120 AIDS TO BACTERIOLOGY 



serum is the subcutaneous tissue of the flank. The 

 dose given varies from 2,000 to 4,000 units up to 30,000 

 or more. A child may require as much as an adult. 



Injections of serum are often followed by the appearance 

 of various rashes, sometimes erythematous. at other times 

 urticarial, and in a few cases not unlike the rash of scarlet 

 fever or of measles. These rashes usually come on in 

 from seven to ten days after the injection; sometimes the 

 rash is accompanied by more or less pyrexia, and in a 

 small number of cases by pains, and even effusion into 

 some of the joints. Such rashes may appear after 

 injection of normal horse-serum (see Serum Disease, 

 p. 26). 



Diphtheritic paralysis seems to occur more frequently 

 than formerly, the explanation being that more cases, 

 and especially severe ones, recover. For cases treated 

 on the first day of the disease the mortality is nil, but 

 rises with delay in treatment, until in cases not treated 

 until after the fourth day the mortality is nearly as great 

 as in pre- antitoxin times. In many cases the injection 

 of the serum is followed by a speedy reduction in the 

 severity of the symptoms, and a rapid separation of the 

 membrane in cases where it was causing obstruction of 

 the air-passages, thus diminishing the number of cases 

 which would otherwise require tracheotomy. 



Prophylactic Use of Diphtheria Antitoxin. To protect 

 contacts the prophylactic dose should be about 500 

 units. The immunity so obtained does not last longer 

 than three weeks. 



Vincent's Angina. 



This affection of the throat often closely simulates 

 diphtheria, but the diphtheria bacillus is absent. In 

 the lesions Vincent describes the presence of two sym- 

 biotic organisms one a bacillus, with pointed ends 6-8 // 

 to 10-12,0. in length and 1-1-5^ in diameter, sometimes 

 motile, not staining by Gram, and cultivable anaerobic- 

 ally on the ordinary media with the addition of human 

 serum (B. fusiformis). With this is usually associated 

 a long, delicate, motile spirillum (Spirochceta Vincenti), 

 which has not been cultivated, and which is supposed 

 to be the fusiform bacillus in another stage. 



