14 
Rolleston fully appreciates and emphasizes the importance of 
early administration and large dosage in diminishing the incidence, 
especially in a severe form of subsequent paralysis. In severe cases 
Rolleston uses 18,000 to 24,000 units, usually repeated once, some- 
times twice, by injections on following days. The mildest cases 
receive early from 3,000 to 12,000 units. 
There is no definite proof that post-diphtheritic paralysis ever 
occurs in cases treated with antitoxin within the first twenty-four 
hours of the disease. This corresponds precisely vdth what we see 
in the guinea pig. Paralysis may follow in cases treated with serum 
on the second and third day of the disease, again an exact duplicate 
of the picture we see in the guinea pig. 
This emphasizes the importance of administering this soveriegn 
remedy early. But if the case is not seen early, can larger doses 
prevent the occurrence of post-diphtheritic paralysis and save life? 
It seemed to Ransom,® 1900, worth while to undertake an exami- 
nation into the conditions under which diphtheritic paralysis occurs 
in animals and to ascertain by means of experiments what effect, if 
any, the antitoxin has on this very disagreeable sequel to an attack 
of diphtheria. As a result of his work Ransom concludes that — 
1. Paralysis may certainly be expected after intoxication with not less than one- 
fourth of the fatal dose. With doses between one-fourth and one-eighth paralyses 
occur but are not constant, and below one-eighth no paralysis was noticed. 
2. The larger the dose of toxine the severer will be the paralysis, if the animal 
survives long enough. 
3. Neutralized mixtures of toxine and antitoxine, containing only about one 
lethal dose or less, do not appear to cause paralysis. 
4. Antitoxine given fifteen to twenty-two hours after intoxication, with doses of 
toxine not greater than the lethal dose, exercises in large doses a mollifying influence 
on the subsequent paralysis. This influence is more evident on smaller doses of toxine * 
than on such as are but little less than the minimal fatal dose. Small doses of anti- 
toxine have no evident effect in diminishing the paralysis. 
5. Transferring these results to practice among human beings, we may expect 
liberal doses of antitoxine, given early in the illness, to influence favorably the sub- 
sequent paralysis, and this beneficial influence is likely to Kianifest itself not so 
much on the local paralysis (soft palate, etc.) as on such symptoms as failure of the 
heart. Severe cases are, however, likely to be followed by some paralysis in spite 
of even large doses of antitoxine. 
POST-DIPHTHERITIC PARALYSIS IN THE GUINEA PIG. 
Diphtheria in the guinea pig closely resembles the same disease in 
man. Post-diphtheritic paralysis in the guinea pig is an almost exact 
counterpart of the same complication in man. We are, therefore. 
Ransom, F.: Diphtheritic paralysis and antitoxine. Journ. path, and bact., 1900 
vol. 6, p. 397. 
