782 SERUM THERAPY 



physician who can make an ordinary exploratory puncture. In all cases 

 where puncture shows the presence of a serous fluid, the needle should 

 not be withdrawn completely, but when its point has reached the sub- 

 cutaneous tissues, from 2 to 5 c.c. should be injected then and there. In 

 some patients it will be necessary to repeat the treatment several times 

 every two or three days before any effect becomes evident. Caf orio 1 

 has reported good results following the tapping of a' bilateral hydrocele 

 and injection of a portion of the fluid into the subcutaneous tissues. It 

 would appear that this procedure may be successful in hydrocele of 

 tuberculous origin, but good results are not to be expected in cases due 

 to contusion, puncture wounds, gonorrheal epididymitis, or orchitis. 



In view of the fact that the fluid may contain a sufficient number of 

 living tubercle bacilli to produce secondary infection, it would appear 

 advisable to withdraw fluid into an equal volume of 2 per cent, sodium 

 citrate in normal salt solution, heat at 60 C. for one-half to one hour, 

 and preserve in a sterile container with the addition of a few drops of 5 

 per cent, phenol until ready for subcutaneous injection in doses of from 

 2 to 5 c.c. 



It would appear, therefore, that reintroduction into the body of 

 fluids obtained from the serous cavities (pleural, peritoneal) of tuber- 

 culous patients may be of value in treatment, and, as a general rule, the 

 earlier in the course of the disease that the autoserum therapy is prac- 

 tised, the better will the results be. A similar treatment may be car- 

 ried out in the subacute or chronic forms of tuberculous meningitis. 

 Fluid is to be collected in sodium citrate solution, heated, and preserved 

 with phenol, as just described. The dose may vary from 0.5 to 2 c.c., 

 according to age and clinical conditions. 



AUTOSERUM IN THE TREATMENT OF NON-TUBERCULOUS EFFUSIONS 

 In pleural and peritoneal effusions of renal, cardiac, or hepatic origin, 

 this method of -autotherapy has generally failed. 



Following the apparent success of Hodenpyl 2 in the treatment of a 

 case of cancer with injections of the patient's ascitic fluid, the autopsy 

 subsequently showing the presence of metastatic cancer not demon- 

 strable during life, Risely 3 treated 65 cases of cancer with ascitic fluids 

 obtained from cancer patients in all stages of the disease, and also with 

 various normal and abnormal body fluids from other than cancerous 

 conditions. None of these various transudates was found to exert any 



* Riform. MeU, 1912, xxviii, 1009. a Med. Rec., 1910, Ixxvii, 359. 



3 Jour. Amer. Med. Assoc., 1911, Ivi, 1383. 



