254 THE PRINCIPLES OF IMMUNOLOGY 



others only rarely. It is, therefore, advisable to determine as soon as 

 possible the type of the organism, and then combat it with its special 

 antiserum. Havens succeeded in dividing these organisms into three 

 distinct groups by means of cultural and immunological examination 

 and found that an immune serum can be produced for each of the three 

 groups. The serum is specific for its own group and protects mice 

 against infection with homologous organisms, but furnishes no pro- 

 tection against infection with organisms from the other groups. From 

 this work it is evident that the utilization of specific sera is of para- 

 mount importance in the treatment of streptococcus infections. The 

 oldest serum is that of Marmorek. This serum was produced by im- 

 munization with a strain which was made highly virulent by animal 

 passage and the serum was found to be protective experimentally when 

 administered twelve to eighteen hours before the bacteria were injected. 

 This serum was used in erysipelas, puerperal septicemia and scarlatinal 

 angina with favorable results. Lenhartz, Baginsky, Zangemeister and 

 others, however, failed to obtain definitely good results with anti-strepto- 

 coccus sera. Sera were later produced by Aronson and Tavel, Van de 

 Velde, Meyer, Ruppel, Menzer and Moser for use in puerperal sepsis, 

 scarlatina, erysipelas and acute articular rheumatism. In puerperal 

 infection a fresh polyvalent anti-streptococcus serum should be given 

 daily in intravenous doses of 30. c.c. until marked improvement occurs. 

 These cases are usually slow in improvement, but the results so far 

 obtained seem to be encouraging. It is, however, of the greatest im- 

 portance to introduce serum treatment at the earliest possible moment. 

 In scarlatina Escherich found that if the serum be used on the first and 

 second days of illness recovery of the majority of cases is likely to 

 occur. Axenow, in fact, believes that it is the only means to ward off 

 a fatal outcome. In erysipelas and acute articular rheumatism the 

 results have been at variance. Park states that the injections should 

 be made before the infection has become advanced and before the 

 streptococci have acquired an increased resistance to the serum anti- 

 bodies and ferments. The repeated local bathing of exposed infected 

 tissues with the serum seems to have a beneficial result beyond that 

 exercised by a non-specific serum. The action of anti-streptococcal sera 

 is largely due to its opsonic powers. The hope for effective serum 

 therapy in streptococcus infection is at present based on the new 

 methods of serologic classification of the organism and further labora- 

 tory and clinical study is highly desired. 



Anti-meningococcus Serum. In 1906 Jochmann for the first time 

 treated cerebrospinal fever with serum of horses immunized to several 

 strains of meningococci. This serum was highly agglutinative, some- 

 what bactericidal, but not antitoxic. The death rate among the treated 

 cases was 27 per cent, as compared to 53 per cent, among the non-treated 

 cases. In the earlier work Jochmann administered the serum subcu- 

 taneously but later advised its use by the intraspinal method. Almost 

 simultaneously Flexner and Jobling carried out extensive work on 

 monkeys. They demonstrated that the most beneficial effect of the 



