SERUM THERAPY 87 



Difficult Diagnosis Physicians are fre- 

 quently called to see a patient where the diag- 

 nosis is not clear at the time of the first visit. 

 It may not always be possible to determine at 

 the first visit whether the case is one of diph- 

 theria, tonsillitis, syphilis or Vincent's angina, 

 and to await the result of a culture means a 

 delay of twenty-four to forty-eight hours. By 

 that time the toxin may have gained such head- 

 way as to cause death within a few days, even 

 though antitoxin be used at that late date. 

 The immediate use of antitoxin will shorten 

 the duration of the illness if it be diphtheria 

 and, to a very large extent, will lessen the 

 probability of serious complications develop- 

 ing later. 



The same is true of croupous cases: when- 

 ever the attack does not subside in two to four 

 hours, antitoxin should be given. An early 

 dose will obviate the necessity of intubation if 

 the infection proves to be diphtheria, and will 

 protect the child from the dangers of such 

 treatment. The antitoxin in these cases will 

 not unfavorably influence the course of the dis- 

 ease, if it should not prove to be diphtheria ; and 

 danger from undesirable effects from the an- 



