2 6o THE PRINCIPLES OF IMMUNOLOGY 



that this serum possesses prophylactic and therapeutic properties in 

 animals. Anti-anthrax serum has been used for several years, espe- 

 cially in Italy, France and England, with encouraging results. Sclavo 

 treated his cases without excision and in a series of 164 cases treated 

 with specific serum this author reduced the mortality from 24 per cent. 

 to 5.3 per cent. Sclavo recommends 30 to 40 c.c. serum administered 

 subcutaneously in doses of 10 c.c. on the first day and repeated if neces- 

 sary on the next day. In severe infections 10 c.c. were given by the 

 intravenous route. In severe cases it is advisable to give the injections 

 in massive doses of 80 c.c. to 100 c.c. and preferably intravenously. 

 Shera advises administration of 20 c.c. every twelve hours until pyrexia 

 ceases. Regan recently injected the serum (10 c.c. to 15 c.c.) into the 

 tissues surrounding the pustule and found that it possesses none of the 

 disadvantages of the previous methods of local treatment, and has a 

 very rapid and complete effect on the pustule, not only in arresting its 

 further development but also in producing a subsidence of all local 

 inflammatory symptoms. He advises also general treatment either 

 intramuscularly or intravenously. Local treatment in order to effect 

 a cure must anticipate the onset of an anthrax septicemia. In case 

 the organisms have been demonstrated in the bloodstream the prog- 

 nosis is usually grave. In this case 200 c.c. of serum is not excessive, 

 and if necessary should be repeated until a negative blood culture is 

 obtained. In intestinal anthrax large doses of serum should be given 

 by the intravenous route. Penna and Beltrami and Penna, Cuenca and 

 Kraus have obtained good results with normal beef serum. Their mor- 

 tality was 6.2 per cent, in 372 cases, while the mortality previous to this 

 period of treatment was about 10 per cent. These authors advise the 

 use of 30 to 50 c.c. of normal beef serum administered subcutaneously. 

 If no improvement occurs the injections should be repeated every 

 twelve, twenty-four or thirty-six hours, but it seldom happens that a 

 patient requires more than two or three injections. In severe cases 

 intravenous administration is recommended. Similar favorable results 

 were obtained by Solari and Langon, but Lignieres has reported un- 

 favorably upon the curative action of normal beef serum, stating that 

 it is inferior to horse anti-anthrax serum. He calls attention to the 

 prevalence of anthrax in cattle as evidence of the apparent lack of 

 natural resistance to the disease. More recently Kolmer, Wanner and 

 Koehler pointed out on the basis of their experiments that normal beef 

 serum as secured from animals under ordinary conditions is but feebly 

 protective or curative for anthrax and while its administration as 

 described by Penna and his associates may favorably influence the pus- 

 tule it is doubtful if the serum is sufficiently powerful to influence 

 anthrax bacteremia. According to Kolmer, cases with sterile blood 

 culture always recover. The potent factor of anti-anthrax serum 

 appears to be a thermostable opsonin. 



The Serum Treatment of Plague. The therapeutic value of anti- 

 plague serum is still a matter of dispute. Plague epidemics are exceed- 

 ingly variable in character. Irregularity in the gravity of the disease 



