944 HUMAN SERUM FROM CONVALESCENT CASES 



In explanation of these results it may be said that in some diseases injections of 

 normal blood have brought about improvement, and that immunity may be increased 

 at times by injections of normal blood, that this has also occurred after injections of 

 other things, such as protease, lipase, ferments (trypsin), or drugs (kaolin). Hyper- 

 leukocytosis, such as occurred in several cases in this series, has assisted immunity in 

 other diseases (arthritis, typhoid), so for lack of consistency in the results obtained 

 in these cases of whooping cough it is not possible to ascribe any of them to a specific 

 action of the blood injected. 



USE OF CONVALESCENT AND NORMAL BLOOD IN THE TREATMENT 

 or SCARLET FEVER 



The development of scarlatinal antitoxin and antibacterial antibodies has large- 

 ly removed the necessity of using human convalescent serum, but it is still at times 

 useful, especially in cases of sepsis. 



The intravenous injection of fairly large quantities (from 2 to 3I oz.) of con- 

 valescent serum has given good results in the hands of Reiss and Jungman,^ and 

 Koch.^ This requires greater skill, and necessitates wasting more than 60 per cent 

 of the blood. These disadvantages are easily avoided by the simple intramuscular 

 injection of whole citrated blood. 



Cases of scarlet fever may be divided roughly into two groups for purposes of 

 blood injection: 



1. The early toxic or malignant scarlet fever cases which are seen between the 

 first and fourth day of disease, and show the clinical picture of delirium and restless- 

 ness, intensive petechial rash, moderate glandular enlargement and severe angina. 

 These cases are suitable, in the absence of antiscarlatinal antitoxin, for the intra- 

 muscular injection of convalescent serum or blood taken from second-or third-week 

 convalescent scarlet fever cases. Such convalescents are generally available in the 

 wards of large contagious disease hospitals. 



The effect of convalescent blood in these early toxic or malignant cases of scarlet 

 fever is seen in a critical drop in temperature beginning about sk hours after the 

 injection and ending in from twenty-four to thirty hours. The temperature often 

 reaches normal and will remain nearly normal in the majority of the cases; in others, 

 especially when complicated with severe tonsillar and faucial exudate, associated with 

 inflamed cervical glands, the temperature may rise again for a few days, but rarely 

 to the same height as at the time of injection. Other results^ which are quite as strik- 

 ing, can be seen in the early fading of the rash, the improvement in the circulation and 

 the character of pulse, the general condition, and mental symptoms. 



2. In the second group are included the later septic cases, seen from the fifth to 

 the eighth day of disease. The rash may have faded entirely, but the membranous exu- 

 date over the fauces and tonsils is severe and extensive, and often appears necrotic. 

 The cervical lymph glands are enlarged and tender. The temperature is high and 

 septic in character, varying between 103° and 105° F. 



In this group of cases, in the absence of blood from convalescents, I would strong- 



' Reiss, E., and Jungman, P.: Deutsche Arch.f. klin. Med., 106, 70. 1912. 

 ^Koch, R.: Miinchen. med. Wcfmschr., 60, 261 1. 1913. 



