STREPTOCOCCUS INFECTIONS 241 



Dosage and Uses. Prophylactic Doses. For prophylactic pur- 

 poses, antistreptococcus serum has been recommended in connection 

 with scarlatina and the puerperal process, either by itself or in combi- 

 nation with the use of a vaccine. To prepare the latter, F. Meyer 

 suggests that a bouillon culture of a corresponding strain be obtained, 

 centrifugalized, the sediment washed repeatedly with saline, and 

 finally emulsified with a quantity of 0.5 per cent, carbolic acid in 

 saline, equal to the volume of the initial culture. The resultant 

 emulsion is killed off by heating for six hours at a temperature of 

 65 C., when it is tested bacteriologically and shaken over night in a 

 shaking machine. This constitutes the finished vaccine, which does 

 not need to be counted out. The individual in question receives a 

 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 in 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. 

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