STREPTOCOCCUS PYOQENES. 495 



but not from all. Failure to do good in human infec- 

 tion cannot, as a rule, be attributed to the variety of 

 streptococcus. The serum will in animals limit an in- 

 fection already started if it has not progressed too far. 

 The apparent therapeutic results in cases of human 

 streptococcus infection are variable. In some cases 

 the disease has undoubtedly advanced in spite of large 

 injections, and here it has not seemed to have had 

 any effect. In other cases good observers rightly or 

 wrongly believe they have noticed great improvement 

 from it. Except rashes, few have noticed deleterious 

 results, although very large doses have been followed 

 in several instances, for a short time, by albuminous 

 urine and even temporary suppression. 



In suitable cases we are, I think, warranted in try- 

 ing it, but we must not expect very striking results. 



For our own satisfaction, and to increase our knowl- 

 edge, we should always have satisfactory cultures made 

 when possible, and the streptococci, if obtained, tested 

 with the serum used in the treatment. In the cases 

 where we want most to use the serum, such as puerperal 

 fever, septicaemia, ulcerative endocarditis, etc., we 

 find that it is very difficult to make a bacteriological 

 diagnosis from the symptoms, and in over one-half of 

 the cases even the bacteriological examination carried 

 out in the most thorough way will fail to detect the 

 special variety of bacteria causing the infection. This 

 is often a great hinderance to the proper use of curative 

 antistreptococcic serum, for it, of course, has no specific 

 effect upon the course of any infection except that due 

 to the streptococcus. 



Care should be taken to get only recently tested 

 serum, for after six weeks the best serum is almost 

 inert; much on the market is worthless, and as it is 



