SERUM TREATMENT OF DIPHTHERIA 



709 



TABLE 28. MORTALITY OF DIPHTHERIA ACCORDING TO THE DAY 



OF ADMISSION (WHICH ALSO INCLUDES THE TIME OF GIVING 



THE ANTITOXIN) IN THE PHILADELPHIA HOSPITAL 



FOR CONTAGIOUS DISEASES 



It is generally believed that the paralyses of diphtheria are due to a 

 toxone, and not to the true toxin. Ehrlich believes toxone to represent 

 a late secretory product of the diphtheria bacillus, whereas others regard 

 it as a modified toxin. It is certainly apparent, however, that the bacilli 

 should be gotten rid of as soon as possible, so as to eliminate the possi- 

 bility of toxone production. This is best accomplished by the early use 

 of large doses of antitoxin, aided possibly by judicious local treatment. 



Dosage of Diphtheria Antitoxin. While it is now generally agreed 

 that the doses of from 100 to 200 units, such as were commonly given 

 during the early years of antitoxin therapy, were far too small, there is 

 still some difference of opinion regarding the proper doses to employ. 

 Since the severity of the disease varies so markedly, no hard and fast 

 rules can be given. The physician who has a clear idea of the nature 

 of diphtheria and of the action of antitoxin, and knows what to expect 

 of the latter in the treatment of the disease, should have no difficulty 

 in properly treating a case of diphtheria. 



It is to be emphasized, however, that while antitoxin constitutes the 

 most important part of the treatment of diphtheria, it is not usually the 

 whole treatment. Absolute rest in bed, a generous diet, combined with 

 the use of tonics and local applications, are all part of the treatment. 

 Special treatment of the laryngeal form of the disease and the treatment 

 of complications are matters of considerable importance that influence 

 the prognosis in a given case. I may mention, in passing, the value of 



