Injection Of Antitoxin Research Articles

XXI Inner Ear Deafness from Tetanus Antitoxin Injection

XXI Inner Ear Deafness from Tetanus Antitoxin Injection

RECURRENT PARALYSIS OF THE LARYNX FOLLOWING INJECTION OF TETANUS ANTITOXIN: REPORT OF A CASE

Paralysis following the injection of antitoxin, although rare in comparison with the frequency of serotherapy, has been reported in nearly a hundred cases since it was first noted, in the early part of the century, by Gangolphe. 1 In most of these cases paralysis has followed the injection of tetanus antitoxin, but other serums, such as those used in the treatment of diphtheria, scarlatina, pneumonia and meningococcic meningitis, have been implicated. Doyle, 2 in a tabulation of forty-nine cases of neurologic complications of serum disease, found involvement of the brachial plexus more frequent (thirty-three cases) than that of any other portion of the nervous system. Next in frequency was isolated involvement of the radial and the optic nerve; that of the latter was first described by Mason. 3 Cases of paralysis of the facial nerve, paralysis of the oculomotor nerve, 4 generalized paralysis 5 and involvement of the auditory nerve 6 have been reported. A search

Methods of prevention in diphtheria and scarlet fever

Hospital isolation is not effective as a means of prevention of diphtheria and scarlet fever. The reduction of deaths from diphtheria and scarlet fever during the past 54 years has been associated with the introduction of anti-toxin treatment of diphtheria and with the hospital treatment of both diseases. The methods of disinfection in general use are without influence in the prevention of the spread of diphtheria and scarlet fever. 3·1 per cent. of hospital treated cases of diphtheria gave rise to return cases while home treated diphtheria cases gave rise to no such return cases in Willesden during a period of five years. 14·1 per cent. of hospital treated cases of scarlet fever but only 3·7 per cent. of home treated cases of this disease gave rise to return cases of scarlet fever in Willesden during a period of five years. Isolation hospitals, by increasing the length of infectiousness of cases, defeat to some extent the object of prevention for which they have been established. Quarantine of well contacts, especially if they are children, cannot be effective practically as a means of prevention of diphtheria and scarlet fever. “Missed” cases have not been demonstrated to be a real factor in maintaining the prevalence of diphtheria or scarlet fever. “Carrier” cases greatly increase the difficulties of control in respect of both diphtheria and scarlet fever and may indeed be a source of the regeneration and continued prevalence of these diseases. Daily supervision of contacts in diphtheria cases with immediate administration of anti-toxin on the first appearance of symptoms would be likely to prove an effective means of prevention with further reduction of deaths from this disease. Routine prophylactic injection of anti-toxin for diphtheria contacts cannot be recommended. The Schick test for diphtheria has been demonstrated as reliable for separating the susceptible from the immune. Active immunisaton against diphtheria has been practised in New York, Edinburgh, Birmingham and Bristol, with results which go to show that this method will reduce the cases of diphtheria which now occur by at least 75 per cent. The Dick test for scarlet fever has been demonstrated as reliable for separating the susceptible from the immune. Immunisation of persons susceptible to scarlet fever can be carried out effectively. Hospital provision for the isolation of diphtheria and scarlet fever cases costs £3,000,000 per annum, exclusive of the cost of disinfection and other means of prevention. The bulk of this cost could be saved by the application of the newer methods of prevention revealed by recent research, namely, the Schick test and the Dick test and Immunisation. The progress of medical science in its relation to their work is a matter of interest to Local Authorities, and they should assume some responsibility in connection therewith. The prevention of diphtheria and scarlet fever is especially a problem for Local Authorities. The value of laboratory findings can be measured only by their field results. Recent Research work into the prevention of diphtheria and scarlet fever indicates that it would well repay a Local Authority of sufficient size to employ an epidemiologist to devote himself mainly to infectious diseases and the newer methods of their control. Communities would reap the benefit of such action by reduction of suffering, damage and deaths from diphtheria and scarlet fever, and enormous saving of expenditure on the hospital isolation of these diseases.

The use of morphine in connection with serumtherapy of botulism

Some time ago we have observed the delay in the rate of absorption of botulinus toxin in the animals subjected to ether anesthesia. Combining ether anesthesia with the specific serum therapy, we have been able to save animals poisoned with botulinus toxin where antitoxin alone failed to do so. In view of the fact that the application of ether anesthesia in cases of botulinus poisoning in men would be difficult on account of the pronounced respiratory distress present as a predominant symptom in such cases, we have attempted to find a satisfactory substitute for ether anesthesia. Among various substances thus far tried with various degrees of success, morphine seems to give the best results. Thus, one-quarter of a cubic centimeter of botulinus toxin (125 M.L.D.) given by the mouth causes death of a guinea pig of 250 grams in from 10 to 12 hours. The administration of an excess of anti-toxin intracardially does not save the animal if more than three hours have been allowed to elapse between the feeding of the toxin and subsequent injection of antitoxin. If guinea pigs of 250 grams are similarly fed with 125 M.L.D. of botulinus toxin and if 0.02 gram of morphine is given to them subcutaneously (in 10 per cent. solution) soon after feeding of the toxin, such guinea pigs die in from 26 to 46 hours if not given any antitoxin. Thus 0.02 gram of morphine delays the death from botulinus poisoning and more than doubles the length of the life of the animal. If antitoxin is introduced intracardially into such animals (treated with morphine) the animals can be saved even as late as 24 hours after ingestion of toxin.

NONSPECIFIC THERAPY IN ARTHRITIS AND INFECTIONS

Many of the clinical effects of the intravenous injection of foreign protein have been known for some time, particularly since the introduction of intravenous dosage of diphtheria antitoxin in diphtheria. 1 It has been observed that, following a previous almost afebrile or slightly febrile period in the course of disease, a more or less pyrogenic reaction followed the intravenous injection of antitoxin. For example, of twenty-six recent cases from my records in the contagious hospital, treated by intravenous injection of antitoxin, twenty-one reacted with chill and rise of temperature. In some cases the rise in temperature was as high as 108 F. The explanation of this reaction was not generally known until the researches of Vaughan and his co-workers were made (1909). Prior to this time, Buchner (1890), Krehl and Matthes (1895) had induced fever in animals by the subcutaneous injection of bacterial and other proteins. No importance was attached to

Observations on a Severe Case of Tetanus Treated with Repeated Intrathecal Injections of Antitoxin.—Recovery

Observations on a Severe Case of Tetanus Treated with Repeated Intrathecal Injections of Antitoxin.—Recovery

The Intramuscular versus the Intrathecal Route in the Treatment of Tetanus by Injection of Antitoxin

The Intramuscular versus the Intrathecal Route in the Treatment of Tetanus by Injection of Antitoxin

A Modification of Roemer's Intracutaneous Method for the Determination of Small Amounts of Diphtheria Antitoxin in Blood Sera

A convenient, practical, and economical test for the determination of the diphtheria-antitoxin content of blood sera is important for a number of reasons, among which may be mentioned the desirability of estimating quantitatively the efficiency of active immunization with toxin-antitoxin, the development of an active immunity after an attack of diphtheria, the antitoxin content of the blood at varying intervals after a single therapeutic or prophylactic injection of diphtheria antitoxin, the effect of one injection of antitoxin on the duration of immunity conferred by a second injection, etc. Such determination of the antitoxin content would help to give us a solid scientific foundation in many experimental and clinical problems connected with the subject of diphtheria. The older subcutaneous test of Ehrlich for determining the antitoxin content by the death of the guinea-pig has been universally accepted as a standard, but it cannot be used with any degree of accuracy when less than 1/20 of a unit of antitoxin to the cubic centimeter of serum is to be determined. The subcutaneous test requires a large amount of serum for each test, especially when the test is made for a fraction of a unit of antitoxin. This amount is not always obtainable in the case of human beings, especially when we are dealing with small children. In addition, the subcutaneous test is expensive in that it requires the use of one guinea-pig for each test. A method, therefore, that would enable us accurately to determine as little as 1/200 unit of antitoxin, require but a small amount of serum, and be saving of animals, would be of considerable advantage. When a larger series of sera is to be tested for small amounts of antitoxin, the intradermal method is practically the only feasible one. Recent work in active immunization against diphtheria' has shown successful results in producing an antitoxic immunity in 90-95% of

The Diagnostic Value of Intracutaneous Injection of Diphtheria Toxin (Schick Reaction)

By means of the Schick intracutaneous reaction, individual susceptibility and immunity to diphtheria may be readily recognized with a fair degree of accuracy. This has been turned to account in the selection of persons requiring immunization in the presence of exposure to diphtheria and in the sparing of those, already protected, from further annoyance and discomfort and from needless sensitization to horse serum. This reaction has also facilitated the study of the immunizing effects of injections of diphtheria toxin-antitoxin mixtures, as advocated by Behring. Schick has also employed the reaction to determine the quantity of diphtheria antitoxin required to bring a person infected with diphtheria into the condition of an immune individual and so to determine the doses of antitoxin required in various sorts of cases. It has also been valuable in estimating the relative efficiency of single and multiple injections of antitoxin and of injections made in various ways. The technic of the test as devised by Schick1 and followed by others is simple and readily applied. First, the minimum fatal dose (M. L. D.) of the diphtheria toxin is determined for a guinea-pig of 250 gm. The toxin is then so diluted that each cubic centimeter contains 0.2 of the M. L. D. Of this dilution, 0.1 c.c. (0.02 M. L. D.) is injected into the skin. The injection is made with a very fine, sharp, short-pointed needle, and a successful injection results in the production of a white, blister-like, punctate-appearing elevation. The traumatic disturbance disappears in a few hours, and if there is antitoxin in the blood of the injected person no further changes occur. This is regarded as a negative result and indicates that the person is immune to infection by diphtheria bacilli. If the person has very little or no diphtheria antitoxin in the blood, the disappearance of the traumatic

Intramuscular Injections of Antitoxin in Diphtheria

Intramuscular Injections of Antitoxin in Diphtheria

On The Administration of Diphtheria Toxin in a Collodion Sac

The therapeutic value of antidiphtheric serum is recognized by all who are conversant with the facts; as to how it acts and how its value can best be tested there is much less unanimity. The Germans, following Behring and Ehrlich, stand for the antitoxic unit as the full measure of therapeutic value, while the French, following Roux, contend that the antitoxic power of a serum is not a satisfactory measure of its therapeutic value. The reason why this question cannot be definitely settled is because diphtheria, as found in man, cannot be produced experimentally in animals. Hence the curative value of a serum can be tested only on human beings and these of course cannot be adequately controlled. On the other hand, the antitoxic value of a serum can be easily and accurately tested on guinea-pigs and this accounts for the universal use of the antitoxin unit. The question still remains: Does the antitoxic power of a serum adequately measure its curative power ? In the attempts which have been made to devise a satisfactory test for the therapeutic value of antidiphtheric serum the use of diphtheria cultures either on scarified ' -mucous membranes, or by subcutaneous injection, has been abandoned because of irregular results, and recourse has usually been had to the subcutaneous injection of toxin followed after an interval by the injection of antitoxin. This method differs from the conditions found in man, chiefly as to the rapidity with which the toxin is absorbed. In man the toxin is absorbed from the false membrane at first slowly, later rapidly, until some influence occurs which checks the production of toxin. When the toxin is injected subcutaneously it is absorbed rapidly and the system is suddenly overwhelmed with toxin. In casting about for some method of introducing toxin into animals more analogous to the manner of its absorp-

Observations on the leucocytosis produced by the toxin of the diphtheria bacillus, with especial reference to the changes which follow the injection of antitoxin

Observations on the leucocytosis produced by the toxin of the diphtheria bacillus, with especial reference to the changes which follow the injection of antitoxin

Intraneural Injections of Antitoxin in the Treatment of Tetanus

Intraneural Injections of Antitoxin in the Treatment of Tetanus

The Intravenous Injection of Antitoxin in Diphtheria

The Intravenous Injection of Antitoxin in Diphtheria

The Treatment of Tetanus by the Intracerebral Injection of Antitoxin: With Notes of a Fatal Case Treated by this Method

The Treatment of Tetanus by the Intracerebral Injection of Antitoxin: With Notes of a Fatal Case Treated by this Method

Sequel to a Case of Acute Tetanus Treated by Intracerebral Injections of Antitoxin

Sequel to a Case of Acute Tetanus Treated by Intracerebral Injections of Antitoxin

A Case of Acute Tetanus Treated by Intracerebral Injections of Antitoxin: Recovery

A Case of Acute Tetanus Treated by Intracerebral Injections of Antitoxin: Recovery

The Treatment of Tetanus by the Intracerebral Injection of Antitoxin: With Particulars of a Case Treated by this Method, Followed by Recovery

The Treatment of Tetanus by the Intracerebral Injection of Antitoxin: With Particulars of a Case Treated by this Method, Followed by Recovery

The Care of Our Wounded Soldiers — Intracerebral Injections of Antitoxin in Tetanus — Medical Notes

The Care of Our Wounded Soldiers — Intracerebral Injections of Antitoxin in Tetanus — Medical Notes

For What Period of Time Can Immunity from Diphtheria Be Conferred by a Single Injection of Antitoxin? The Dosage

For What Period of Time Can Immunity from Diphtheria Be Conferred by a Single Injection of Antitoxin? The Dosage