822 PASSIVE IMMUNIZATION SERUM THERAPY 



of his serum produces leukocytosis and raises the opsonic index of the 

 patient's serum. He emphasizes the fact that the serum should be given 

 early, before the seventh day, and reports that, by its use, the mor- 

 tality has been reduced from 17 per cent, to 4.3 per cent. These results 

 have not been generally confirmed, and the subject is still sub judice. 



THE SERUM TREATMENT OF PLAGUE 



Of the various antipest serums that have been prepared, that of 

 Yersin is probably best known. This serum, it would appear, possesses 

 some prophylactic and therapeutic value. For purposes of prophylaxis 

 from 10 to 20 c.c. of serum may be injected subcutaneously or intra- 

 venously; the period of protection is short, averaging from ten to four- 

 teen days. Combined active and passive immunization, effected by means 

 of injections of a pest vaccine and an antipest serum, will probably exert a 

 protective action of several months' duration, and should be used by physi- 

 cians, nurses, and others during epidemics of plague. When used for 

 therapeutic purposes, the results have been quite variable. If serum is 

 used in the treatment of plague, it should be given as early as possible, 

 in the form of intravenous or intramuscular injections of from 50 to 150 

 c.c., if this amount 'is available. Injections should be continued at 

 twelve- to twenty-four-hour intervals for two or more days until sup- 

 puration has been controlled and the disease shows signs of abating. 

 The Plague Commission of India 1 has not issued very favorable reports 

 upon the use of either this serum or that of Lustig. 



Chosksy, 2 who has had the most extensive experience with the serum 

 treatment of plague, emphasizes the necessity of treating the patient 

 on the first day. He advises giving 100 c.c. of serum, followed by a second 

 and third dose at intervals of six to eight hours. This treatment usually 

 cut short the attack if the case were not pneumonic, malignant, or septi- 

 cemic. Of 400 cases treated with serum the mortality was 63.5 per cent., 

 while in 200 controls the mortality was 74 per cent. The mortality among 

 cases treated with serum on the first day was 30 per cent. ; on the second 

 day, 52 per cent., with a gradual increase in the mortality until on the 

 seventh day the mortality was 100 per cent. Burnett 3 has reported a 

 mortality of 29.7 per cent, among cases treated with serum as against 

 a mortality of 73.9 per cent, treated without serum. In the treatment 

 of pneumonic plague the serum has given no favorable results. 



r Tj 1 Brit j, sh Commission. Seventh Report on Plague Investigation in India, Jour. 

 of Hyg., Supplement II, 1913, 326. 



2 Brit. Med. Jour., 1908, i, 1282. 



3 Report on Plague in Queensland, 1900-07, Brisbane, 1907. 



