Intramuscular injections of antitoxin in the treatment of diphtheria / by J.D. Rolleston and C. Macleod.

  • Rolleston, John Davy, 1873-1946.
Date:
1914
Catalogue details

Licence: In copyright

Credit: Intramuscular injections of antitoxin in the treatment of diphtheria / by J.D. Rolleston and C. Macleod. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    moderate faucial cases received from 8000 to 12,000 units on admission, the same dose being occasionally repeated on the following day. The mild faucial cases received from 4000 to 8000 units, and it was rarely found necessary to repeat the dose. The cases of nasal, laryngeal, conjunctival or aural diphtheria in whom there was no faucial involvement, and consequently little, if any, toxaemia, received from 4000 to 12,000 units. Table It shows the total amount of antitoxin given in each case. Table II. Doses. Cases. Remarks. 4,000 40 8,000 97 1 death on forty-fifth day from glottic spasm. 12,000 56 3 deaths, 2 from toxaemia within twenty-four hours of admission, and 1 from broncho- pneumonia. 16,000 18 20,000 15 2 deaths, 1 from toxannia, 1 from cardiac paralysis. 24,000 10 1 death from glottic spasm. 28,000 10 4 deaths from toxaemia, 1 within twenty-four hours. 32,000 P7 ! 2 deaths from toxaemia. 36,000 3 All recovered, and none had any rash. 40,000 4 2 deaths from toxaemia. One of the survivors had palatal palsy only, the other no compli- cations. Neither had any rash. 44,000 l 261 Recovery with palatal palsy only. No rash. The average dose for each patient was 12,459 units—a dose slightly below the average used in the Board’s hospitals, in which, since 1908, the average dose has ranged from 14,571 to 17,328 • units (27). Our dosage for intramuscular injections has indeed been decidedly smaller, especially in severe cases, than it had been for subcutaneous. In a paper published by one of us in the Board Reports for 1908' (23), it will be seen that out of 78 haemorrhagic cases, 40, of whom 7 recovered, received doses varying from 42,000 to 72,000 units; fj while out of 22, who received less than 33,000 units, none recovered. With intramuscular, as with subcutaneous injection, the frequency !; of rashes and other serum phenomena, in spite of large doses, is less -§ than usual, as is the rule in severe diphtheria.