A REPORT ON THE SERUM TREATMENT OF TWENTY-SIX CASES OF EPIDEMIC POLIOMYELITIS.

1. Serum taken from recently recovered cases of poliomyelitis may be employed in its treatment and probably yields the best results. 2. When sterile for ordinary bacteria, free of corpuscles and hemoglobin, and when injected by the gravity method, observing well known rules of caution, it may be employed without danger. 3. The serum should be injected both intraspinally and intravenously, the latter either directly or by way of the subcutaneous tissues. 4. The earlier in the course of the disease the serum is employed in suitable doses, the more promise there is of benefit. 5. The action of the serum appears to be more precise and definite in arresting paralysis than in rapidly bringing about its retrogression. 6. The decision to employ the serum should rest upon a clinical examination supported by the results of the microscopic and chemical study of the cerebrospinal fluid. 7. The question of multiple and repeated injections of the serum has not yet been worked out. In the cases here reported and especially in the group in which no paralysis existed at the time of the first injection, the pathologic process either did not progress at all, or where there was extension, as in Cases 14 and 15, the upper segment of the spinal cord became rapidly involved, and was followed by respiratory paralysis and death. Probably in cases in which some degree of muscular weakness develops soon after the injection of serum, reinjection 12 to 24 hours later may be advantageous. The temperature curve may serve to indicate the time for reinjection. 8. The favorable results thus far achieved in human beings by means of the immune serum support and extend those obtained experimentally in monkeys and indicate, as was foreseen, that the milder or less fatal form of poliomyelitis appearing in man is even more amenable to the serum treatment than is the highly fatal disease produced by inoculation in monkeys.