20 PROTEIN THERAPY 



treatment of influenza. Rabbit plasma is mixed with human serum 

 and injections of this mixture are given intravenously. 



Blister Serum, an infrequently used method, consists in producing a 

 local vesicle in some area of the skin, withdrawing the fluid transudate 

 and reinjecting the same. It possesses no properties of unusual ac- 

 tivity. 



Pleural Transudates and Exudates (also termed autoserotherapy). 



Gilbert at the Medical Congress at Rome in 1894 reported that 

 he had successfully treated pleuritic effusions by withdrawing a limited 

 amount of fluid from the chest and reinjecting the same under the 

 skin of the patient. The resorption of the pleural exudate was said 

 to be greatly hastened. A long list of clinicians soon published re- 

 ports with the method, most of them with favorable results Fedde, 

 Gerouzi, Tchigaoff, Nassetti, Marcon, Durand, Schniitgen, Duncan, 

 Modinos, Indelli, Fiori, Landmann, Linser, Spiethoff, St. Mello a 

 summary of the work having been collected in a review by Fish- 

 berg. 



The technique is very simple; 5 to 10 c.c. of fluid are withdrawn 

 from the chest on alternate days or at longer intervals and reinjected 

 subcutaneously without withdrawing the needle to the surface of the 

 skin. In some instances a very slight temperature rise has been noted 

 to follow the injections; in most cases, however, no reaction follows. 

 Zimmermann studied the mechanism involved and observed that a 

 leukocytosis followed the injection. He was of the opinion that the 

 reaction was due to autolytic products of tissue degeneration that were 

 contained in the pleural fluid and made the observation that when he 

 injected such products of tissue destruction peptones in animals, a 

 leukocytosis resulted. Eisner also observed this leukocytosis. 



Lyter has recently gone over the subject and has come to the conclusion 

 that the injections of pleural fluid have little or no influence in hastening 

 the absorption of the exudate. In 23 cases carefully followed, treated by 

 withdrawing 5 c.c. of fluid daily and reinjecting the same, 8 were com- 

 pletely reabsorbed in two weeks' time 34%, while in the balance the 

 effusion did not lessen as a result of the treatment. Lyter observed prac- 

 tically no leukocytosis and in only two of the 8 rapidly resorbing cases 

 did he observe any temperature reaction at alL 



It seems probable that the method is at best a very mild stimulant 

 of resorption because the nonspecific response is practically negligible 

 as far as the effect on temperature and leukocytosis is concerned. 

 Perkins has recently modified the procedure somewhat in that he 

 draws a larger amount of fluid from several patients, pools the samples 

 and adds the same to citrated saline solution. To this a 5% solution 

 of carbolic acid is added (to 10% of the total volume). Of this mix- 

 ture he begins injections of from 1 to 2 c.c. subcutaneously, gradually 

 increasing the dose until he gives from 10 to 25 c.c. 



