86 MODERN BIOLOGIC THERAPEUSIS 



value is when the first injection given has been 

 smaller in amount than it should have been. 



Repeating the Dose It may be necessary to 

 repeat the dose. The indications for this are: 

 (1) If, after twenty-four hours, the false mem- 

 brane is spreading or does not show signs of 

 curling at the edges; (2) if the general symp- 

 toms are not improved, as shown by the pulse- 

 rate which is the same or increased; (3) the 

 mental apathy being the same or more marked. 

 This latter condition is an extremely valuable 

 guide. In cases where sufficient antitoxin has 

 been given, the improvement in the mental con- 

 dition is more rapid than that of any other 

 symptom. In croupous cases unless the ob- 

 struction is lessened as shown by the cough 

 being looser, less metallic, and more moist 

 with less dyspnea the dose should be repeat- 

 ed. In all cases the second dose should be as 

 large as the first. According to Dr. Park, 

 when a maximum of from 20,000 to 25,000 units 

 in a child and 40,000 to 50,000 units in an adult 

 has been reached, it is useless to administer 

 more antitoxin. He states (The Journal A. M. 

 A., September 5, 1914). "Forty thousand units 

 will save any patient that one million will. ' ' 



