826 PASSIVE IMMUNIZATION SERUM THERAPY 



in cases treated with normal and with convalescent serum; Koch also 

 suggests that the convalescent serum be reserved for the gravest cases, 

 and that otherwise normal human serum be used. Zingher has used 

 intramuscular injections of whole citrated blood, administering from 

 2 to 8 ounces in a series of injections at close intervals. Normal human 

 blood was also found of value in the treatment of a group of later septic 

 cases, seen from the fifth to the eighth day of the disease. It is apparent 

 that these methods of treatment are worthy of further trial, and particu- 

 larly in the treatment of severe or anginose cases of scarlet fever. 



The technic is very simple and the method of treatment particularly 

 applicable in hospitals for the treatment of scarlet fever. Donors are 

 selected after the second week of the disease, and preferably from among 

 adolescents or adults who show no evidences of tuberculosis. From each 

 person 30 to 100 c.c. of blood may be obtained under aseptic precautions 

 and the serum carefully separated, submitted to the Wassermann test, 

 cultured for sterility, and preserved with 0.2 per cent, tricresol in sterile 

 containers in a refrigerator. In young children an intravenous injection 

 may not be possible unless one of the larger veins, as the external jugular 

 or longitudinal sinus, is selected. It is advisable to inject the serum as 

 early in the disease as possible in large doses (20 to 50 c.c. for a child 

 seven years of age) and, preferably, by intravenous injection. The in- 

 jections appear to be harmless and no special precautions as to the 

 presence of hemagglutinins or hemolysins appear necessary. Otherwise 

 the serum may be injected intramuscularly in the gluteal region, and in 

 the absence of specific convalescent serum normal human serum collected 

 in the same manner may be injected. As a general rule three or four in- 

 jections are required at intervals of six to twelve hours to influence the 

 disease, and particularly the severe infections. 



In using whole blood the method employed by Zingher is very satis- 

 factory. Two c.c. of a sterile 10 per cent, solution of sodium citrate in 

 normal salt solution is placed in a sterile 100-c.c. bottle; 2 ounces of 

 blood are collected, added, and briefly shaken; the blood is now ready 

 for intramuscular injection. Wassermann reactions should be made 

 beforehand on all possible donors so that the proper persons may be 

 selected. In private practice the physician may take the blood from 

 either one of the parents or close relatives. 



Acute Anterior Poliomyelitis. During the epidemic of acute anterior 

 poliomyelitis in 1916 interest was renewed in the treatment of the disease 

 with intraspinal and intravenous injections of serum from recovered 

 and normal persons. 



