.jl() LOCAL ILSSUK REACH IVLIY 



t\vc'iU)-l()ui hours alU'i aclininistriition ol tlic scniiii. In ;> cases 

 it reached a titer ol 1:25,600, in another iiio.ooo. In 10 other 

 cases there was a rise in Widal titer up to a dilution ol iilijo 

 iollo^ving the administration of serum. 



These observations can be interpreted as the residt oi the in- 

 jected serum, for the rise in the Widal titer occinred in the early 

 stages of the disease immediately following the injection of the 

 serum, and in titers well above normal expectancy for the given 

 stages of the disease. Four cases showed a doubtful effect of the 

 serinn upon the agglutination titer and in 1 1 cases n(j effect was 

 ol3served. 



Because of the small number of cases in each group it seemed 

 to be difficidt to draw any conchisions as to the correlation f)e- 

 t\veen the rise of the Widal titer following administration of 

 serum and the therapeutic effect. 



Effect on bactcretnia. Out of the 42 cases on ^vhom an unques- 

 tionable effect of the therapeutic serum ujx)n the toxic manifes- 

 tations of the disease was noted, the blood cultures became nesa- 

 tive in 22 cases ^vithin forty-eight to seventy-t\v() hours after the 

 administration of the serum. Negative blood cultmes after the 

 serum treatment ^vere also noted in the 12 cases classified as 

 showing moderate effect of the serum. 



In other words, the bacteremia cleared uj) within a few days 

 after the serinn treatment in 34 cases. In contrast to this result, 

 the follo^ving case must be reported as luiusual in our experience. 



Case B. S. This girl was gi\en 400 c.c. of serum between the fourteenth 

 and eighteenth days of her ilhiess because she was toxic and typhoidal. The 

 clinical picture changed within twenty-four hours and at the end of forty- 

 eight hours she was normally active, looked entirely well and had a good 

 appetite for food. The temperature began to fall within twenty-four hours 

 after the serum was administered and reached normal three days later. From 

 that time on, her temperature remained normal and she felt well. To cjur 

 smprise, blood cultures taken on the fourth, eighth and tenth days of 

 nornral temperature were positive for B. typhosus although clinically the 

 jsatient was no longer suffering froin typhoid fever or from any typhoidal 

 complications. The first negative blood culture was obtained on the four- 

 teenth day of normal temperature. 



In this one instance B. tyjjho.siis bacteremia persisted for at least 

 ten days after all the toxic manifestations of typhoid fever had 

 been apparently completely neutralized by the antitoxin and the 

 patient was clinically Avell. 



