACTERIOLOGY. 



method. Unfiltered attenuated cultures were injected into the 

 horse. Later, large quantities of living diphtheria bacilli from 

 the surface of solid cultures, of gradually increasing virulence, were 

 repeatedly injected so as to allow the bacilli to grow and multiply. 

 In twenty-three days an antitoxic serum was obtained, one part 

 of which was found capable of protecting 20,000 to 40,000 

 grammes of guinea-pig against more than a fatal dose of both living 

 bacilli and the resulting toxin. 



Serum Treatment of Diphtheria. The results obtained by 

 Behring, Ehrlich, Kossel, and Wasserman, in the treatment of 

 diphtheria in children in Germany by means of the curative serum, 

 and by Roux and others in France, led to the adoption of the treat- 

 ment in this country. It is best to use an especially constructed 

 hypodermic syringe, which can be easily taken to pieces, and placed 

 in boiling water to sterilise it. The skin surface of the flank is 

 washed, and disinfected with 1 in 20 carbolic, and the antitoxin is 

 then injected. The syringe is taken to pieces, placed again in boiling 

 water, and thoroughly cleaned. 



The dose will depend upon the age of the patient and the 

 strength of the serum. From 10 cc. to 20 cc. are injected in children 

 under fifteen, and 30 cc. to 40 cc. in older patients, and the 

 injection may be repeated in 12 hours. The best results are said 

 to be obtained by injecting every 12 hours, for the first 12, 36 or 

 48 hours, according to the nature of the case, 1,000 Behring's units, 

 this being the dose calculated according to the immunising power of 

 the serum. The result of the injection is to lower the temperature 

 and pulse, but frequently the reverse occurs, and in about half the 

 cases an urticarial and sometimes a scarlatiniform rash is produced. 

 Pains in the joints, in rare cases effusion, may also result from the 

 injection. 



The beneficial results of the treatment are, according to the 

 Report of the Medical Superintendents of the hospitals of the 

 Metropolitan Asylums Board, as follows : 



(1) Diminution of the faucial swelling and of the consequent 

 distress ; 



(2) Lessening or entire cessation of the irritating and offensive 

 discharge from the nose ; 



(3) Limitation of the extension of membrane ; 



(4) Earlier separation of the exudation ; 



(5) Limitation and earlier separation of membrane in laryngeal 

 cases ; 



(6) Improvement in general condition and aspect of patients ; 



