94 
BACTERIOLOGY. 
Serum 
sickness 
Schick 
test 
nurse, should receive an immunizing dose of antitoxin. 
The curative property of antitoxin was discovered 
by von Behring in 1894. By the use of antitoxin the 
fatal cases have been reduced 75 per cent. The 
antitoxin should be given in all suspected cases and in 
large amount. In urgent cases it may be given directly 
into the veins, but under ordinary circumstances it is 
given into the muscles. The greatest effect is attained 
with a large first dose, for as the disease progresses the 
toxin unites with the cells and is then unaffected by 
the antitoxin. The immunizing dose protects from two 
to six weeks. Occasionally the injection of antitoxin 
is followed after a few days by a feeling of malaise, 
skin eruption, vomiting, albuminuria, and swelling of 
the lymphatic glands. This condition is due to an in¬ 
creased susceptibility on the part of the patient to cer¬ 
tain constituents of the antitoxin, probably the horse- 
serum. A few cases of sudden death following the in¬ 
jection of diphtheria antitoxin have been attributed to 
anaphylaxis. 
In epidemics the Schick test gives information 
which is of the greatest value in checking the spread of 
the disease. It is well known that a considerable num¬ 
ber of people are normally immune to diphtheria. If 
a minute quantity of diphtheria toxin is injected into 
the skin of such people no effect is produced while 
in those not immune a local reaction results in twenty- 
four hours which is characterized by an area of redness 
and infiltration y 2 to 1 inch in diameter. 
