SERUM THERAPY 533 



[For the treatment of anthrax in man the initial dose of the serum should 

 be large 40 c.c. and may be repeated if necessary. The serum is generally 

 inoculated sub-cutaneously but in severe cases intra-venously. As with all 

 other therapeutic serums the sooner it is administered after the infection has 

 taken place the better will be the result of the treatment. 



[The immediate results following inoculation of the serum are sometimes 

 rather startling ; the temperature rises often to over 105 F. and the patient 

 becomes very ill, at the same time the local lesion appears to get much worse 

 and the oedema increases. Then follows a period of recovery during which 

 the temperature falls to normal, the size of the inflamed area diminishes and 

 the bacilli disappear from the lesion. 



[The rapid disappearance of bacilli from the lesions is one of the most striking 

 results of serum treatment. In one of the first cases treated in England Andrewes 

 found that no bacilli could be cultivated from the fluid of the vesicles 19 hours 

 after the administration of 40 c.c. of serum though previously abundant colonies 

 developed on the medium sown with the fluid. 



[" The claims which have been made as to the effect of serum treatment 

 can be summarized by saying that : (1) even in very large doses it is innocu- 

 ous ; (2) it can be well borne even when introduced into the veins ; (3) no 

 case taken in an early stage or of moderate severity is fatal if treated with 

 serum ; (4) with the serum some cases are saved when the condition is most 

 critical and prognosis almost hopeless ; (5) when injected into the veins the 

 serum quickly arrests the extension of the oadematous process so as to reduce 

 notably the danger from suffocation which exists in many of the cases where 

 the pustule is situated on the face or neck ; (6) if used soon enough it reduces 

 to a minimum the destruction of the tissues at the site of the pustule ; (7) in 

 some situations of the pustule, as the eyelid, serum treatment must be used 

 in preference to any other as it alone can hold out hope of success without 

 permanent injury ; and (8) in internal anthrax it is the only treatment which 

 holds out any hope of benefit " (Legge). 



[In 1903 Sclavo tabulated all cases known to have been treated with his 

 serum up till that time in Italy. In all 164 cases were treated with 10 deaths 

 a rate of 6'09 per cent, as against 24'1 per cent, for the whole of Italy.] 



5. Agglutination. 



Cultures of the anthrax bacillus do not lend themselves to the demonstra- 

 tion of the phenomena of agglutination because the bacilli are linked 

 together in chains. To study the phenomenon it is necessary to work with 

 attenuated cultures (and especially Pasteur's No. 1 vaccin) with which fairly 

 homogeneous emulsions can be obtained. These emulsions are agglutinated 

 by the serum of various untreated animals (rat, rabbit, guinea-pig, ox, horse, 

 etc.) in dilutions of 1 in 10 to 1 in 50. Normal human serum agglutinates 

 them powerfully even in dilutions of 1 in 500 in some cases. " Great care 

 should be exercised in the serum diagnosis of anthrax " (Lambotte and 

 Marechal). Sobernheim arrived at a similar conclusion namely that there is 

 no relation between the degree of agglutination reaction and the degree of 

 immunization : sometimes a normal serum will agglutinate as powerfully as 

 a serum obtained from immunized animals. 



SECTION IV. DETECTION, ISOLATION AND IDENTIFICATION OF 

 THE ANTHRAX BACILLUS. 



The anthrax bacillus should be looked for 



I. In fche serous fluid of the malignant pustule in man and in the gelatinous 

 cedema in the lower animals. 



