232 PASSIVE IMMUNIZATION 



horse antitoxin is less urgent in these for prophylactic purposes than 

 in children and can indeed often be neglected. 



The Avoidance of Anaphylaxis by the Production of Antianaphylaxis. 

 Of late the suggestion has been offered that it may be possible 

 to produce a state of antianaphylaxis (which see) by injecting the 

 patient with a small quantity (0.5 c.c.) of antitoxin (sc., horse serum) 

 a few hours before the principal injection is made, and that any 

 dangers arising from anaphylaxis may thus be minimized or alto- 

 gether eliminated. This should be borne in mind if serum treatment 

 is necessitated in a patient who has been previously injected with 

 horse serum. That antianaphylaxis may indeed develop in a very 

 short time following the introduction of serum is undoubted, and 

 Friedberger has lately devised an apparatus by means of which an 

 intravenous injection of serum may be given so slowly that anti- 

 anaphylaxis has an opportunity to develop during the administration. 



Results. If now we come to study the effect which the treat- 

 ment of diphtheria with antitoxin has had upon the mortality of the 

 disease, it is apparent from a survey of the accompanying table that 

 the lowest death-rate will be obtained, if the injections can be given 

 on the first day, and that the mortality percentage increases for 

 every day that the treatment is delayed. Taking the results corre- 

 sponding to the first day we have an average of 4.8 per cent. Further 

 argument than this should be unnecessary to convince anyone 

 that in the use of antitoxin we now have a weapon in the face of 

 which diphtheria has indeed lost its terrors, and that a physician 

 who refuses to avail himself of its use is indeed unfitted to practise his 

 profession. 



In the earlier days of the use of antitoxin the question was asked 

 whether the lower mortality could not be explained on the assump- 



