DIPHTHERIA 173 



should be understood that the blood serum of the horse containing 

 the antitoxin is not bactericidal. It does not kill the bacilli in the 

 throat, but it neutralizes the toxin in the blood and tissues. It must 

 be evident from this that the earlier in the disease the antitoxin is 

 used, the more beneficial it is. When the toxin poured from the throat 

 into the blood meets with no antibody, it acts on the body cells and 

 destroys them, and to the extent to which this has been done before 

 the antitoxin has been administered, it is without value. Kossel has 

 shown that when the antitoxin is injected on the first sign of the 

 disease, the percentage of recoveries is 100. In this every hour counts. 

 Out of 2,428 cases reported by Hilbert, the percentage of deaths 

 varied with the day on which the antitoxin was administred, as follows : 

 First day, 2.2; second day, 7.6; third day, 17.1 ; fourth day, 23.8; fifth 

 day, 33.9; sixth day, 34.1; after the sixth day, 38.2. According to 

 Wernicke the saving of lives during the first year of the use of anti- 

 toxin in Germany amounted to 20,000, and if the agent was properly 

 and promptly used the saving would amount to 45,000 lives annually. 

 The value of this agent, however, is even greater than is indicated by 

 the lowering in the death-rate. For every sick child saved, at least 

 five are saved from being sick. While the curative value of diphtheria 

 antitoxin is great, its preventive value is greater still. The physician 

 called to a family in which one child has diphtheria gives a curative 

 dose to the one and immunizing doses to all others. Even when the 

 sick one has been neglected so long that the curative value of the agent 

 is lost, its preventive value is still potent. Diphtheria antitoxin has 

 lowered not only the mortality rate, but still more the morbidity rate. 

 Unfortunately, the immunity induced by diphtheria antitoxin is only 

 temporary, lasting only from three to four weeks. From this it 

 frequently happens that a child. who has once had an immunizing dose, 

 may a few months or possibly a few years later, need a curative dose. 

 The fear of anaphylactic shock has led many a physician to hesitate 

 about a "reinjection" of horse serum after an interval of ten days or 

 longer, but one may do this with safety. In all cases of "reinjection" 

 after an interval of ten days or longer, a fraction of a cubic centimeter 

 should be injected. If there are or are not untoward symptoms follow- 

 ing this, after an hour or two any amount of the serum may be injected 

 with safety. This procedure should be adopted not only in all cases 



