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Serum Treatment

fever, scarlet, temperature, injection, obtained and blood

SERUM TREATMENT The excellent results obtained from the use of diphtheria antitoxin have led a number of observers to attempt the production of a similar serum in scarlet fever. Von Leyden made use of a serum secured from the blood of persons convalescent from scarlet fever. However, the difficulty of getting such a serum makes its use impracticable. Further more, the results obtained from its use have been so discouraging as to cast considerable doubt on its efficacy.

The constant finding of streptococci associated with scarlet fever suggested the feasibility of immunizing animals against scarlet fever and to secure from them an antistreptococcus serum.

Marmorek, Tavel, Moser and Aronson have been bending their efforts in this direction. Our experience with Marmorek's serum and horse serum has been entirely negative, but Moser's serum has proven more satisfactory. This is the only scarlet fever serum which has met with any considerable favor. There are few opponents to its use.

In the preparation of this serum, Moser proceeded on the basis that the scarlet fever streptococci are possessed of certain specific prop erties. He immunized horses, using only streptococci obtained in pure culture from the heart's blood of persons dead of scarlet fever. His method differed further from that of Marmorek and Aronson in that he grew the organism in bouillon without passing it through animals, thus preserving any specific characteristics of which the germ may have been possessed.

The scarlet fever serum differs, further, from diphtheria antitoxin in that horses are injected with a bouillon culture and not a filtrate of the germ. Venesection is clone after a month or two; the blood serum is pipetted off and placed in sterile containers—without the addition of phenol.

Disadvantages connected with the use of scarlet fever serum arc: (1) the difficulty with which it is obtained, and (2) large closes must be administered to secure any effect. For that reason, too, serum disease occurs not only more often, but is more intense in its manifestations than that which follows the injection of diphtheria antitoxin.

The use of scarlet fever serum is restricted to the severe unfavorable cases, because of these undesirable properties. We convinced ourselves that Moser's serum has a decided influence on the course of scarlet fever. Two sisters became ill with scarlet fever simultaneously, and in the same degree. One was injected with serum; the other was not.

Emilie St., aged six years, and Rosa St., aged eight (Fig. 62), became ill, had fever and an eruption. The following clay at 10 A.M. they were removed to the hospital. The eruption was typical; lacunar angina; no complications. Two hour temperature record kept.. At 9 P.M., Emilie, 39.9°; Rosa, 39.7°. Emilie received 200 c.c. of Moser's serum. For several hours after the injection, the temperature remained unaffected. At I. A.M., crisis; 7 A.M., temperature, 37.2°. Rosa had the usual morning remission, the temperature being 38.7°, rising again to 40.2°. Emilie's afternoon temperature was 33.1"; 37.5° on the following clay; then grad uallv going to normal. Rosa's temperature curve was typical, reaching 37.5° on the eleventh day.

The toxic symptoms show most markedly the therapeutic action of the serum—sensorium normal; improved pulse; disappearance of cyanosis and chilly sensations: cessation of diarrlftea. Although one would naturally expect the serum to have a bactericidal action, amelio rating the streptocoecie processes, it is in reality antitoxic and therefore is most effective in the pure toxic cases. In order to secure distinctive results from its use, the serum must be injected during the first three days of the disease. After the fifth day the serum loses its effectiveness. The occurrence of complications, especially nephritis, is not prevented.

Only one injection of 200 c.c. of serum is made. The site of injection is the abdominal wall. The puncture wound is sealed with collodion. The injection should be made under the strictest antiseptic precautions.