

SERUM THERAPEUTICS 269 





The serum is inoculated in doses of 10-40 c.c., either in one dose or at 

 different times according to the severity of the disease : the technique of 

 administration need not be dealt with here. 



The serum has been used as a prophylactic during epidemics of diphtheria ; 

 the immunity so produced is only of short duration and varies from 3-6 weeks. 

 The dose to be used as a prophylactic should be 5-10 c.c. (Roux). 



6. Agglutination. 



Antitoxic serum obtained by the inoculation of toxin possesses, as has been 

 pointed out, no agglutinating properties and contains no immune body 

 (substance sensibilisa trice). By the inoculation of the bacilli themselves a 

 serum containing both agglutinins and immune body can be obtained . Wasser- 

 mann, Bandi, Martin, thought that such a serum might be of use in clinical 

 practice to facilitate the disappearance of diphtheria bacilli from the pharynx 

 of those cases in which it remained an unduly long time even after the use of 

 antitoxin. 



(i) Wassermann inoculated into the veins of a rabbit an extract of bacilli 

 to which antitoxin had been added to neutralize the toxin. After several 

 inoculations the serum of the rabbit precipitated the bacillary extract and 

 agglutinated the diphtheria bacillus. 



It would not appear to be true, as Wassermann thought, that this serum can be 

 used to differentiate the pseudo- diphtheria from the diphtheria bacillus. As Lip- 

 stein points out, a serum obtained by the inoculation of a given strain of bacilli may 

 agglutinate that strain in high dilution, while having no effect whatever on other 

 strains. 



(ii) Lipstein obtained a serum which agglutinated the diphtheria bacillus 

 in a dilution of 1 in 1,000 by inoculating into the peritoneal cavity of a rabbit 

 first a mixture of dead bacilli and antitoxin and later a mixture of living 

 bacilli and antitoxin. This serum has no prophylactic properties. 



(iii) Bandi inoculated a dog sub-cutaneously several times during the 

 course of a month with sensitized diphtheria bacilli bacilli, that is, which had 

 been treated with antitoxin and had then been washed and centrifuged to 

 remove any excess of serum. This observer obtained a serum which besides 

 possessing agglutinating and sensitizing properties was also feebly antitoxic 

 (15 units per c.c.). He had good results in seven cases of diphtheria which 

 he treated with the serum. 



(iv) Martin also prepared a serum which exhibited agglutinating, sensitizing 

 and immunizing properties. The serum was obtained from a horse by 

 inoculating it sub-cutaneously, intra-peritoneally, or better into the veins 

 with bacilli which had been heated to 100 C. for an hour. Martin treated 

 a number of cases of diphtheria locally with this serum. Repeated applica- 

 tion to the false membranes gave very little result some diminution of pain 

 but by making it into pastilles with gum and so ensuring a more prolonged 

 contact with the membrane the results were more satisfactory. Under these 

 conditions the false membranes swelled up, became softened and were soon 

 detached. Cultures showed a rapid and marked diminution in the number 

 of bacilli. 



SECTION IV. DETECTION, ISOLATION, AND IDENTIFICATION OF 

 THE DIPHTHERIA BACILLUS. 



The diagnosis of diphtheria is often impossible by clinical methods alone ; 

 hence in practice the nature of the infecting agent in all cases of croup and 



