SPECIFIC SERUM THERAPY 239 



20 c.cm. The latter form is more advisable for the sake of preventing anaphylaxis. 

 Citron has found the serum entirely harmless, the bad effects described by some being 

 probably due to the idiosyncrasy of patients against foreign sera. The most favorable 

 results have been claimed in localized bone and joint tuberculosis and in the incipient 

 stages of pulmonary tuberculosis. Especial consideration of the serum should be given 

 in those patients who evince persistent temperature or the very severe but not hopeless 

 cases, where the tuberculin therapy cannot be undertaken. In some of these instances 

 very encouraging results have been noted. 



Occasionally the author started with the serum treatment, and then combined with 

 it the tuberculin administration and finally left the serum entirely. 



6. Anthrax Sera. Sclavo, Deutsh, Sobernheim and others have produced immune 

 sera by the immunization of donkeys, sheep and horses. These have been mainly 

 employed in veterinary practice. 



In man the serum has been tried only by Sclavo. He injects 30 to 40 c.cm. sub- 

 cutaneously for several successive days; in severe infections 10 c.cm. are administered 

 intravenously. Two cases described by Bandi received 150 c.cm. intravenously. 



7. Typhoid Immune Sera. The ordinary bacteriolytic sera (Tavel) have not met 

 with the desired success in the therapy of typhoid fever. Attempts have, therefore, 

 been made to produce antiendotoxic sera. Chantemesse treats horses for several 

 years with bouillon nitrates; Besredka injects first dead and then living typhoid bac- 

 teria from agar cultures, Mac Fadyen breaks up the bacteria at very low temperatures 

 and thus liberates the endotoxin for purposes of immunization. Kraus and von Sten- 

 itzer use bouillon filtrates and aqueous bacterial extracts as is likewise done by Meyer- 

 Bergell and Aronson. Garbat and Meyer employ sensitized typhoid bacilli, i.e., 

 bacteria united with their bacteriolytic amboceptors. 



Chantemesse injects several drops of his serum subcutaneously. Its effect lasts 

 ten days. Only occasionally is a second inoculation necessary; if so, it must be much 

 smaller. His results have been good and have mainly depended upon an increase in 

 the opsonic index. 



Meyer and Bergell as well as Kraus give 20 to 50 c.cm. subcutaneously. 



8. Cholera Serum.- Similar attempts for the production of a cholera antiendotoxic 

 serum have been made. "Kraus has succeeded in obtaining an antitoxin against some 

 El-Tor vibrios which have all the characteristics of true cholera vibrios. 



The experiments with Kraus' serum, and Kolle's serum (Bern Institute), at present 

 being conducted in Russia, seem to be favorable. 



The serum therapy of infectious diseases is still in its prime. The 

 contradictory results of many authors are to be attributed not only to 

 the variable efficiency of the sera, but also to the method, the time, and 

 the dose chosen for administration. 



The same serum in the hands of different physicians may yield opposite 

 results. These subjective sources of error must be overcome or minimized 

 by making a complete and thorough study of the effects which a certain 

 serum may have and actually does have; here all the clinical and laboratory 

 guides must be made use of. Employed in this manner, serum therapy 

 will even at the present stage lead to beneficial results. 



Wright's motto at the beginning of his book on vaccines "The physi- 

 cian of the future will be an immunizator," can justly be reversed to read, 

 "the immunizator of the future will be the physician in the true sense." 



