68 THE PRINCIPLES OF IMMUNOLOGY 



receive serum treatment, three received non-specific treatment and 

 three suffered complications, thirty-five deaths were recorded, while 

 in a series of twenty-four specifically treated cases only five deaths 

 occurred, thus reducing the mortality from more than 55 per cent, 

 to less than 21 per cent. The serum used in these cases was poly- 

 valent, produced against bacillus aerogenes capsulatus, the vibrion 

 septique, and bacillus edematiens. Duval and Vaucher, in 1917, 

 reported fifty cases in which a combination anti-perfringens, anti- 

 edematiens, and anti-vibrion septique serum prepared by Weinberg 

 and Seguin was injected prophylactically. In none of these patients 

 did gas gangrene develop, although all were of the most severely 

 wounded type. Twenty-five died as a result of severe multiple 

 wounds without any signs or symptoms of gas gangrene. 



Prophylactic Use of Sera. A year later these same authors re- 

 ported a series of 281 cases in which severely wounded patients 

 were injected with polyvalent serum prepared at the Pasteur Insti- 

 tute. Eighteen developed gas gangrene (6.4 per cent.), and of these 

 ten died, resulting in a mortality of 3.5 per cent., the usual mortality 

 from gas gangrene in severely wounded being 16 per cent. Mairesse 

 and Regnier found among 1016 wounded men examined bacteriologi- 

 cally 297 gas bacillus infections. They received prophylactic injec- 

 tions of anti-serum depending on the type of organism present. In 

 thirty instances, or 10 per cent, of the cases, the disease developed. 

 Ivens also used Weinberg and Seguin's serum in 222 cases for 

 prophylactic injections. Among these no deaths occurred, and 

 fourteen amputations were performed without fatal results. With 

 Leclainche and Vallee's serum (154 cases) four died, and in fifty- 

 seven other cases treated with both sera two deaths occurred. 

 Further favorable reports were made by Quenu, Bazy and Routier, 

 Vincent and Stodel, Marquis, Dufour and Samelaigne. Curative 

 injections were given by Duval and Vaucher with 20.7 mortality. 

 Rouvillois, Guillaume, Louis, Pedeprade, and Thibierge treated 

 twenty-five cases, five of whom died. Of these three were moribund 

 on entrance to the hospital. Mairesse and Regnier's thirty treated 

 cases had a mortality of 16.6 per cent. 



Van Beuren, who reports a personal communication from Lieut.- 

 Col. W. Elser, states that prophylactic doses were given to 15,000 

 soldiers and controlled by 15,000 others. According to this finding 

 there was not sufficient difference in the incidence rate to warrant 

 any definite declaration as to the protective value of the sera used. 

 Apparently these investigators were favorably impressed; for they 

 laid the failure to secure better results to the weakness of the 

 serum then available. Elser advises the following routine for the 

 serum treatment: 



1. A prophylactic dose of polyvalent serum, combined with 

 tetanus antitoxin, given as early as possible after the receipt of 

 the wound. 



2. Bacteriologic examination of the wound and establishment of 



