500 Chapter XV 



opinion was due in great measure to the vaccinations carried out in 

 the wards of Heubner's Clinic at Berlin ^ At first, injection of the 

 antidiphtheria serum as a protective into patients who were found 

 in the immediate vicinity of the children attacked with diphtheria 

 (contacts) was deemed to be sufficient : but in consequence of the 

 results obtained by this method it was decided (starting from January, 

 1896) to inject all children who came into the hospital. During the 

 first period there still occurred a few cases of diphtheria contracted 

 in hospital, but from the moment systematic and general vaccinations 

 were introduced not a single new case occurred. 



The immune condition of the vaccinated children is maintained 

 for three to four weeks. After this lapse of time some of them 

 contracted diphtheria. But it was sufficient to introduce revacci- 

 nation at the end of this period to prevent the outbreak of any 

 further case of diphtheria in Heubner's wards. Results quite as 

 favourable and as convincing were obtained in the department for 

 children attacked by scarlet fever. 



The amount of serum injected varied, but it was usually given in 

 doses of Ic.c. containing from 200 to 250 i.e. (immunising units of 

 Ehrlich). The serum was always found to be innocuous except in 

 certain cases where it set up erythemata of greater or less extension. 

 In 460 injections 20 cases of these exanthemata were produced, that 

 is to say 4*34 °l^. The frequency of these complications was not pro- 

 portional to the amount of serum injected. According to the figures 

 communicated by Lbhr the largest doses of the serum employed 

 did not produce exanthemata more frequently than did the smaller 

 quantities. Thus 117 injections of 1 c.c. only were followed in ^\e 

 cases by these erythemata, which corresponds to 4*27 per cent. The 

 hope of diminishing the frequency of the exanthemata by diminishing 

 the amount of serum injected was therefore not realised. This 

 fact lends support to the conclusion above formulated as to the 

 exaggeration of the importance of the measurement of serum. If it 

 could be established that small quantities of serum rich in antitoxin 

 caused cutaneous eruptions less frequently than did stronger doses 

 [524] there would certainly be a great advantage in using serums containing 

 a very large number of immunising units for vaccination. Perhaps 

 serums having a great antimicrobial power but of comparatively 

 low antitoxic potency might even render great service in protective 



1 See the report by Lohr in Jahrb.f. Kinderh.^ Leipzig, 1896, Bd. xliii, S. 67. 



