SERO-THERAPY. 



713 



nized animal, were not wholly expelled from its 

 blood. In the serum of this victorious animal 

 has accumulated such bactericidal or antitoxic 

 power that if it is thrown into conflict with the 

 specific microbe or its toxines in the blood of a 

 human subject affected therewith (but so ad- 

 justed in quantity and strength and so gradually 

 applied as not to overtax but to stimulate the 

 resistant capacity of the patient) its virtue is dif- 

 fused throughout the natural circulation, the re- 

 active power of the patient's blood is invigorated 

 at once by the re-enforcement from without and 

 by the conflict excited with the microbes or tox- 

 ines of the disease, and as a result the patient 

 comes to share the victory as well as the conflict 

 of the immune animal with which he has been 

 put into partnership. In the case of persons ex- 

 posed to an infection but not as yet possessed by 

 it, the same process becomes one of immuniza- 

 tion against the threatened attack, although it 

 is not yet found that such immunization is per- 

 manent or even very long continued. At all 

 events, it almost infallibly defends against the 

 present danger, and by its general application as 

 prophylactic may yet expel and thenceforward 

 keep at bay, like smallpox, the hosts of pesti- 

 lence. 



While tetanus and cholera were earlier heard 

 of as objects of attack on this line, the great in- 

 terest inspired by reports of unequivocal success 

 has been centered, thus far, on the most usually 

 formidable of the infections save tuberculosis 

 diphtheria. The success realized in combating 

 this terrible infection has been universal, though 

 not uniform, in the hospitals of the chief cities 

 of the civilized world, the apparent reduction of 

 mortality from actual attacks ranging from 10 

 per cent, to 80 per cent., while the prevented at- 

 tacks must' have been close to 100 per cent., 

 wherever the prophylactic has been applied to 

 families and neighborhoods exposed to the dis- 

 ease. In an exhaustive critical discussion of the 

 treatment by the Berlin Medical Society, which 

 was prolonged for several days, Prof. Virchow, 

 the severest critic of the new bacteriological ther- 

 apeutics, announced his hesitating experimenta- 

 tion with the serum and his unequivocal con- 

 cession of its virtue from the following most 

 significant tests, positive and negative, in the 

 Kaiser-and-Kaiserin-Friedrich Hospital : Begin- 

 ning in March, 1894, the cases of diphtheria were 

 treated with Aronson's serum for eight weeks, 

 when the supply suddenly gave out. The result 

 had been recoveries, 54 ; deaths, 8. For the next 

 seven weeks, when there was no serum, the deaths 

 exceeded the recoveries 55 to 54. Hochst's serum 

 was then obtained, and for the next six weeks the 

 recoveries were 69, to 12 deaths. This experi- 

 ment seems to have disposed of all doubt as to 

 the beneficent power of sero-therapy in diphthe- 

 ria at least. 



The preparation of the serum is in three steps 

 or stages: 1. The preparation of the original spe- 

 cific poison from a bouillon culture of the mi- 

 crobes which is filtered, tested to a standard of 

 virulency on guinea pigs, and sealed up for pres- 

 ervation in darkness and fixed temperature. 2. 

 The immunization of the animal that is to fur- 

 nish the serum, preferably the horse, which 

 stands the process better and yields more and 

 stronger serum than any other. After testing 



the health of the animal with tuberculin, etc., a 

 small trial injection of the toxine is administered 

 and the effects noted and modified by treatment 

 if necessary in the course of a few days' observa- 

 tion. The injections are continued once a week 

 or oftener, according to the time of recovery from 

 immediate effects, for nearly ninety days, the 

 dose being steadily increased until at last it is 

 perhaps five hundred times as strong as at first, 

 and the system has become insensible to its ef- 

 fects beyond the local inflammation at the punc- 

 ture. When this condition is reached, and not 

 before, the blood becomes rich in the antitoxine. 

 3. The withdrawal and preparation of the serum. 

 The blood of the horse, to the amount of 6 or 8 

 litres at a bleeding, is withdrawn from the jugu- 

 lar vein into sterilized bottles with all antiseptic 

 precautions, allowed to coagulate, and placed in 

 an ice chest for twenty-four hours, when the 

 serum will have separated, and is then trans- 

 ferred through a pipette to proper receptacles ^for 

 use. The administration of the serum to the pa- 

 tient is generally similar to that of any other 

 subcutaneous injection. The locality preferred 

 for injection is generally the side. It is advised 

 that whenever the physician suspects a case of 

 diphtheria he should immediately inject a dose 

 of 20 cubic centimetres and give to all those ex- 

 posed to the possible infection a protective dose 

 of 5 cubic centimetres. These doses are for chil- 

 dren, but for subjects as old as fifteen years they 

 are duplicated on the other side at the same time. 

 The only risk incurred is said to be that of giv- 

 ing rise to slight urticaria or nettle rash. There 

 remain, however, as in all cases of disease and 

 modes of treatment, elements of uncertainty and 

 variation due to possible complications in the 

 constitution or health of the patient, which keep 

 room always for skillful discrimination. In a 

 few cases quite serious trouble has been reported 

 following the treatment, though nothing so seri- 

 ous as death by diphtheria or death from the 

 after effects of the treatment. It is obvious that 

 much is yet to be learned respecting the best use 

 of the remedy and the net result after all conse- 

 quences are known. There are not wanting con- 

 servative critics who assert that disorders of the 

 kidneys, joints, and other seats of chronic dis- 

 ease are sure to follow such a vigorous interfer- 

 ence with the routine of Nature. The more en- 

 thusiastic friends of the treatment are equally 

 sure that no such thing is to be feared in view 

 of present experience, although it must be ad- 

 mitted that the time has yet been short for ade- 

 quate observation. The following is the chro- 

 nology of the recent discoveries in diphtheria and 

 its sero-therapeutic treatment : 



1883, the diphtheritic bacillus discovered by 

 Klebs in the false membrane. 



1884, the bacillus isolated and proved upon 

 animals as to the false membrane, by Loeffler, 

 whence known as the Klebs-Loeffler bacillus. 



1888, proving of the Klebs-Loeffler bacillus 

 completed as to the diphtheritic paralysis, by 

 Roux and Yersin. Continuing their investiga- 

 tions, they discovered later the diphtheritic tox- 

 ine produced by the bacillus and proved it, as to 

 the paralysis, etc., the same as with the microbe. 

 The German bacteriologists proceeded from these 

 data in experiments by inoculation of animals for 

 immunity under the lead of Karl Fraenckel and 



