THE SERUM TREATMENT OF STREPTOCOCCUS INFECTIONS 813 



producing lobar pneumonia vary in different years, and the curative 

 effect of the sera has not generally been found as promising as the earlier 

 results indicated. 



Aside from this decided influence upon mortality, the general effects 

 of the serum were good. In 10 cases pneumococci were isolated from 

 the blood before the treatment was begun. In all these patients the 

 blood had become sterile after the first treatment. Following the in- 

 jection of serum all the patients seemed to feel better, and in a number 

 of them there was an apparent lessening in the degree of intoxication. 

 While in no case was one injection sufficient to bring about a crisis, in 

 all except the fatal cases the serum had apparently an ultimate favorable 

 effect, lowering the temperature and shortening the course of the disease. 



THE SERUM TREATMENT OF STREPTOCOCCUS INFECTIONS 

 The acute character of streptococcus infections and their relative 

 frequency and severity have made them the subject of numerous efforts 

 on the part of various investigators toward developing an efficient serum 

 therapy. To Marmorek belongs the credit of first attempting, in 1895, 

 to prepare a curative serum on a large scale. Since then Aronson, 

 Tavel, Krumbein, Moser, Meyer-Ruppel, Menzer, and others have pre- 

 pared immune serums with various cultures and according to various 

 methods. While many antistreptococcus serums will show undoubted 

 protective value, especially against their homologous cultures as tested 

 in experimental animals, the general opinion regarding their curative 

 value in streptococcus infections of man have been conflicting and as a 

 rule unfavorable. Occasionally the rapid improvement of a patient 

 following an injection of the serum would indicate that it has proved 

 beneficial, and the same is occasionally true of a particular group of 

 infections treated with a specially prepared serum. The tendency of 

 acute streptococcus infections to end spontaneously by crisis must, 

 however, be borne in mind, and the good result observed in individual 

 cases may be coincident with, rather than the result of, the administra- 

 tion of the serum. 



Several causes for the failure of antistreptococcus serum therapy 

 are now understood, and if these can be eliminated, the value of this 

 form of therapy will be greatly augmented. 



1. The serum should be given in large doses, and by intramuscular and 

 intravenous injection. In a true streptococcic infection the cocci are 

 likely at some time to be found in the blood-stream, and an attempt to 

 destroy these organisms or to limit a local infection by injecting 10 c.c. 



