12 
the high mortality, the association of other grave symptoms during 
the acute stage, and subsequent more frequent development of 
paralysis in convalescence in the cases in which it occurs. It resem- 
bles the ordinary forms of diphtheritic palsy in its tendency to be 
frequently incomplete and by its higher incidence among young 
persons. It is, as a rule, of much longer duration than the palatal 
affection which occurs at a later date. 
THE RELATION OF POST-DIPHTHERITIC PARALYSIS TO ANTI- 
TOXIN. 
The statement is frequently made that paralysis is even more 
common in the cases treated with antitoxin than under former methods 
of treatment. 
Welch®, 1895, thinks this doubtful; if true, it may be attributed 
to the survival of a larger proportion of the cases. 
McCollom^, 1905, drawing from his rich experience with diph- 
theria at the Boston City Hospital, states that, although parah^sis 
occurs after the severe cases, it has not been so frequent as it would 
have been in an equal number of cases treated without antitoxin. 
Marfan^, at the Hopital des Enfants Malades de Paris, where 
over 1,000 young diphtheria patients are treated annually, is of the 
opinion that since the introduction of antidiphtheric serum paralysis 
has become much less frequent. It seems, however, that the cases 
are not kept under observation long enough at' this hospital to war- 
rant such a strong conclusion. 
Variot,^^ 1898, dismisses the subject briefl}^ by saying that paral- 
yses are not rarer after serum treatment than before, but present 
the same localization, the same clinical characters, and the same dura- 
tion as before. 
Weill and Deguy ^ distinguish two kinds of paralysis: The first 
including paralysis of the palate and lar^mx, which they admit is 
still very frequent, but according to them is less due to diphtheritic 
intoxication than to local inflammation. The second group includes 
paralysis of the limbs, eyes, and viscera, which is due to the action 
of the diphtheria toxine and is much less frequently met with since 
the introduction of antitoxin. 
Rolleston believes that the most satisfactory answer to this ques- 
tion is given by the statistics published annually by the Metropolitan 
Asylums Board. The yearly admission to its fever hospitals of 
“AVelcli, W. II.: The treatment of diphtheria by. antitoxin. Bull. Johns Hopkins 
Hosp., July-Aug., 1895, vol. 6, Nos. 52 and 53, p. 1119. 
^McCollom, J. II.: Boston med. and surg. joiirn., vol. 152, 1905, pp. 621-632. 
c Clinique Infantile, May 15, 1904. 
<^La diphterie et la seruratherapie, 1898. 
eTraitement de la diphterie, 1902. 
