260 PASSIVE IMMUNIZATION 



fever develops during the puerperal period, if this is not manifestly 

 sapremic in character. 50 c.c. given subcutaneously is sufficient 

 in the milder cases, while in the presence of ominous symptoms 

 larger doses should be employed (100 to 200 c.c.), which here, also, 

 may be suitably combined with a subcutaneous infusion of saline 

 (500 to 1000 c.c.). In urgent cases intravenous injections should 

 be made (50 c.c.). After hysterectomy it is recommended to give 

 an intraperitoneal infusion of 500 c.c. of serum with 1000 c.c. of 

 saline, the operation being preceded by an intravenous injection 

 of 100 c.c. In cases which have become chronic the serum treatment 

 should be combined with the use of an autogenous streptococcus 

 vaccine. 



In the chronic infections associated with endocarditis, arthritis, 

 tuberculosis, and carcinoma, etc., much smaller doses are given, viz., 

 5 to 20 c.c., as larger amounts are apt to cause an aggravation of 

 some of the symptoms, and notably temperature disturbances 

 lasting for sixteen to twenty-four hours. But in these cases more 

 good may, cceteris paribus, be expected from the use of a vaccine 

 which should, if possible, be autogenous, than from the serum. 

 (Both may, however, be advantageously combined.) 



Results. Upon surveying the literature in reference to the cura- 

 tive value of antistreptococcus serum, one is struck with the fact 

 that while diphtheria antitoxin is generally used as early as possible, 

 the antistreptococcus serum is usually resorted to too late and in 

 insufficient amount. The result is, that from a statistical stand- 

 point the general verdict has been rather unfavorable. This empha- 

 sizes the importance that immunization treatment in hospital work 

 particularly should be placed in the hands of especially trained 

 men, who should be consulted in doubtful cases. My belief is that 

 then and only then immunotherapy will yield its best results. 



As I have already indicated, the most favorable reports have 

 been published in connection with the use of the serum in scarlatina. 

 Escherich, speaking of the effect of the Moser serum, remarks that 

 this is "zauberhaft" (magic), and especially so when used early. Of 

 112 cases which had been injected on the second or third day every 

 one recovered, while among those in whom the treatment had been 

 delayed the mortality ranged between 13 and 50 per cent. 



In erysipelas, very curiously, the least favorable results have 

 been obtained; in the migratory forms, however, the disease usually 



