PRODUCERS OF AHSCKSSES, CKLl.l' 1.ITIS AND si-'.rTH'.KM 1 A 347 



not from all. Failure to do good in human infection cannot, as a rule, 

 he attributed to the variety of streptococcus. The serum will in animals 

 limit an infection 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 warranted, we believe, in trying it, but we 

 should not expect very striking results. 



For our own satisfaction, and to increase our knowledge, we should 

 always have satisfactory cultures made when possible, and the strepto- 

 cocci, 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 bac- 

 teria causing the infection. This is often a great hindrance 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 and the full effect only on its own type. 



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 weak, and the testing for strength is still very crude, full 

 doses (10 to 20 c.c.) of serum should be given if the case is at all serious, 

 for the dose is limited only by the amount of horse serum which we 

 feel it safe to give, not because we have sufficient protective substance. 



Bacteriological Diagnosis. 



Streptococci, using the name in a broad sense, can often be demon- 

 strated microscopically by simply making a smear preparation oj 

 the suspected material and staining with methylene-blue solution or 

 diluted Ziehl's fluid. In order to demonstrate them microscopically in 

 the tissues, the sections are best stained by Kiihne's methylene-blue 

 method. In all cases, even when the microscopic examination fails, 

 the cocci may be found by the culture method on plate agar or slanted 

 agar at 37 C. To obtain them from a case of erysipelas it is best 

 to excise a small piece of skin from the margin of the erysipelatous 

 area in which the cocci are most numerous; this is crushed up and part 

 -of it transferred to ascitic or serum bouillon, and part is streaked 

 across freshly solidified agar in a Petri dish on which a drop of sterile 

 rabbit's blood had previously been placed. Both are kept in the incu- 

 bator at 37 C. 



