638 The Philippine Journal of Science 1921 
hours following injection. Where there has been collapse the 
pulse becomes fuller and stronger a few hours after the injection. 
There is marked abatement of the subjective symptoms on 
succeeding days. In my experience it seems that the combina- 
tion of intramuscular injection and serum enema in acute cases 
is advisable because we combat the disease from two sides; 
namely, by direct neutralization of toxin in the blood, and by 
July. 
ZZ 23 24 25 26 27 28 23 30 3 / 
Fig. 5. Showing the effect of serum administered intramuscularly and per rectum 
(enema). Patient F. D. 
direct action of the serum on the bacteria and their poisonous 
products in the large intestines (see figs. 4 and 5). 
The action of the serum introduced intravenously is similar 
to that of the intramuscular injection except that the effects 
are more rapid. The special indication of this method is in 
very severe cases, where injection is followed by marked allevia- 
tion of the subjective symptoms; the pulse becomes fuller and 
stronger a few hours after the injection; restlessness diminishes 
and the general appearance becomes brighter in the next 
twenty-four hours. Marked improvement of the objective symp- 
