DIPHTHERIA ANTITOXIN 



137 



7. Rashes are produced in about one-third of 

 the cases, and are attributable to the antitoxin. 



8. Pain, and occasionally swelling about the 

 joints, are produced in a number of cases. 



9. Even when used in large doses, no serious 

 ill effects have followed the injection of anti- 

 toxin." 



IV 



The use of the antitoxin in the hospitals of the 

 Metropolitan Asylums Board began in 1895. ^ 

 had been used in 1894 on a f ew cases only ; and 

 during that year it had been procured with much 

 difficulty from various sources, chiefly from the 

 Institute of Preventive Medicine. On 9th November 

 1894, the Board applied to the Laboratories' 

 Committee of the Royal Colleges of Physicians 

 and of Surgeons, asking them to undertake the 

 supply. Arrangements were made for this purpose ; 



while the paralysis-rate has risen. In the hospitals of the 

 Metropolitan Asylums Board, the former has been reduced 

 from 29 per cent, to 15.3 per cent., while the latter has risen 

 from 13 per cent, to as high as 21 per cent, in 1896. This 

 increase of paralysis is chiefly due to the fact that many more 

 patients now recover from the primary disease, and live long 

 enough for paralysis to show itself. During the last two years, 

 however, the occurrence of paralysis has began to diminish in 

 frequency. . . . The earlier antitoxin is given in diphtheria, the 

 less likely is paralysis to follow." It is to be borne in mind that 

 post-diphtheritic paralysis, in the great majority of cases, 

 affects only a very small group of muscles ; of Dr Woollacott's 

 tabulated cases, 377 were of this kind, and 97 were severe. 

 And 8 the type of paralysis has, on the whole, become less 

 severe, or at all events less dangerous to life." 



