246 BACILLUS DIPHTHERIA. 



The observation has been made that paralysis occurs more 

 often after the use of antitoxin than when it is not used. 

 McFarland has studied this subject very carefully, and arrives 

 at the conclusion that this is to be expected, as these palsies 

 usually follow very severe cases, and that they would have 

 occurred anyway no matter whether or not the antitoxin was 

 used ; so that the antitoxin is not responsible for the paraly- 

 ses. Furthermore, he says that these cases were so severe 

 that they would not have recovered even if the antitoxin had 

 not been used. In cases in which a large amount of toxin 

 has been elaborated and absorbed, the antitoxin is not able to 

 neutralize all the toxin, and the result is nil; but when used 

 in sufficient quantity it never fails to produce the expected 

 results. 



If small quantities of a high grade of antitoxin are used, 

 the skin rashes which occasionally follow the administration 

 of antitoxin are not so apt to occur as when large quantities 

 of an antitoxin having a low degree of immunizing power 

 are used. These skin rashes are of no significance, however, 

 so far as the course of the disease is concerned ; but they 

 may be exceedingly annoying, as, for instance, an extensive 

 urticaria. 



Bacteriologic diagnosis : A bacteriologic diagnosis should be 

 made as soon as the case is seen. For the sake of conve- 

 nience, special diphtheria diagnosis outfits are put up by 

 nearly all boards of health. Each outfit comprises a small 

 platinum box, containing blood-serum, which is sealed with a 

 heavy rubber band to prevent evaporation of the medium ; 

 and a swab or inoculator consisting of a small iron rod 

 or wooden stick, one end of which is wound with cotton. 

 This inoculator is absolutely sterile, and is enclosed in a 

 sterile glass tube. A wooden tongue-depressor completes the 

 outfit, which is placed in a heavy Manilla envelope. The 

 latter may be opened conveniently without destroying it, and 

 on the outside is stamped the date after which it is no longer 

 advisable to use the culture-medium. 



A small portion of the membrane is removed from the 

 throat with the inoculator and transferred to the culture- 

 medium. If no membrane is visible, the inoculator should 



