SERUM TREATMENT OF LOBAR PNEUMONIA 601 



by the filtering action of the viscera. Antibody, by combining with 

 somatic or capsular substance of homologous pneumococci, inhib- 

 its some of the vital activities of the cells and renders them more 

 susceptible to ingestion by leucocytes. The completeness of the 

 phagocytosis and the ability of the body to dispose of any remain- 

 ing free cocci determine whether recovery or death is to take place. 



There are other unexplained aspects of serum action. Serum 

 may bear components antagonistic to its own antibodies, creating 

 a restricted zone of effective action. The phenomenon is involved 

 in the question of the optimal dosage of serum — a question influ- 

 enced by the potency of the particular lot of serum at hand and 

 the type and severity of the infection to be treated. Underlying 

 these specific immunological considerations is the non-specific fac- 

 tor represented by the physical ability of the patient to cope with 

 the invading pneumococci. Debilitation from any cause detracts 

 from the active properties of the serum, but the matter is one 

 largely of clinical interest. There are conceivably as yet unknown 

 qualities of human blood or human tissue cells as well as of pneu- 

 mococci which may either augment or decrease the curative action 

 of specific immune serum. 



The conditions stipulated by Neufeld and Haendel 992 " 8 in 1912 

 for the successful use of antipneumococcic serum have been subject 

 to only slight modification in the intervening years. Based on the 

 German authors' recommendations, the following main directions 

 should guide the physician if serum is to be administered to great- 

 est advantage: 



1. The serological type of Pneumococcus infecting the patient 

 should be determined with minimal delay, and the serum should corre- 

 spond immunologically to the infecting organism. 



2. The serum should be of known high potency and injected intra- 

 venously at the earliest possible moment after diagnosis is established. 

 It is during the incipiency of the disease before pneumonic consolida- 

 tion is advanced and before invasion of the vascular system is massive 

 that the Schwellenwert of the serum is theoretically at its highest. Se- 



