200 PASSIVE IMMUNIZATION. 



a. The Paris serum (Yersin) produced at Pasteur Institute by immunization of horses 

 with dead and later on living bacilli. 



b. The Bern serum of Tavel employs the same principles. 



c. Lustig's Serum. For this serum, horses are immunized with the pest-nucleopro- 

 teids. Pest cultures are broken up by i per cent, of potassium hydroxide and from this, 

 by the addition of acetic acid, the nucleoproteid is precipitated and then suspended in salt 

 solution to serve as antigen. 



d. Serum of Terni-Bandi is prepared by the immunization of donkeys and sheep with 

 natural pest aggressins. 



e. Serum of Markl is supposedly an antitoxic serum prepared by immunization with 

 nitrates of old pest bouillon cultures. 



All the above sera contain agglutinins, precipitins, bacteriotropins and amboceptors; 

 the serum of Terni-Bandi contains aggressin amboceptors, that of Markl, antiendotoxins. 



The sera are tested for their anti-infectious properties in animals such as guinea-pigs, 

 rats, mice. Markl also estimates the toxin neutralization power of his serum. 



The Paris serum comes either in dry form or in bottles containing 20 c.c. without any 

 preservatives. Ten to 20 c.c. should suffice as a prophylactic injection, although Martini 

 advises 100 c.c. at least. The period of protection is short, averaging about fourteen days. 



Prophylactic injection is advisable in those instances where an immediate protection 

 is necessary, like the inoculation of physicians and nurses attending pest patients. Under 

 all other circumstances either active immunization or the simultaneous method of Shiga 

 should receive the preference. 



For the treatment of pest infections, Calmette and Salimbeni advise intravenous ad- 

 ministration of 20 c.c. and two subcutaneous injections of 40 c.c. each all to be given on 

 the first day; on the second day two similar subcutaneous injections; and if the case is of a 

 severe nature, the dose may be doubled. The results are variable. 



From comparative studies, it seems that Lustig's serum is somewhat weaker than the 

 Paris serum. The sera of Terni-Bandi and Markl have not been sufficiently employed, 

 so that opinion is reserved. 



5. Tuberculosis Sera. The best known and most studied are those of Maragliano and 

 Marmorek. 



a. Serum Maragliano is prepared by Maragliano's institute in Genoa from horses 

 which are immunized for about six months with the soluble substances of tubercle bacilli. 

 The favorable action of the serum is reported on, especially by Italian authorities. 



b. Serum Marmorek is prepared in the laboratory of Marmorek, at Paris-Neuilly, by 

 the immunization of horses with the so-called "primitive" tubercle bacilli, i.e., young 

 tubercle bacilli whose acid fast character is still very slight or entirely absent. When the 

 horses have attained a high grade of immunity, they receive injections of various strains 

 of pure cultures of streptococci obtained from the sputum of tuberculous patients. The 

 serum of these animals is, therefore, antituberculous and at the same time polyvalent 

 antistreptococcic (a double serum), serving against the mixed infections. 



This serum is administered daily, either subcutaneously 5 to 10 c.c. or per rectum 

 20 c.c. The latter form is more advisable for the sake of preventing anaphylaxis. Citron 

 has found the serum entirely harmless, the bad effects described by some being probably 

 due to the idiosyncrasy of patients against foreign sera. The most favorable results have 

 been claimed as found in localized bone and joint tuberculosis and in the incipient stages 

 of pulmonary tuberculosis. Especial consideration of the serum should be given in 

 those patients who evince persistent temperature or the very severe but not hopeless cases, 

 where the tuberculin therapy cannot be undertaken. In some of these instances very 

 encouraging results have been noted. 



