THE SERUM TREATMENT OF TUBERCULOSIS 771 



THE SERUM TREATMENT OF TUBERCULOSIS 



While numerous efforts have been made to prepare an efficient anti- 

 tuberculosis serum, only two those of Maragliano and Marmorek 

 have been studied and are familiar. 



Maragliano's serum is prepared by immunizing horses for from four 

 to six months with a mixture of a toxin prepared by the nitration of cul- 

 tures only a few days old and concentrated in vacuo at a temperature of 

 30 C., mixed with that obtained by aqueous extraction of killed virulent 

 cultures and concentrated by heating on a water-bath at 100 C. for 

 three or four days. Maragliano assumes that the antiserum possesses 

 antitoxic, bactericidal, and agglutinating properties. One cubic centi- 

 meter of this serum is injected every other day for one and a half months. 

 The favorable action of the serum is reported on, especially by Mircoli 

 and other Italian physicians, but in Germany and France proof of its 

 value could not be established. 



Marmorek's serum is now prepared by immunization of horses with 

 young tubercle bacilli, whose acid-fast character is still very slight or en- 

 tirely absent. When the horses have attained a high degree of immun- 

 ity, they receive injections of various strains of pure cultures of strep- 

 tococci obtained from the sputum of tuberculous patients. The serum 

 of these animals is, therefore, antituberculous and also antistreptococcic, 

 and is serviceable against a mixed infection. 



The serum is administered daily, either by subcutaneous injection, 

 in doses of from 5 to 10 c.c., or by the rectum in doses of from 10 to 20 

 c.c. The latter form of administration is quite objectionable to most 

 patients, but is the one least likely to produce serum sickness. 



While this serum has been used quite extensively, the evidence at 

 present is too conflicting to permit definite conclusions to be drawn as to 

 its value in treatment. It would, however, seem to be worthy of further 

 trial in cases of localized bone and joint tuberculosis and in the incipient 

 stage of pulmonary tuberculosis. Citron recommends its use in patients 

 who evince persistent rise of temperature, and in the very severe but 

 not hopeless cases where tuberculin therapy cannot be undertaken. In 

 some of these cases he has obtained very encouraging results. Citron 

 occasionally begins with the serum treatment, and later combines tuber- 

 culin administration with it, finally omitting the serum altogether. 



