262 THE PRINCIPLES OF IMMUNOLOGY 



of the Parisian serum in his cases, repeating this six to eight 

 hours later, and if necessary followed again by another injec- 

 tion. The next two days he administered 20 to 50 c.c., so that 

 an adult received a total of 590 c.c. From a careful study he obtained 

 a mortality of 72.5 per cent, among the serum-treated cases, and 82.3 

 per cent, among his control cases. This author also emphasizes the 

 enormous advantage of early injections. In a series of 222 cases 

 treated on the second, third, fourth, fifth, sixth and seventh day of 

 illness he found the mortality as follows: 38.2, 56.7, 58.2, 50.8, 62.9, 

 60.0, and 75 per cent, respectively. According to Burnet, satisfactory 

 results have been obtained in Queensland at the Colmolie Plague Hos- 

 pital. Among 190 serum-treated cases during the period 1901 to 1907 

 the mortality was 29.7 per cent., while the mortality during the same 

 period among non-treated cases was 73.9. Penna in Argentina injects 

 massive doses 80 to 100 c.c. intravenously, and repeats the injection of 

 50 c.c. after twelve to twenty-four hours. Among 664 treated cases 

 during the period 1905 to 1912 he reported a mortality as high as 23 

 per cent, in 1906, and a mortality of 7.3 per cent, in 1912, the average 

 mortality was 12.5 per cent. From 1914 to the middle of 1919 Kraus' 

 serum was used with an average mortality of 7.8 per cent. Kraus' 

 serum, therefore, gave better results than Yersin's serum. Intravenous 

 or intramuscular injections can be employed to ensure rapid absorption 

 and the injections should be continued every twelve to twenty-four hours 

 for two or more days until diarrhea has been controlled and the disease 

 begins to subside. From all these studies we may conclude that although 

 serum therapy of plague has not given striking results as diphtheria 

 antitoxin in diphtheria, still it is the only specific means of combat- 

 ing the disease and when given early and in massive doses appar- 

 ently influences the disease favorably. 



Anti-bacterial Serum in the Treatment of Diphtheria Carriers. 

 Although Wassermann in 1902 recommended the use of a bactericidal 

 serum, Martin was the first to use anti-bacterial serum in the treatment 

 of diphtheria carriers. Martin injected diphtheria bacilli intravenously 

 or intraperitoneally into horses and obtained sera with marked agglu- 

 tinating properties. He claims that this serum has, when applied 

 locally, the property of causing a rapid decrease in number of living 

 bacilli in the throat. The best results were obtained by incorporating 

 the dried serum with gum and using it in the form of pastilles. Dopter 

 and many others have reported a decrease in the carrier period by the 

 use of anti-bacterial serum. More recently Roskam and Arloing and 

 Stevenin have called attention to the value of this method of treatment. 

 Ecker immunized sheep with various strains of diphtheria bacilli, and 

 by using massive doses obtained a potent agglutinative and lytic serum. 

 To this serum fresh guinea-pig complement was added and the mixture 

 sprayed by means of atomizers into the nasal passages, and over tonsils, 

 fauces and pharynx four and five times a day. A total of forty-eight cases 

 were treated, eighteen convalescent and thirty contact carriers. The 

 duration of the carrier state after the introduction of the serum was seven 



