Paralysis following relapses and second attacks of diphtheria / by J.D. Rolleston.

  • Rolleston, John Davy, 1873-1946.
Date:
1910
Catalogue details

Licence: In copyright

Credit: Paralysis following relapses and second attacks of diphtheria / by J.D. Rolleston. 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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    26, who was admitted to hospital in October, 1900, with mild faucial and nasal diphtheria. She had previously suffered several times from sore throat. No antitoxin was given, but only local treatment was employed. After removal to a con- valescent hospital, palatal palsy, cycloplegia and loss of motor power in the lower limbs developed, necessitating her detention until February, 1901. She was admitted again in December, 1906, with a more severe angina than on the first occasion, on the third day of disease, when she received 12,000 units of anti- toxin. Ciliary palsy developed on the thirty-second day, and lasted till the forty-fifth. No other paralysis occurred, and the knee and ankle jerks remained active during her forty-seven days’ stay in hospital. The value of early administration of antitoxin in preventing paralysis, especially of a severe character, has been illustrated experimentally by Rosenau and Anderson, and clinically by several observers, including myself. The entire absence of paralysis following a relapse was due to the fact that the disease arising in hospital could be jugulated at once by serumtherapy, so that in every case the throat symptoms were mild. In this connection I would insist on the fact universally accepted by the physicians of large fever hospitals, but contested by some neu- rologists, that the frequency and severity of diphtheritic paralysis bear a direct relation to the initial angina. The partial im- munity conferred by the primary attack and the initial dose of antitoxin was the cause of none of the relapses displaying those features of malignancy which are manifested by severe local symptoms, deficient reaction to antitoxin and a high mortality, and are followed by a precocious paralysis, which in survivors is of unusually long duration. Second attacks, on the other hand, do not always run a mild course, since five such cases had severe local symptoms, and two developed paralysis, in one case fatal. It would seem that the immunity conferred by the first attack had been exhausted owing to the length of the interval which in these five cases ranged from one to three years. The references in literature to the occurrence of second attacks of diphtheritic paralysis are very meager. The following which are arranged in chronological order are the only ones which I have been able to discover after a laborious search. It will be seen that there was usually a remarkable difference in the I
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