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be too forcibly urged that in all cases of sore throat
which may suggest the possibility of Diphtheria, antitoxin
should be at once given, pending the result of an
examination of swabs of the throat, as in this way much
valuable time in the treatment of the disease will not be
lost, and the sooner the antitoxin is used the greater the
chance of ultimate recovery of the patient is assured. It
would be well to controvert a statement that one hears
very often, viz., that the Diphtheria antitoxin sometimes
kills the patient by inducing heart failure. Now what
really happens is, firstly, that the case has not come
under treatment sufficiently soon, and therefore the dose
of antitoxin has not been given sufficiently early to
ensure complete recovery, but it has prevented the
immediate death of the patient, and has given the patient
a chance which, without the antitoxin, it would not have
had of ultimate recovery. The poison of Diphtheria,
although local at first, soon becomes a constitutional
one, and unless counteracted by the administration
of antitoxin, may act upon the muscular walls of the
heart, inducing a condition of fatty degeneration
(myocarditis).
Occasionally, however, such degeneration is not
found upon post-mortem examination, and the death of
the patient may be due to heart failure, owing to
paralysis of the cardiac branches of the par vagum, or
possibly the little understood condition status lymphaticus
may exist. It is noticeable that most cases of failure of
the heart occur between the end of the first week and
the end of the third week of the disease, and that in
such cases, where vomiting occurs of a "coffee
ground" material, death is always to be expected.