49 Diphtheria 



Administration. Ehrlich asserts that a dose of 500 units 

 is valueless for the treatment of diphtheria, 2000 units being 

 probably an average dose for an adult and 1000 units for a 

 child. As the remedy is practically harmless, it is far better 

 to err on the side of administering too much than on that of 

 not enough. Forty thousand units have been administered 

 to a moribund child with resulting cure. 



Diphtheria paralysis is said to be more frequent after the 

 use of antitoxin than in cases treated without it. In a paper 

 upon this subject I * have shown that this is to be expected, 

 as the palsies usually occur after bad cases of the disease, 

 of which a far greater number recover when antitoxin is used 

 for treatment. The subject has been worked over in an in- 

 teresting manner, from the experimental side, by Rosenau.f 



An interesting collection of statistics upon the antitoxic 

 treatment of diphtheria in the hospitals of the world has 

 been published by Professor Welch, J who, excluding every 

 possible error in the calculations, "shows an apparent re- 

 duction of case-mortality of 55.8 per cent." 



Nothing should so impress the clinician as the necessity 

 of beginning the antitoxin treatment early in the disease. 

 Welch's statistics show that 1115 cases of diphtheria treated 

 in the first three days of the disease yielded a fatality of 

 8.5 per cent., whereas 546 cases in which the antitoxin 

 was first injected after the third day of the disease yielded 

 a fatality of 27.8 per cent. 



On the other hand, it can scarcely be said that any time 

 is too late to begin the serum treatment, for the experiences 

 of Burroughs and McCollum in the Boston City Hospital 

 show that by the immediate and repeated administration of 

 very large doses of the serum, apparently hopeless cases, 

 far advanced in the disease, may often be saved. 



After the toxin has occasioned destructive organic lesions 

 of the nervous system and in the various organs and tissues 

 of the body, no amount of neutralization can restore the 

 integrity of the parts, and in such cases antitoxin must fail. 



Urticaria and erythema sometimes follow the injection of 

 antitoxic serum, for reasons not clearly understood. In a 

 few cases pains in the bones and joints have been complained 



* "Medical Record," New York, 1897. 



f "Bulletin No. 38 of the Hygienic Laboratory, U. S. Public Health 

 and Marine Hospital Service," Washington, D. C., 1907. 



J " Bull, of the Johns Hopkins Hospital," July and Aug., 1895. 



