346 BACTERIA PATHOGEXIC TO MAX 



dose of a very virulent streptococcus. The dose is usually a thousand 

 times the average fatal amount of a very virulent streptococcus. 



This method gives, as a rule, to those unfamiliar with bacteriology, 

 an exaggerated idea of the potency of the serum. 



A thousand times the amount of a very virulent streptococcus cul- 

 ture required to kill an animal by producing septicaemia is more easily 

 controlled than four times a fatal dose of a slightly virulent strepto- 

 coccus. The serum acts upon a certain quantity of organisms, while 

 it is only their enormous multiplication in the animal which kills. 



It is entirely different in case of an antitoxin which does not prevent 

 primarily the growth of the germ, but neutralizes a chemical substance 

 its toxin. 



Therapeutic Results. To estimate the exact present and future value 

 of antistreptococcus serum is a matter of the utmost difficulty. Many 

 of the cases reported are of little or no help, because no cultures 

 having been made, we are in doubt as to the nature of the bacterial 

 infection. 



Marmorek's results are by far the best reported, but without casting 

 any doubt upon the justification of his conclusions, from the data at 

 his command, I believe they undoubtedly give too favorable a view of 

 the value of the serum. 



In the few cases of puerperal fever, erysipelas, wound infection, 

 scarlet fever, and bronchopneumonia that we have seen, the apparent 

 results under the treatment have not been uniform. Only occasionally 

 have we seen results which appeared to be distinctly due to the serum. 



In a number of cases of septicaemia where for days chills had 

 occurred daily they ceased absolutely or lessened under daily doses of 

 20 to 50 c.c. The temperature, though ceasing to rise to such heights, 

 did not average more than one or two degrees lower than before the 

 injections. In some cases the serum treatment was kept up for four 

 weeks. Some cases convalesced; others after a week or more grew 

 worse and died. In some cases the temperature fell immediately upon 

 giving the first injection of serum, and after subsequent injections re- 

 mained normal, and the cases seemed greatly benefited. As a rule, in 

 these cases no streptococci or any other organisms were obtained from 

 the blood. In bronchopneumonia, laryngeal diphtheria, scarlet fever, 

 smallpox, and phthisis, we have seen absolutely no effect. In the 

 exanthemata our injections were much smaller than those used in 

 Vienna, in which city very striking results are reported from 100 c.c. 

 doses. 



The results obtained here in New York by both physicians and sur- 

 geons have not, on the whole, been very encouraging. 



In some of the cases where apparently favorable results were obtained 

 other bacteria than streptococci were found to be the cause of the dis- 

 ease. We believe that the following conclusions will be found fairly 

 accurate : 



A single antistreptococcic serum protects healthy rabbits from infec- 

 tion from most of the streptococci obtained from human sepsis, but 



