242 PASSIVE IMMUNIZATION 



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 

 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, 



