250 PASSIVE IMMUNIZATION 



tracted sepsis, vaccination (see above) may well be combined with 

 the serum treatment. In fulminating cases, where blood examina- 

 tion reveals the presence of streptococci already within a few hours 

 of the first appearance of symptoms, nothing short of an intravenous 

 injection (50 c.c.) should be tried, and it would seem worth while 

 in just such cases, in fact in all the more severe infections, to inject 

 the serum diluted with normal salt solution, as has been suggested 

 by F. Meyer, or to follow its injection with a subcutaneous infusion 

 of 500 c.c. or more. 



In severe streptococcus anginas the dosage is essentially the same 

 i. e., 50 c.c., given subcutaneously and diluted, if desired, the dose 

 being repeated in accordance with the urgency of the symptoms, 

 and two injections a day given if necessary. 



In erysipelas the use of the serum is advocated especially in cases 

 affecting the head and neck, as also in migratory cases, while the 

 facial type of the disease usually does well with ordinary treatment. 

 The dosage here also ranges between 50 and 100 c.c. according to 

 the gravity of the case. 



In puerperal infections the rule should be to use the serum early 

 or not at all. A great deal of valuable time is here often lost in 

 waiting to ascertain whether the infection will not cure itself. The 

 patient should receive the benefit of the doubt, no matter whether 

 the statistics are thereby unduly turned in favor of the serum or 

 not. Its use is logical and should be resorted to in every case where 

 fever develops during the puerperal period, if this is not manifestly 

 sapremic in character. 50 c.c. given subcutaneously is sufficient 

 in the milder cases, while in the presence of ominous symptoms 

 larger doses should be employed (100 to 200 c.c.), which here, also, 

 may be suitably combined with a subcutaneous infusion of saline 

 (500 to 1000 c.c.). In urgent cases intravenous injections should 

 be made (50 c.c.). After hysterectomy it is recommended to give 

 an intraperitoneal infusion of 500 c.c. of serum with 1000 c.c. of 

 saline, the operation being preceded by an intravenous injection 

 of 100 c.c. In cases which have become chronic the serum treatment 

 should be combined with the use of an autogenous streptococcus 

 vaccine. 



In the chronic infections associated with endocarditis, arthritis, 

 tuberculosis, and carcinoma, etc., much smaller doses are given, viz., 

 5 to 20 c.c., as larger amounts are apt to cause an aggravation of 



