Colon-Streptococcus Anti-serum. 



245 



sections were done with ten deaths or 12 per cent, mortality. 

 It is a very simple matter to account for the lowering of the mor- 

 tality rate from 40 to 30 per cent. It embraced the training of the 

 staff and the development of an improved surgical technique. 

 The fall from 30 per cent, to 12 per cent, followed immediately 

 upon the introduction of the serum treatment, all other factors 

 remaining as before. Coincident with the 30 per cent, mortality 

 among the insane, the writer's mortality among private cases 

 was 17.7 per cent., showing that psychotic patients are not good 

 surgical risks. They are all physically sick. Their systolic blood 

 pressure is abnormally low, and, as is well known, they often have 

 an abnormally high small lymphocyte count coupled with a very 

 small number of polymorphonuclear cells, the former sometimes 

 exceeding the latter. 



Aside from the extensive pathological lesions in the mucous 

 membrane and the wall of the colon, which were found in the speci- 

 mens removed at operation, it was noted that the mesenteric 

 lymph nodes were very much enlarged. In the very beginning of 

 the woik these lymph nodes were cultured and various strains of 

 streptococci and colon bacilli were isolated. This finding was of 

 the utmost importance as it clearly indicated that these bacteria 

 were passing through the wall of the intestine and were in all 

 probability the cause of the lesion in the intestinal wall. 



When these enlarged nodes were found in the mesentery of the 

 colon alone, resection was clearly indicated. In many cases, 

 however, it was found that the adenitis was not limited to the 

 mesentery of the colon, but extended throughout the whole 

 mesentery of the small intestine. In such cases it was evident 

 that removal of the colon would not correct or eliminate the evident 

 lesion throughout the whole of the small intestinal tract. 



It was necessary, therefore, to devise some other method where- 

 by these infections could be mitigated or eliminated. Autogenous 

 vaccines made from the streptococci and colon bacilli isolated 

 from the lymph nodes, were tried, but without success, probably 

 because of the extent and severity of the infection existing in the 

 intestinal wall, a condition analogous to that found in typhoid 

 fever. As is well known, typhoid vaccine will immunize a patient 

 against typhoid fever, but once the disease is established the 



