STREPTOCOCCUS INFECTIONS 259 



serum injection of 20 c.c., and at intervals of three days increasing 

 doses of the vaccine (0.1, 0.2, 0.4, 0.8, and 1.6 c.c.). 



Curative Dose. For curative purposes the serum has been used 

 in scarlatina, in severe streptococcus infections of the throat, in 

 erysipelas, in puerperal streptococcus infections, in chronic strepto- 

 coccus infections associated with tuberculosis and malignant growths, 

 in streptococcus endocarditis and arthritis, etc. In scarlatina the 

 treatment is indicated especially jn those cases in which the throat 

 infection is at all severe, or in which the initial general symptoms 

 suggest the likelihood of a severe course. In cases of the first type 

 the injection of 50 to 100 c.c., given subcutaneously, and repeated 

 once or twice, if necessary, is usually sufficient, while in severe 

 systemic infections, when the blood examination frequently shows 

 the presence of large numbers of organisms, still larger doses, and 

 repeated even more frequently, are advocated. In cases of pro- 

 tracted sepsis, vaccination (see above) may well be combined with 

 the serum treatment. In fulminating cases, where blood examina- 

 tion reveals the presence of streptococci already within a few hours 

 of the first appearance of symptoms, nothing short of an intravenous 

 injection (50 c.c.) should be tried, and it would seem worth while 

 in just such cases, in fact in all the more severe infections, to inject 

 the serum diluted with normal salt solution, as has been suggested 

 by F. Meyer, or to follow its injection with a subcutaneous infusion 

 of 500 c.c. or more. 



In severe streptococcus anginas the dosage is essentially the same, 

 i. e., 50 c.c., given subcutaneously and diluted, if desired, the dose 

 being repeated in accordance with the urgency of the symptoms, 

 and two injections a day given if necessary. 



In erysipelas the use of the serum is advocated especially in cases 

 affecting the head and neck, as also in migratory cases, while the 

 facial type of the disease usually does well with ordinary treatment. 

 The dosage here also ranges between 50 and 100 c.c. according to 

 the gravity of the case. 



In puerperal infections the rule should be to use the serum early 

 or not at all. A great deal of valuable time is here often lost in 

 waiting to ascertain whether the infection will not cure itself. The 

 patient should receive the benefit of the doubt, no matter whether 

 the statistics are thereby unduly turned in favor of the serum or 

 not. Its use is logical and should be resorted to in every case where 



