PROPHYLAXIS OF DIPHTHERIA 341 



In the fetid cases, due to a mixed infection with streptococci 

 or staphylococci, diphtheria antitoxin may prove of less value, as 

 it has no influence on the streptococcic or staphylococcic infec- 

 tion. Injections of anti-streptococcic serum, or, better, of sensi- 

 tised streptococcic vaccine, may be given in addition. 



Diphtheritic paralysis seems to be rather more frequent after 

 the use of antitoxin than in the cases not treated with it, probably 

 because a greater number of cases survive. 



The antitoxin has also been employed as a prophylactic in 

 schools or other places where susceptible individuals are congre- 

 gated, and where cases of diphtheria have occurred, with excellent 

 results. 



The procedure in such circumstances should consist of a 

 bacteriological examination of the throats of all the inmates in 

 the institution, isolation of those in whom the B. diphtherice is 

 found, and the injection of every one, or at least of all the young 

 contacts, with a prophylactic dose, repeated if considered desir- 

 able, ten days later. For this purpose a dose of 500-1,000 units 

 should be given. The immunity so produced does not last for 

 more than three weeks. 



The objection to the use of antitoxin for prophylaxis is that 

 should the patient subsequently develop diphtheria, or any other 

 condition requiring serum treatment, this may induce serious 

 symptoms due to supersensitisation or anaphylaxis. To obviate 

 this, an antitoxin prepared in the ox has been placed on the 

 market for prophylactic use. The writer believes that all the 

 advantages of antitoxin without its disadvantages may be 

 obtained by the use of a vaccine consisting of diphtheria endo- 

 toxin, and that it is of service in the treatment of carrier cases. 1 

 Behring 2 suggested the use of a toxin -antitoxin mixture for pro- 

 phylactic use and the treatment of carrier cases. This, although 

 non-toxic for the guinea-pig, engenders the formation of a large 

 amount of antitoxin in the recipient and the immunity persists 

 for a long time, at least three years. This method has been 

 tried by Park in New York City with, it is claimed, successful 

 results. 



Some clinicians assert that antitoxin exerts its effect when 



1 Lancet, July 20, 1912, and June 28, 1913- 



2 Deut. Med. Woch., May 8, 1913. 



