406 INFECTION AND IMMUNITY. 



It is probable that few cases are so mild or so 

 hopeless, unless moribund, that the omission of 

 antitoxin is justifiable. 



Diphtheritic The belief that antitoxin favors the development 

 Paralysis. ^ diphtheritic paralysis is no longer held. If 

 there has been an actual increase in the percentage 

 of cases which suffer from paralysis, as sometimes 

 stated, it is because a larger number of severe 

 cases is saved; and the severe cases are those 

 in which the patients most frequently develop 

 paralysis. If we accept the view of Ehrlich that 

 a special toxin of weak affinity for the anti- 

 toxin, i. e., the toxon, causes the paralysis, we find 

 all the more justification for large doses of 

 antitoxin, for antitoxin neutralizes the toxon as 

 well as the toxin. On the basis of experi- 

 mental work Eansom concludes: "Transferring 

 the results (of experiments) to practice among 

 human beings, we may expect liberal doses of 

 antitoxin given early in the illness to influence 

 favorably the subsequent paralysis; and this fa- 

 vorable influence is likely to manifest itself, not so 

 much in the local paralyses (soft palate, etc.), as 

 in such fatal symptoms as failure of the heart. 

 Severe cases, however, are likely to be followed by 

 some paralysis in spite of even large doses of anti- 

 toxin/' 



Cases in which there is severe mixed infection, 

 septic diphtheria, respond less favorably to anti- 

 toxic therapy than uncomplicated cases. At some 

 time a mixed serum therapy suited to the mixed 

 infection may be possible. 



The suggestion made by Wasserman of a com- 

 bined treatment with bactericidal and antitoxic 

 serums has not been applied practically. 



