Treatment 



445 



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. In a few cases sudden death, with symptoms 

 suggesting anaphylaxis (q.v.), has followed the injection. 



In moribund cases or those in which for any reason the treatment 

 is begun late, the first doses should be lairge and the injection made 

 into a vein. 



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



Fig. 159. — ^Deaths from diphtheria and croup per 100,000 in ig large cities, 

 1878-1905 (Park and Bolduan in Nuttall and Graham-Smith's " Bacteriology 

 of Diphtheria"). 



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 

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

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



An interesting collection of the early statistics upon the antitoxic 

 treatment of diphtheria in the hospitals of the world was published 

 by Welch,! who, excluding every possible error in the calculations, 

 "showed an apparent reduction of case-mortality of 55.8 per cent." 



A more recent statistical study of diphtheria mortality, with care- 



* "Medical Record," New York, 1897. 



t 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. 



