THERAPEUTIC IMMUNIZATION IN MAN 473 



his earliest reports the results of the treatment of 413 cases of ery- 

 sipelas leave one very much in doubt as to the value of the serum since 

 the difference in mortality between the treated and the untreated 

 cases is less than 2 per cent. However, an analysis of the individual 

 cases makes the serum treatment appear more favorable. He re- 

 ported good results also in 7 cases of puerperal septicemia and in 

 scarlatinal angina. Later observers, notably Lenhartz, 50 Baginsky, 51 

 and many others, have not been able to confirm the favorable results 

 reported by Marmorek, and it may be stated that at the present day 

 the value of Marmorek's serum is very much in question. Anti- 

 streptococcus sera have also been produced by Aronson 52 and Tavel, 

 Van de Velde, Menzer, 53 Moser, 54 and some others. Aronson at 

 first worked from the idea which Marmorek also had used that there 

 was a close relationship between the various streptococci pathogenic 

 for man. He adopted the opinion first developed by Denys 55 and 

 Van de Velde that many different strains should be used for im- 

 munization in order to allow for possible difference in the character- 

 istics of the pathogenic streptococci. This principle of the necessity 

 for the production of polyvalent sera was also emphasized strongly by 

 Tavel, who based his opinion on careful agglutination tests, and by 

 Menzer and Moser. 



That the action of the antistreptococcus sera, however produced, 

 is very largely due to its opsonic properties has been shown by 

 Bordet, 56 by Meier and Michaelis, and a number of other workers. 

 If there is any bactericidal power it is probably relatively slight. 



It would be quite impossible to attempt in this place to analyze 

 the large number of streptococcus infections of man which have been 

 treated with one or the other antistreptococcus sera. Those men- 

 tioned, moreover, do not by any means include all the sera which 

 have been produced and marketed for this purpose. In general we 

 may say that here, as well as in the cases of other sera in which no 

 antitoxic action is evident, beneficial results have been obtained 

 chiefly in cases in which the streptococcus infection has been localized 

 and treated early after its inception. In generalized or advanced 

 cases it cannot be said that the results are encouraging. Even in 

 animals, in which experimental conditions can be so much more 

 thoroughly controlled, the protective action of even the strongest 

 sera is evident only if the serum is administered either before in- 



50 Lenhartz. "Die Septischen Erkrankungren Holder," Wien, 1903. 



51 Baginsky. Berl kl Woch., 1896, p. 340. 



52 Aronson. Berl. kl. Woch., Vol. 39, 1902; Deutsche med. Woch., 29, 

 1903. 



53 Menzer. Berl. kl Woch., 1902, and Munch, med. Woch., 1903. 



54 Moser. Wien. kl. Woch., 1902. 



55 Denys. Bull, de VAcad. Beige, 1896, cited from Schwoner K. and 

 L. H., Vol. 2. 



56 Bordet. Ann. de I'Inst. Past., 1897. 



