DIPHTHERIA 201 



those who have had the best opportunities of observing the 

 effects of the serum in an extended number of cases. 



Unquestionably the most important factor in the anti- 

 toxin treatment is the dose, as will be seen from the 

 following observations by Wernicke and Behring, who have 

 shown that it is necessary to inject ten times as much 

 antitoxin into a guinea-pig that has received subcutaneously 

 a lethal dose of diphtheria toxin eight hours previously, as 

 when it is treated immediately after the injection of the 

 toxin, whilst after twenty-four hours fifty times the initial 

 quantity is necessary to effect a cure. That the importance 

 of this fact is fully recognised is indicated quite clearly by 

 Behring in the directions sent out with the serum prepared 

 under his supervision. Thus he recommends as sufficient 

 a dose of 600 ' normal antitoxin units ' ' in cases where the 

 serum treatment is commenced on the appearance of the 

 first symptoms of the disease,' whilst at a more advanced 

 state of the disease doses of 1,000 or 1,500 ' normal units ' 

 are required. Dr. Sidney Martin is of opinion that in the 

 case of patients suffering from a severe attack of diphtheria, 

 it is necessary to give as much as 4,000 ' normal immunisa- 

 tion units ' as a dose. 



In the issue of the Lancet of July 18, 1896, is the report 

 of the Lancet special commission on the relative strengths 

 of diphtheria antitoxins. The report is most valuable, and 

 should be carefully studied by everyone who intends to 

 employ antitoxin. 



In this report attention is drawn to the fact that the 

 employment of antitoxin in this country has not been 

 attended with anything like the success that has attended 

 it abroad, and that this is, at least in part, due to the 

 quality of the serum manufactured and distributed in this 

 country. It is impossible to use sufiicient volume of a 

 serum of low immunising value to do any good, and hence 



