[The anti-diphtheria serum and the case of Langerhans]. / Das Diphtherie-Serum und der Fall Langerhans.

An eighteen-month old boy called Ernst Langerhans died shortly after being injected with a prophylactic dose of anti-diphtheria serum in April 1896. The father, a well-known pathologist in Berlin, claimed, in the obituary notice, that his son had been poisoned by Behring's anti-diphtheria serum. This paper describes the tragic events of Spring 1896: the death of Ernst Langerhans, the official investigations that followed as well as the reactions in the daily newspapers and the medical journals. The death of Ernst Langerhans afforded the opponents of the new serotherapy an opportunity to call into question the whole immunological concept. Supporters of the serotherapy, in turn, defended it against these attacks. The spectacular nature of Ernst Langerhans's death combined with the fact that he came from a prominent family of physicians made the event a public scandal. The tuberculine affair which had happened only a few years earlier was another reason for the public concern. Finally, the "Langerhans case" was a scandal because of the way in which Robert Langerhans published the death notice also causing resentment within the scientific community. Indeed, the publication of the accusation was one of the reasons why the "Langerhans case" failed to provoke a crisis with respect to the new therapy, as the central argument was displaced onto wider ethical questions. Furthermore, the medical administration had learned from the tuberculine affair, and had subsequently implemented a large confidence-inspiring system of quality control. The "official" cause of death, following the investigations into the case, was proclaimed to be an accident; a tragic piece of bad luck.

[Mathematical model of the infection process in diphtheria for determining the therapeutic dose of antitoxic anti-diphtheria serum]. / Matematicheskaia model' infektsionnogo protsessa pri difterii dlia opredeleniia terapevticheskoi dozy antitoksicheskoi protivodifteriinoi syvorotki.

It is known that administration of horse serum against diphtheria toxin can cause autoimmune and allergic complications. Therefore it is important for improvement of serotherapy to develop methods of prediction of disease course and quantity of diphtheria toxin and antitoxic antibodies in a serum. We have developed the mathematical model of diphtheria infection, which consists of six differential equations describing dynamics of diphtheria toxin and antitoxic antibodies in a serum, quantity of infection agent and macrophages in a site of inflammation. This mathematical model allows to predict the course of infectious process, the level of diphtheria toxin and antitoxic antibodies in the sera of people with diphtheria and to calculate the individual therapeutic dose of antitoxic serum for each patient.

[Basic features of diphtheria (author's transl)]. / Grundlagen der Diphtherie

The basic features of diphtheria, especially clinical aspects, differential diagnosis and therapy are set out insofar as they are important for the general practitioner. The doctor, not the bacteriologist, must make the diagnosis. Serotherapy must be begun as rapidly as possible, and in adequate dosage. The patients must be carefully watched over in the interests of early detection of possible complications. Rest in bed is required in every case for at least 3 to 4 weeks, longer if possible. Even mild "localized" forms can lead to toxic damage during the course or subsequently. In infants, diphtheria may run its course as the well-defined clinical picture of "diphtheria intoxication" of infants.