286 A MANUAL OF BACTERIOLOGY 



bent posture and general and local treatment should be pursued 

 as usual. 



In cases of mixed infection, in which the diphtheria bacilli are 

 associated with streptococci or staphylococci, diphtheria antitoxin 

 may prove of less value, as it has no influence on the streptococcic 

 or staphylococcic infection, and injections of anti-streptococcic 

 serum 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 congregated together, 

 and where cases of diphtheria have occurred, with excellent results. 



The procedure in such circumstances should consist of a bacterio- 

 logical examination of the throats of all the inmates in the institu- 

 tion, isolation of those in whom the B. diphtheria is found, and the 

 injection of every one, or at least of all the young contacts, with a 

 prophylactic dose, repeated if considered desirable, ten days later. 

 For this purpose a dose of about 500 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, treatment with 

 antitoxin 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 disadvan- 

 tages may be obtained by the use of a vaccine consisting of diph- 

 theria endotoxin, and that it is of service in the treatment of carrier 

 cases. x Behring 2 has suggested the use of a toxin-antitoxin mix- 

 ture for prophylactic 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 which persists for a 

 long time. 



Some clinicians assert that antitoxin exerts its effect when 

 administered by the mouth or the rectum. Hewlett was unable to 

 detect any absorption of tetanus antitoxin from the stomach or 

 rectum, nor Sternberg of diphtheria antitoxin from the rectum, of 

 rabbits. Blumenau and Dzerzhgovsky could in no instance secure 

 immunity in animals by oral administration of diphtheria antitoxin, 

 nor could any antitoxin be detected in the blood of animals so 

 treated (Roussky Vratch, March 9, 1913). 



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



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



