The Health bulletin [serial] - University of North Carolina at Chapel Hill

18 The Health Bulletin May, 1927
susceptible ase is 6 montlis to about
6 years. This is therefore the age where
artificial immunization is most important.
This is the "preschool ajie."
Toxin antitoxin is a certain preventive
of diphtheria and in addition it
has another feature that is frequently
not thought of. This is the saving of
mental anguish. Whenever a case of
diphtheria occurs it carries with it
inevitably a state of anxiety in the
minds of the parents of all children
who have been exposed, or possibly exposed.
If the exposed child has had
toxin antitoxin in the past there is no
need for anxiety and the feeling of
security is worth much.
The local inflammation in diphtheria
is a minor consideration as compared
to the danger from the circulating
poison of the disea.se. The exception
to this is membranous croup or laryngeal
diphtheria. Antitoxin's first efCect
is to netralize the circulating poison as
fast as it is produced in the tliroat.
Its secondary effect is to cause the subsidence
of the throat inflammation.
Antitoxin cannot affect the toxin or
poison that has coviMned icith the tissues
hefore antitoxin iras given. This
damage has been done, and cannot be
undone by any amount of antitoxin.
The poison has a special tendency to
attack the heart muscle and the nei'-
vous system—producing often severe
damage to heart function and widespread
paralyses. Both of these effects
of the toxin are often fatal. No damage
to heart or other tissues ever takes
place after an adequate dose of antitoxin
is given, but enough damage may
have been done before it was given
to produce serious results. For this
reason the time element in the administration
is the one most important
consideration. 10,000 units on the first
or second daj' of the disease is worth
ten times as much as 40,000 or 100,000
given on the fourth and fifth day or
later.
There are certain special practical
features about antitoxin that deserve
mention.
(1) Alarming immediate reactions
are rare, and occur most frequently in
people with a history of asthma. Adrenalin
chloride given hypodermically is
the most valuable drug to combat this
reaction.
(2) Paralysis following diphtheria
occurs in those cases where antitoxin
has been given late, or in cases where
the diagnosis of diphtheria was not
made and the patient made a spontaneous
recovery.
(3) There is no such thing as paralysis
or heart damage due to antitoxin.
If either of these occur it is due to the
toxin of the disease. The statement
that paralysis occurs more frequently
in cases where antitoxin is used is true
in the sense that most of those who do
not receive antitoxin do not live long
enough to become paralyzed.