702 PASSIVE IMMUNIZATION SERUM THERAPY 



lapse appear, the fluid may be drained from the canal by gentle suction 

 with the piston. This is usually impossible when the manufacturers' 

 syringe is used. Otherwise the syringe is detached and the fluid col- 

 lected in tubes until the patient's condition improves and the injection 

 is resumed or the needle removed. 



At times the patient is so restless that this slow method is not feas- 

 ible. In such instances the physician should make the injection as 

 slowly as possible, endeavoring to put into the canal as much serum as 

 fluid was removed or at least a reasonable amount. 



ANTITOXIC IMMUNIZATION 

 SERUM TREATMENT OF DIPHTHERIA 



The discovery of diphtheria antitoxin and its use in the treatment 

 of this infection constitute one of the triumphs of modern medicine. 



Twenty years ago diphtheria was one of the most dreaded of diseases, 

 accompanied ordinarily by a mortality of at least 30 per cent., while the 

 loss of life from the laryngeal form of the disease, particularly after 

 tracheotomy, was simply appalling. 



Shortly after Roux and Yersin (1888) had demonstrated that the 

 symptoms of diphtheria were due largely to a soluble poison or toxin se- 

 creted by the bacilli, Ferran, and later Fraenkel and Brieger (1890), 

 undertook experiments in active immunization against diphtheria. 

 About the same time von Behring discovered the antitoxin, and in a 

 series of extensive researches with Wernicke he established experiment- 

 ally its prophylactic and therapeutic value in diphtheria. The first 

 attempt to apply this discovery to the cure of this infection of the human 

 being was made in von Bergmann's clinic (1891). The results, while 

 encouraging, were not altogether satisfactory, owing largely to the fact 

 that the serums were weak and the doses given too small. The dis- 

 covery, however, resulted in creating an extraordinary stimulus to re- 

 searches in immunity, and during the following two years more powerful 

 serums were prepared, so that in 1896 a marked drop in the mortality of 

 diphtheria was apparent in those places where the antitoxin was being used. 



Since then diphtheria antitoxin has been the means of saving count- 

 less thousands of lives, and the treatment of diphtheria, instead of being 

 a reproach to medicine, has become the model of what the scientific 

 treatment of an infectious disease ought to be. Statistics and the in- 

 dividual experiences of those especially engaged in the treatment of 

 diphtheria show that when the antitoxin is used on the first day of the 



