DIPHTHERIA 17 1 



can only be avoided by using serum from a thoroughly 

 reliable source, and by taking care not to use serum 

 from a bottle that has been left open and exposed to the 

 air. 



' The most suitable place for injection is the subcutaneous 

 tissue of the flank. The injection should be made as soon 

 as the disease is diagnosed, for the earlier the treatment is 

 commenced, the better the chance of recovery. The quantity 

 used must depend upon the severity of the case, the strength 

 of the antitoxin, and the age of the patient. A severe case 

 requires a dose larger and more frequently repeated than a 

 mild case. Probably an adult requires a larger dose than a 

 child, but this poiat does not appear to me to be definitely 

 settled. 



'As far as the strength of antitoxin is concerned, we are 

 met with the difficulty that a uniform method of standard- 

 ising is not always adopted. The testing of the serum is 

 not an easy matter, and can only be performed by a skilled 

 bacteriologist ; but until a uniform system is adopted, it 

 will be impossible for clinical observers to agree upon the 

 proper dose to be employed in any individual case.' 



Practical Disinfection. — The saliva and discharges of the 

 nose and mouth should be regarded as virulently infectious, 

 and should, as far as possible, be received into rags and 

 burned before they have a chance to become dry; the 

 excreta also should be disinfected. Any polluted linen that 

 cannot be conveniently burned should be soaked for one 

 hour in a solution of mercuric chloride (1 in 500) or 

 in bleaching-powder solution (6 ounces to the gallon), 

 and then well rinsed in fresh water before going to the 

 wash. 



