THE SERUM TREATMENT OF TYPHOID FEVER 821 



1. If the lesion is relatively small and accompanied by but slight 

 glandular involvement, with little or no evidences of toxemia, a blood 

 culture should first be made by placing from 2 to 5 c.c. of blood in a flask 

 of neutral bouillon, followed by an intravenous or intramuscular injection 

 of from 20 to 50 c.c. of serum. The object sought is to introduce serum 

 before the lesion is handled, and the blood culture is the best indication 

 for subsequent injections of serum and serves as a guide to prognosis 



2. The lesion should then be excised, leaving a wide margin so as to 

 include infected lymphatic channels. It should be handled as little as 

 possible. The wound is then dusted lightly with powdered calomel 

 and next heavily powdered with ipecac. Edema soon subsides, and the 

 wound usually heals rapidly, with surprisingly little scar-tissue forma- 

 tion. If the edema does not subside and the infection is spreading at the 

 margins of the wound, more tissue should be excised or multiple local 

 injections with phenol and anti-anthrax serum should be made. 



3. The blood culture may be examined within twenty-four hours. 

 If anthrax bacilli are present, from 100 to 200 c.c. of serum should be 

 given intravenously, the injection being repeated in twenty-four hours. 

 Daily blood cultures should be made, and the serum injections con- 

 tinued until the blood becomes sterile. Salvarsan may also be injected 

 intravenously. In our experience, cases with sterile blood cultures have 

 invariably recovered. 



4. In internal anthrax all the physician can do is to administer large 

 doses of the serum intravenously. Salvarsan may also be tried. (See 

 Chapter on Chemotherapy.) 



. 

 THE SERUM TREATMENT OF TYPHOID FEVER 



The serum of Chantemesse is the only serum that has been used on a 

 large scale in the treatment of typhoid fever in man. 



The serum is derived from horses that have been immunized for 

 several years with bouillon filtrates containing typhoid toxin, chiefly 

 endotoxin, and with typhoid bacilli. Kraus and von Stenitzer, Meyer, 

 Bergell, and Aronson use bouillon filtrates and aqueous bacterial ex- 

 tracts; Besredka injects dead and then living cultures; MacFadyen 

 uses an endotoxin secured by breaking up cultures frozen at very low 

 temperature. It would appear that a serum should be bacteriolytic and 

 endotoxic, and this probably is best secured by prolonged intravenous 

 immunization of horses with a large number of dead cultures and then 

 with autolysates and living cultures conjointly. 



According to Chantemesse, the subcutaneous injection of a few drops 



