Circulating Antitoxin at the Onset of Diphtheria in 425 Patients

Abstract

Summary The author has determined the antitoxin-titer of 425 patients with clinical manifest diphtheria faucium. Of these, 287 were unvaccinated, 32 vaccinated once and 106 vaccinated with more than one injection. In the case of the vaccinated the course of the disease was distinctly milder than that of the unvaccinated, while at the same time the antitoxin titre was much higher for the former than for the latter. When the unvaccinated are divided into groups according to the severity of the disease, there is only a slight difference in the antitoxin-titers of the groups. When all the cases are grouped according to the antitoxin-titer there is a scarcely demonstrable difference in the course of the disease for groups with a high titer and those with a low titer, provided that the course is indicated by means of the relative occurrence of complications and deaths in the groups. When a comparison is made between the distribution of antitoxin-titer among diphtherics and distributions among the rest of the population, there are found to be fewer cases of a titer higher than 0.1 A.U. among the diphtherics. The material is further treated statistically, the author having found a single quantity as an indicator for the course of the disease for each patient. The average course of each group can then be computed as the mean of the course of the individual cases. This provides greater statistical certainty than an analysis of the percentage of complications. It was then possible to show a significant dependence between antitoxin-titer and course of disease, although the slope of the regression found was rather flat. The vaccinated patients had a better course of illness than the unvaccinated who presented the same clinical picture on hospitalization and had the same initial antitoxin-titer.