PROTECTIVE MEASURES IN DIPHTHERIA INTOXICATION

The fundamental cause of death from diphtheria intoxication appears to be a shock state due to paralysis of the entire periph-eral vascular mechanism (1). Well recognized are the mani-festations of cardiac depression or capillary paralysis, or both. Therefore, prevention and treatment of the shock state should be directed at support of the circulation, and protection of the heart and capifiaries from action of the toxin. Theoretically, desirable measures would be digitalis for the heart, and protective colloids and pituitary extract for the capillaries. According to G. N. Myers (1), digitalis is satisfactory in the diphtheria intoxication of cats and guinea pigs, provided the drug is given in the early stages of the intoxication, but it has no value as a life-saving measure in the late stages. Myers has recently reviewed the results with digitalis and other hemodynamic measures tried by previous investigators, so there is no need of detailing them here. Briefly, epinephrine and pituitary extract produce pressor effects in the early stages, but not in the late. Injections of saline, acacia, or dextrose solutions appear to be superior, as rapidly act-ing agents, and the efficiency of dextrose appears to be increased by the addition of alcohol. However, none of these agents, except digitalis, would be chosen for support of the circulation before symptoms of collapse are manifested