444 



Diphtheria 





found and valuable time is saved preparatory to the use of the 

 antitoxin. 



Diphtheria Antitoxin.' — Behring* discovered that the blood of 

 animals rendered imanune against diphtheria by inoculation, first 

 with attenuated and then with virulent organisms, contained a 

 neutralizing substance (Anfi-korper) capable of annulling the effects 

 of the bacilU or the toxin when simultaneously or subsequently 

 inoculated into susceptible animals. This substance, held in solu- 

 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 looo units is sufficient for 

 the purpose. The protection thus afforded 

 does not continue longer than about six 

 weeks. The transitory nature of the im- 

 munity afforded by prophylactic injec- 

 tions of antitoxin is probably dependent 

 upon the fact that the antitoxin is slowly 

 eliminated. 



Treatment. — Diphtheria antitoxin is 

 preferably administered by the hypodermic 

 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. 



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 chUd. 

 It is far better to err on the side of admin- 

 istering too much than ~ on that of not 

 enough. Forty thousand units have been 

 administered 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, accordmg 

 to the case. Occasionally there is an outbreak of local urticaria— 



* "Deutsche med. Wochenschrift," 1890, Nob. 49 and 5°; "Zeitschrift fiir 

 Hygiene," 1892, xii, i. 



Fig. 158.— Sterilized 

 test-tube and swab for 

 collecting pus and fluids 

 for bacteriologic examina- 

 tion (Warren). 



