428 Diphtheria 



is used for treatment. The subject has been worked over in an in- 

 teresting manner, from the experimental side, by Rosenau.* 



An interesting collection of statistics upon the antitoxic treatment 

 of diphtheria in the hospitals of the world has been published by 

 Professor Welch, f who, excluding every possible error in the calcu- 

 lations, "shows an apparent reduction of case-mortality of 55.8 per 

 cent." 



Nothing should so impress the clinician as the necessity of begin- 

 ning the antitoxin treatment early in the disease. Welch's statistics 

 show that 1 1 15 cases of diphtheria treated in the first three days of 

 the disease yielded a fatality of 8.5 per cent., whereas 546 cases in 

 which the antitoxin was first injected after the third day of the dis- 

 ease yielded a fatality of 27.8 per cent. 



On the other hand, it can scarcely be said that any time is too late 

 to begin the serum treatment, for the experiences of Burroughs and 

 McCoUum in the Boston City Hospital show that by immediate 

 and repeated administration of very large doses of the serum, ap- 

 parently hopeless cases far advanced in the disease, may often be 

 saved. 



After the toxin has occasioned destructive organic lesions of the 

 nervous system and in the various organs and tissues of the body, 

 no amount of neutralization can restore the integrity of the parts, and 

 in such cases antitoxin must fail. 



One disadvantage under which the diphtheria antitoxic serum is 

 administered both for purposes of prophylaxis and treatment, is 

 the inability of the operator to find out what may be the already 

 existing antitoxin content of the patient's blood. Though it is cer- 

 tain that existing diphtheria is proof that the patient needs the 

 remedy, it is by no means certain that all normal persons exposed 

 to diphtheria in institutions, etc., require it for prophylactic purposes. 

 Some may already possess enough to defend them and the promiscu- 

 ous administration of the serum to every child in an asylum, may re- 

 sult in sensitizing some to the allergizing effect of the horse-serum 

 without just reason. A means by which some knowledge of the nor- 

 mal diphtheria-toxin neutralizing quality of the blood of a healthy 

 individual can be arrived at, has been devised by Schick, J and is now 

 known as Schick's reaction. It consists in the intracutaneous ad- 

 ministration of a minute dose of diphtheria toxin. If the patient's 

 blood contains the neutralizing substance, no reaction takes place; 

 if it contain none, a reddened and tumefied circumscribed area ap- 

 pears. W. H. Park uses one-fiftieth of the L+ dose of diphtheria 

 toxin, injecting it into the skin with a very fine hypodermic needle. 

 Kolmer prefers to use one-fortieth of theL-f- dose. The presence of 

 one-thirtieth of a unit of antitoxin in i cc. of the patient's blood pre- 



* " Bulletin No. 38 of the Hygienic Laboratory, U. S. Public Health and Marine 

 Hospital Service," Washington, D. C, 1907. 



t "Bull, of the Johns Hopkins Hospital," July and Aug., 1895. 

 j "Miinchener. med. Wochenschrift, 1913, p. 2605. 



