198 PASSIVE IMMUNIZATION. 



of these, treatment was given outside of the barracks to 



15 cases with 12 deaths =80% mortality, 

 inside the barracks were treated 



40 cases with 17 deaths =42.5% mortality, 

 of these 



14 cases were not treated with serum with n deaths as a result 



= 78.6% mortality, 

 those treated with serum were 



23 cases with 5 deaths = 21.7% mortality, 



of these, those which were treated only incompletely (subcutaneously) and with insuffi- 

 cient doses, numbered 



6 cases with 3 deaths as the outcome =50% mortality, 

 systematic intraspinous treatment with large doses. 



17 cases with 2 (i) deaths = 11. 8 (6.3)% mortality. 



The figures in parenthesis represent the moribund cases coming under treatment and the 

 percentage which would result if these were not included in the calculation. 



The experiences with the serum of Flexner and Jobling are similarly encouraging. In 

 a report of 400 cases the mortality is reported as lowered from 80 per cent, to 20 per cent. 



2. Streptococcus Immune Sera. The rdle of the streptococcus in some diseases, for 

 example, scarlet, is imperfectly understood. Moreover it has only been indefinitely es- 

 tablished whether there are various groups or only one kind of streptococcus; even the 

 significance of their virulence or hemolysin formation is not clear. Such are the difficulties 

 which account for the great number of methods advocated for the production of an im- 

 mune streptococcus serum. The oldest serum of the many, is that of Marmorek. It was 

 produced by immunization with a strain made highly virulent by passage through animals. 

 The various other forms of the sera on the market are: 



a. Serum Aronson (Schering). This is a polyvalent serum produced by immuniza- 

 tion of horses with cultures pathogenic for man; some strains having previously been 

 passed through animals, others not. The strength of the serum is tested in mice infected 

 with the latter strains., 



b. Serum Meyer-Ruppel (Hochst Farbwerke). Horses are first immunized with a 

 strain of streptococcus whose virulence has been raised by passage through horses and 

 mice; each horse is then injected with a different strain of human streptococcus. When 

 the serum of each animal is of such a strength that doses of o.oi to 0.0005 c - c - protect mice 

 infected .with its own particular strain, the sera of the different horses are mixed. Thus 

 a polyvalent serum is obtained. 



c. Serum Menzer (Merck) is monovalent and produced by immunization with a culture 

 which is pathogenic for man and not passed through animals. 



d. Serum Moser is polyvalent, produced by injections of streptococci from scarlet 

 fever. The sera of Menzer and Moser are not tested by injections of white mice. The 

 others are. One cannot strictly rely upon this method of serum titration for its employ- 

 ment in man. The virulence of streptococci against mice and human beings bears no 

 definite relation. A serum may be perfectly efficient in mice both for prophylactic and 

 therapeutic purposes, and be entirely inactive in man; also vice versa. The action of the 

 serum should be in the main of bacteriotropic nature. 



Antistreptococcus serum has been tried in scarlet fever, puerperal sepsis, 

 erysipelas, and articular rheumatism. 



Recently complement fixation experiments (Foix and Mallein, Schleiss- 

 ner) have shown that the streptococci of scarlet fever can be definitely sepa- 

 rated from the other varieties of these bacteria. 



