THE SERUM TREATMENT OF STREPTOCOCCUS INFECTIONS 761 



of serum in the subcutaneous tissues is almost sure to result in failure. 

 As in the serum treatment of pneumonia, at least 100 c.c. of serum 

 should be given intravenously and the dose repeated if necessary. 



2. The serum should be used as early in the disease as possible, 

 instead of waiting until the patient has become moribund. In puerperal 

 sepsis and scarlet fever, for instance, the question of serum therapy 

 should be considered early, for when properly administered, the serum 

 will at least do no harm and may prove efficacious. In order to determine 

 the value of the serum a bacteriologic diagnosis should always be at- 

 tempted, especially by means of blood cultures obtained by placing from 

 2 to 5 c.c. of blood in a flask containing at least 100 c.c. of dextrose broth 

 just prior to injecting the serum. 



3. The serum should be polyvalent. Marmorek maintains that all 

 streptococci are alike, and he has, accordingly, prepared his serum from 

 a single highly virulent strain. Other investigators question this asser- 

 tion, and at present the consensus of opinion is agreed that streptococci 

 from different infections, such as puerperal sepsis, scarlet fever, ulcer- 

 ative endocarditis, and erysipelas, exhibit certain immunologic differ- 

 ences, even though their biologic and morphologic characters are quite 

 similar. Thus far no adequate methods for differentiating between 

 these organisms have been discovered, but it is likely that future re- 

 searches will show that streptococci from different infections, and even 

 from cases of scarlet fever, possess different immunologic characters 

 similar to the variations observed among the pneumococci causing lobar 

 pneumonia. If this is found to be true, under these conditions, a sim- 

 ilar serum treatment, while complicated, is likely to prove valuable in 

 the treatment of streptococcus infection. For the treatment of strep- 

 tococcus infection in scarlet fever the serum should be prepared of nu- 

 merous strains isolated from patients having this disease. What has just 

 been said is also true of the other three infections so frequently strepto- 

 coccal, namely, puerperal sepsis, phlegmonous cellulitis, and ulcerative 

 endocarditis. If not these four, at least two antistreptococcus serums 

 should be available: one for scarlet fever and the other for other infec- 

 tions; both, and especially the latter, should be prepared by immuniz- 

 ing horses with a large number of various strains. 



Mode of Action of Antistreptococcus Serum. Virulent strepto- 

 cocci exert a powerful negative chemotactic influence upon leukocytes, 

 repelling them and effectively resisting phagocytosis for varying periods 

 of time. The early researches of Bordet showed that antistreptococcus 

 serum neutralizes this influence and promotes phagocytosis. Since 



