DIPHTHERIA 231 



been urged. Should such symptoms develop, it is recommended 

 to administer atropin and adrenalin hypodermically and to resort 

 to artificial respiration. It should be borne in mind, however, that 

 actual disaster is an extreme rarity when compared with the innu- 

 merable instances in which antitoxin is used without any untoward 

 results, and that the danger which the unprotected patient incurs 

 from the diphtheria is infinitely larger than that which would likely 

 follow the use of the serum. Unless, therefore, it is known before- 

 hand that the patient is hypersensitive to such an extreme degree, there 

 should be no hesitancy on the part of the physician to use the serum. 



It would, of course, be ideal if some method could be worked 

 out which would enable us to definitely establish the existence of 

 abnormal hypersensitiveness before the injection, but as yet no 

 such method exists. In some instances in which alarming symptoms 

 followed the injection of the horse serum a history was obtained 

 that the patients had been subject to asthmatic attacks, and in 

 some of these such attacks were brought on when the individual 

 came into close contact with horses. It would accordingly be well 

 to inquire into this point before the injection is given, and possibly 

 to rule out from the treatment all those in whom a distinct history 

 of asthma is obtained. In such cases antitoxin derived from some 

 other animal than the horse could probably be used with impunity, 

 and it is urgently to be hoped that ere long the manufacturers will 

 place such material upon the market. 



This could then also be employed in those cases in which horse 

 serum has been used not long before, and in which we would hence 

 have reason to expect the development of a sharp attack of serum 

 sickness. The nature of the latter we have already discussed before 

 (Chapter XI), suffice it to say at this place that its development 

 cannot be regarded as a contra- indication to the use of the serum, 

 and that not a single case has been reported in which the serum sick- 

 ness in itself has endangered the life of the patient or caused any 

 permanent damage to the individual. That it is undesirable, of 

 course, stands to reason, and as the liability to the disease increases 

 to a certain extent with the amount of the serum employed, it 

 follows that sera of high potency in small bulk are generally to 

 be preferred to larger quantities of serum of low antitoxic content. 

 As the blood of adults, moreover, has been found to contain not 

 inconsiderable amounts of natural diphtheria antitoxin, the use of 



