Diphtheria Antitoxin 



427 





tion in the blood-serum of the immunized animals, is the diphtheria 

 antitoxin. For the method of preparing see Antitoxins. The serum 

 may be employed for purposes of prophylaxis or for treatment. 



Prophylaxis. — The serum can be relied upon for prophylaxis in 

 cases of exposure to diphtheria infection. In most cases a single 

 dose of 1000 units is sufficient for the purpose. The protection thus 

 afforded does not continue longer than 

 about six weeks. The transitory nature 

 of the immunity afforded by prophylactic 

 injections of antitoxin is probably de- 

 pendent upon the fact that the antitoxin is 

 slowly eliminated. 



Treatment. — Diphtheria antitoxin is al- 

 ways to be administered by the hypo- 

 dermic method at some point where the 

 skin is loose. Some clinicians prefer to 

 inject into the abdominal wall; some, into 

 the tissues of the back. A slightly painful 

 swelling is formed, which usually disap- 

 pears in a short time. In a few cases sud- 

 den death, with symptoms suggesting ana- 

 phylaxis iq.v.), has followed the injection. 



Ehrlich asserts that a dose of 500 units 

 is valueless for the treatment of diphtheria, 

 2000 units being probably an average dose 

 for an adult and 1000 units for a child. It 

 is far better to err on the side of administer- 

 ing too much than on that of not enough. 

 Forty thousand units have been adminis- 

 tered to a moribund child with resulting 

 cure. The administration of the remedy 

 should be repeated in twelve hours if the 

 disease is one or two days old, in six hours 

 if three or four days old, in four hours 

 if still older. The serum may have to be 

 given two, three, four, or even more times, 

 according to the case. Occasionally there 

 is an outbreak of local urticaria — rarely 

 general urticaria. Sometimes considerable local erythema results. 

 Fever and pain in the joints (serum disease of von Pirquet) also 

 occur, especially if the patients have been previously treated with 

 horse-serum. 



Diphtheria paralysis is said to be more frequent after the use of 



antitoxin than in cases treated without it. McFarland* has shown 



that this is to be expected, as the palsies usually occur after bad cases 



of the disease, of which a far greater number recover when antitoxin 



* "Medical Record," New York, 1897. 



Fig. 160. — Sterilized 

 test-tube and swab for 

 collecting pus and fluids 

 for bacteriologic examina- 

 tion (Warren). 



