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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    subject to just the same conditions in the subcutaneous tissue and muscles as Meltzer and Auer had shown to apply to crystalloid solutions, viz. delayed absorption after subcutaneous injection, and rapid absorption after intramuscular injection. The highest antitoxin value in the blood was naturally found after intravenous injection, but even after eight hours this con- centration was found to have diminished, whereas in intramuscular injections, after eight hours, the antitoxin content of the blood came very close to that after intravenous injection. In four to five hours the antitoxin content with intramuscular injection was five to twenty times, and in seven to eight hours at least three to ten times, that after subcutaneous injection. Confirmatory experiments were performed by Levin (14), who found that absorption of diphtheria antitoxin in goats occurred much more quickly with intramuscular than with subcutaneous injections. • This difference was particularly marked during the first few days, as the antitoxin concentration reached in the blood after ten hours was fourteen times greater after intramuscular than after subcutaneous injections. Morgenroth’s investigations induced clinicians to give intramuscular injections of antitoxin in the treatment of diphtheria, and this method was first used in E. Neisser’s clinic at Stettin, as will be seen from Gabriel’s paper published in 1909 (11). Since then, intramuscular injections have largely superseded subcutaneous in German hospitals, as reference to the writings of Baginsky (1), Bauer (3), Bliihdorn (6), Eckert (8), Iloesch (13), Lorey (16), and Schreiber (26) will show. Ganghofner (12), of Prague, and Feer (9), of Zurich, have also recently adopted the method. So far, however, to judge from the literature,* the practice of intramuscular injections of diphtheria antitoxin has been confined to German-speaking countries. As regards the site of injection, Gabriel, Eckert, Berlin, and Iloesch use the gluteal region, while Baginsky, Feer, and Ganghofner, following the advice of Morgenroth Levy, prefer the outside of the thigh, * We are indebted to Dr. Germain Blechmann for informing us that intramuscular injections of antitoxin are not employed in any of the children’s hospitals in Paris. Dr. C. B. Tver, however, in a letter dated February the 13tli, 1914, informs us that lie lias been using the method exclusively at the City Hospital, Edinburgh, for the last six months, owing to the recommendation of the practice in the new edition of Baginsky’s book. Lastly, Dr. Bruckner, Medical Superintendent of the Dresden Children’s Hospital, writing on May the 3rd, 1914, tells us that for the last year he has given diphtheria antitoxin intramuscularly and occasionally intravenously as well.