Tlhis difficult topic may fittingly be introduced by a brief consideration of the role of antitoxic immunity in various infections other than staphylococcal. In diphtheria and tetanus the presence of antitoxin in sufficient quantity at the right time in the circulating blood is synonymous with immunity. In scarlet fever also-fortunately now a rare infection-antitoxin is of value in preventing the rash due to streptococcal toxin, and in causing it to disappear rapidly if it is already present at the time of administration. However, in other streptococcal diseases, in the era before effective chemotherapy was introduced, antitoxic serum was tried as soon as it was realized that the erythrogenic toxins of the haemolytic streptococci were for practical purposes identical (Okell and Parish, 1928;Okell, 1932); the small number of qualitative variations to which attention was subsequently directed has not invalidated the main thesis.Results in treatment were conflicting at first because they rested on clinical impressions and not on any more certain means of scientific assessment. In retrospect, streptococcus antitoxin was certainly useful in a few cases of sepsis with a scarlatiniform rash, but in the ordinary run of puerperal infection, erysipelas, and general septicaemia the final verdict was that it was valueless-and that in spite of the laboratory evidence that antitoxic serum delayed the death of rabbits injected intravenously with large doses of living haemolytic streptococci from these conditions. As there was apparently no protection against virulent strains of streptococcus, the neutralization of the specific erythrogenic toxin was not a complete answer to the problem of streptococcal invasion.

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