Till-: BACILLUS AXD THE BACTERIOLOGY OF DIPHTHERIA 209 



No deleterious effects are to l>e feared except a rash, with some rise 

 of temperature, in about 20 per cent, of the cases. In about 1 per 

 cent, of the cases swelling and tenderness of one or more joints occur. 

 Except in septic cases no permanent disability follows. 



There are on record some five or six cases where following an injec- 

 tion in a case of diphtheria sudden death has followed. The result is 

 probably due to the excitement caused by the operation rather than to 

 the serum. 



With the serum from some horses the rashes are very infrequent, 

 while with that from others they occur more often. The same horse 

 will at one time furnish a serum which produces no rashes and at 

 another one which gives a great number. No way has yet been found 

 to eliminate them entirely. Filtering and moderate heating produce 

 little effect. Standing for some months causes a precipitate to occur, 

 and the clear serum seems somewhat less liable to produce rashes 

 than when it was fresh. 



Use of a Serum to Eradicate Diphtheria Bacilli from Convalescents 

 and Healthy Persons. A great difficulty in combating diphtheria is 

 this : that in healthy children, but especially in diphtheria convalescents, 

 despite the use of antitoxin, the diphtheria bacilli often remain in the 

 nasopharynx for a very long time. This is extremely annoying, because 

 a child so affected cannot be sent to school until all diphtheria bacilli 

 have disappeared from the nasopharynx. Wassermann has done as 

 follows: A strongly agglutinating, multipartial diphtheria serura is 

 evaporated to dryness in vacuo, mixed with sugar of milk, pulverized, 

 and pressed into tablets. These tablets when dissolved in the mouth 

 cause the fluids in the mouth to become strongly agglutinating. The 

 question was, and is, whether this process of agglutination will help us 

 to get rid of the diphtheria bacilli from the nasopharynx more quickly 

 and surely than was heretofore possible. His clinical experiments 

 thus far made speak in favor of the employment of this serum. Whereas, 

 it is no rarity for diphtheria bacilli to be present in the throats of con- 

 valescents for weeks, he found that in the cases in which these tablets 

 have been used the bacilli disappeared within a few days. 



His method is this: A tablet is allowed to dissolve in the mouth 

 about every two hours, and then, after fifteen minutes, the child's 

 nasopharynx is rinsed out with an indifferent fluid in the form of a 

 spray or gargle. He conceives the action to be such that, whereas when 

 this serum is not employed the diphtheria bacilli are scattered diffusely 

 throughout the nasopharynx, under the influence of this serum they 

 are agglutinated or clumped together. The diphtheria bacilli are 

 massed together more or less by the serum, and these clumps are then 

 removed by the subsequent rinsing. In this way they are so much 

 decreased in amount that the natural power of the organism is able 

 much more quickly to make away with those remaining. He has hopes 

 that this new diphtheria serum will be destined to be of great service, 

 especially in making prophylaxis easier and in making it possible to 

 send the diphtheria convalescents to school earlier than heretofore. 



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