THE SERUM TREATMENT OF STREPTOCOCCUS INFECTIONS 817 



facturers use different cultures in the preparation of these serums, it 

 would be well to use a different brand of serum if the first does not exert 

 a beneficial effect. In patients with sever^ infections the activity of the 

 serum may be enhanced by adding, just tiefore injection, 5 c.c. of fresh 

 sterile guinea-pig serum to each 50 c.c. of the immune serum. 



In the treatment of localized streptococcus infections, such as men- 

 ingitis and sinusitis, it may be well to mix antistreptococcus serum with 

 sodium oleate and boric acid, as previously described. 



Value of Antistreptococcus Serum. Although the serum has been 

 in use for almost twenty years, the true exact value of the remedy has 

 not as yet been estimated. It may be stated that a carefully prepared 

 and properly administered serum will do no harm and may do good, and 

 that its use should form a part of the treatment of severe streptococcal 

 infections. 



In some cases of wound infections with severe cellulitis and septicemia 

 the serum may at times exert a most pronounced and happy effect. In 

 other cases, and especially in those in whom the cocci are found in the 

 blood, repeated injections may be of no value. 



In severe anginose or malignant scarlet fever large doses of serum 

 from horses especially immunized with strains of streptococci from 

 scarlet-fever patients have, on the whole, yielded favorable results. 

 Not all cases of severe scarlet fever, however, are due to secondary 

 streptococcal infections : those patients who are overwhelmed and pros- 

 trated at the very outset are probably intoxicated with the true scar- 

 latinal virus, whatever that may be, and such cases are not likely to be 

 benefited by serum treatment. The patients most likely to improve 

 under serum therapy are those who become severely ill after the onset 

 of the disease and the appearance of the eruption. 



In puerperal sepsis and endocarditis of streptococcal origin the results 

 of serum treatment have not been uniform, but are generally unfavorable. 

 If serum is administered at all, it should be given early, in large doses, 

 and intravenously. Not all cases of puerperal sepsis are streptococcic, 

 and while the physician may not be justified in withholding serum until 

 a bacteriologic diagnosis has been made, this factor must be considered 

 when estimating the value of a serum. 



In erysipelas the results of serum treatment have been very indiffer- 

 ent, but may at times prove beneficial in severe cases when administered 

 in large doses, and the same may be said of bronchopneumonia, laryngeal 

 diphtheria, small-pox, and tuberculosis. 

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