254 THE INTERNAL SECRETIONS—1920 
infection will indicate the serum or phylacogen to be 
used in the treatment. Naturally, this cause must be 
removed if any permanency of results is expected from 
the treatment. 
If the hemoglobin figure is below 40 per cent., trans- 
fusion from a properly grouped donor should be per- 
formed at once and should be repeated once or twice as 
the results from other treatment are far from satisfac- 
tory. 
The treatment is begun with suitable injections of a 
vaccine or filtrate similar to the phylacogens to corre- 
spond with the character of the infection present. If 
syphilis is the underlying infection, transfuse first and 
begin at once with a vigorous antisyphilitic treatment. 
Many cases not of syphilitic origin may give a weak 
positive Wassermann reaction, and in these cases con- 
tinuation of the antisyphilitic treatment does no perma- 
nent good. The absence of a suspicious history, scars 
and other marks of lues should help to make the diag- 
nosis, and with a negative Wassermann the reverse 
holds true. Any suspicion of an old syphilis should be 
sufficient reason to begin at once with the routine potas- 
sium iodide solution together with intravenous and 
other indicated medication. 
Next in importance in the treatment of these cases 
is the use of the sera, since it has been found that their 
use in cases with a negative Wassermann frequently 
may change it to positive. As long as they cause a 
reaction in reasonable doses it is absolutely imperative 
to continue their use. If the Wassermann test becomes 
positive, active and prolonged antisyphilitic treatment 
is called for. It is of great importance during this time 
to use generous doses of products that stimulate the 
ductless glands. This is a phase of the treatment that 
must not be overlooked as many cases refuse to make 
a gain until after ductless glandular therapy has been 
vigorously and persistently used. Arsenic and iron, 
