842 SERUM THERAPY 



companied by chill, lassitude, and, in the majority of cases, diuresis or, 

 more rarely, diarrhea, followed by gradual absorption of the fluid within 

 the following few days up to two or three weeks. Fishberg mentions the 

 disappearance of pain, dyspnea, and prostration within two or three 

 days in favorable cases. 



It is difficult to state whether the improvement is due to autotherapy 

 or simply to the puncture and removal of so much fluid. Eisner 1 has 

 seen a leukocytosis follow injection of serum in experimental tuberculous 

 infections of rabbits and guinea-pigs, and believes that this explains the 

 good results in this particular form of therapy. Zimmermann 2 has ex- 

 pressed a similar opinion. Other investigators assert their belief in the 

 presence of aggressins, bacteriolytic amboceptors, complements, and 

 endolysins from disintegrated leukocytes as explaining the results. It 

 is more likely that these fluids contain the bacilli or their products, and 

 constitute a form of vaccine or auto-tuberculin, stimulating body-cells 

 to produce antibodies largely in the nature of bacteriotropins and bac- 

 teriolysins. Levy, Valenzi and Ponzin, 3 Szurek, 4 and Arnsperger 5 are 

 inclined to believe that the beneficial results are obtained independently 

 of the injections, and while the procedure is quite generally regarded as 

 perfectly safe, Jousset 6 has recorded a case of cold abscess following an 

 injection. This mode of treatment seems to have failed in about 10 to 

 15 per cent, of cases. 



The technic is very simple, and the injections may be given by any 

 physician who can make an ordinary exploratory puncture. In all cases 

 where puncture shows the presence of a serous fluid, the needle should 

 not be withdrawn completely, but when its point has reached the sub- 

 cutaneous tissues, from 2 to 5 c.c. should be injected then and there. In 

 some patients it will be necessary to repeat the treatment several times 

 every two or three days before any effect becomes evident. Caf orio 7 

 has reported good results following the tapping of a bilateral hydrocele 

 and injection of a portion of the fluid into the subcutaneous tissues. It 

 would appear that this procedure may be successful in hydrocele of 

 tuberculous origin, but good results are not to be expected in cases due 

 to contusion, puncture wounds, gonorrheal epididymitis, or orchitis. 



In view of the fact that the fluid may contain a sufficient number of 

 living tubercle bacilli to produce secondary infection, it would appear 



1 Zeitschr. f. klin. Md., 1912, Ixxvi, 34. 



2 St. Peters, med. Wchnschr., 1909, No. 34, 461. 



3 Bull. et. Mem. de la Soc. d. Hop. d. Paris, 1910, xxvii, 265. 



4 Med. Klinik, 1909, No. 44, 1665. 5 Therap. d. Gegenwart, 1911, lii, 495. 

 6 Arch. Gen. de Med., 1912, xci, 141. ' Riform. Med., 1912, xxviii, 1009. 



