ANTITOXIN TREATMENT 285 



must be kept as constant as possible, guinea-pigs weighing 

 250 grm. or thereabouts employed, and to eliminate irregu- 

 larities a number of animals must be used. The antitoxic 

 constituent of diphtheria antitoxin is globulin in nature, 

 or is intimately associated with the globulin content of 

 the serum. Thus Atkinson found that if the serum is 

 precipitated by saturation with magnesium sulphate, the 

 whole of the antitoxin is carried down with the precipitate, 

 and also that the globulin content of the blood- serum of 

 antitoxin horses is increased. His results were confirmed 

 by Ledingham. 1 



There can now be no doubt as to the value of the antitoxin 

 treatment of diphtheria. Since the introduction of antitoxin 

 treatment, which was commenced about the middle of 1894, there 

 has been a steady decline in the case mortality from diphtheria, 

 especially in London, where probably the majority of the cases 

 are injected with antitoxin. From 1891 to 1894 the case mortality 

 from diphtheria in the hospitals of the Metropolitan Asylums Board 

 averaged about 30 per cent, in 1895 it was 22-8 per cent., and after- 

 wards steadily fell, until during the last eight years it has ranged 

 between 8-3 and 10 per cent. 



Not less than 2000 units should be injected for a dose, and early 

 treatment is of paramount importance. As soon as there is a 

 reasonable probability that the case is one of diphtheria the anti- 

 toxin should be used, and treatment should not be delayed for the 

 result of the bacteriological examination. The statistics show that 

 in cases treated on the first day of the disease the case mortality 

 is 3-3, on the second day it is 6-5, on the third day 10-6, on the 

 fourth day 12-9, and on the fifth day and afterwards 14-8 per cent. 



In bad cases, and in those coming under treatment at a late 

 stage of the disease, the dose may be increased to 10,000, 20,000, 

 or even 30,000 units with advantage, and to bring the patient under 

 the influence of the antitoxin as rapidly as possible the first dose 

 may be administered intravenously. The dose may have to be 

 repeated once or twice in mild cases, in bad cases perhaps every 

 six or twelve hours until several doses have been given, the guide 

 being the general condition of the patient and the rapidity of the 

 separation of the membrane. In addition to antitoxin, the recum- 



1 Journ. of Hygiene, vol. VA * 007, p. 65. 



