STREPTOCOCCUS INFECTIONS 251 



some of the symptoms, and notably temperature disturbances lasting 

 for sixteen to twenty-four hours. But in these cases more good 

 may, cceteris paribus, be expected from the use of a vaccine which 

 should, if possible, be autogenous, than from the serum. (Both 

 may, however, be advantageously combined.) 



Results. Upon surveying the literature in reference to the cura- 

 tive value of antistreptococcus serum, one is struck with the fact 

 that while diphtheria antitoxin is generally used as early as possible, 

 the antistreptococcus serum is usually resorted to too late and in 

 insufficient amount. The result is, that from a statistical stand- 

 point the general verdict has been rather unfavorable. This empha- 

 sizes the importance that immunization treatment in hospital work 

 particularly should be placed in the hands of especially trained 

 men, who should be consulted in doubtful cases. My belief is that 

 then and only then immunotherapy will yield its best results. 



As I have already indicated, the most favorable reports have 

 been published in connection with the use of the serum in scarlatina. 

 Escherich, speaking of the effect of the Moser serum, remarks that 

 this is "zauberhaft" (magic), and especially so when used early. Of 

 112 cases which had been injected on the second or third day every 

 one recovered, while among those in whom the treatment had been 

 delayed the mortality ranged between 13 and 50 per cent. 



In erysipelas, very curiously, the least favorable results have 

 been obtained; in the migratory forms, however, the disease usually 

 comes to a standstill in from three to four days. The facial cases, 

 of course, should not be included in an analysis of the results, as 

 they usually do well without serum treatment. In puerperal cases 

 the testimony is most conflicting. Some observers, such as Bumm, 

 Peham, and Burkard, thus speak quite favorably of its use (when 

 employed early), Burkard reporting 50 cases, of which twenty-nine 

 were pure streptococcus infections, without a single death, while 

 others deny having seen any good accomplished whatever. It is 

 in these very cases that I would advocate that the serum treat- 

 ment should be placed in the hands of experts who shall decide how 

 the serum is to be given, when it is to be given, and how much is to 

 be given. That even then there will be unfavorable results also is 

 to be expected, but it would stand to reason that the maximum 

 amount of good that could be accomplished would be obtained under 

 such conditions. 



