From a study of three hundred and sixty-five cases
of Simple Scarlet fever, treated by intramuscular injection of 10 com. of concentrated Scarlet fever
streptococcus antitoxic serum, the following are the
conclusions:-1 . The administration of antitoxic serum within the
first three days of disease produces a very
favourable effect upon the specific toxaemia of
the disease as manifested by:-
(a) A more rapid return to normal of temperature
and pulse curves,
(b) Marked diminution of nervous symptoms.
(c) Definite blanching of the rash which, in 60%
of the cases treated, entirely disappeared
within 24 hours.2. For cases of simple Scarlet fever of average
severity an efficient therapeutic dose should
contain enough antitoxin to neutralise 500,000
akin test doses of a standard Scarlet fever toxin,
i.e. 5,000 units of antitoxin.3. This should be regarded as the minimum therapeutic
dose which ought to be increased according to the
severity of the case.4. The methods at present in use of standardising
such a serum present considerable difficulties.5. The full therapeutic dose should be given at the
earliest possible moment. When thus given the
results are, in most cases, strikingly favourable.6. The use of a reliable concentrated serum produces
fewer and less severe reactions than an unconcentrated preparation.7 . When given within the first three days of disease
it cuts short the course of the disease, lessens
the incidence and reduces the severity of complications.8. The administration of serum even on the first day
of disease is not an absolute safeguard against
the development of complications of the septic
type.10. Until more definite data are available it does
not seem advisable to further reduce the usual
quarantine period of Scarlet fever patients
treated with specific antitoxic serum, but the
total period of hospitalisation of such patients
is reduced owing to the serum therapy reducing
the incidence and severity of complications.11. Antitoxin treatment of Scarlet fever does not
appear to increase the incidence of relapses
beyond normal limits.12. A further period of study is required to determine
what influence serum therapy has upon the prevalence of second attacks of the disease.13. The case mortality from Simple Scarlet fever is
so low at present that it renders it difficult
to determine the effects of serum therapy in
further reducing this figure.14. In cases of septic Scarlet fever the specific
antitoxic serum only indirectly benefits the
initial septic complications by curing the
toxaemia.15. There is reason to believe that the treatment of
Septic Scarlet fever by a combination of specific
antitoxic serum and polyvalent antistreptococcal
serum cuts short the course of the disease and
lessens the liability to the development of
subsequent septic complications.16. Specific antitoxic serum, if given early and in
large doses, is an extremely efficacious treatment for cases of Toxic Scarlet fever.17. The intravenous method of administration is more
advantageous to toxic cases than the intramuscular route as it ensures a more rapid maximum
concentration of antitoxin in the patient’s
circulation.9. The therapeutic efficacy of the serum diminishes
with each day of delay in its administration and
beyond the third day of disease it appears to
have little or no effect in influencing the
incidence of subsequent complications
