SERUM TREATMENT OF LOBAR PNEUMONIA 603 



of the Rockefeller Institute for Medical Research. Following the 

 favorable report in 1913 by Cole and Dochez 267 on the treatment 

 of Type I pneumococcus pneumonia, equally favorable reports 

 from this source have from time to time been presented on an in- 

 creasingly large number of cases. By 1929, Cole's 265 treated series 

 numbered 371 with a case fatality rate of only 10.5 per cent. In 

 addition to the low death rate in the treated group, such impor- 

 tant supporting evidence as the cessation of spread, rapid appear- 

 ance of protective antibodies in the blood, and the prevention or 

 disappearance of blood invasion in consequence of specific therapy 

 has been presented. In spite of these brilliant therapeutic results, 

 the advantage of specific treatment was not generally recognized 

 for some time. This was because the expected fatality rate in a 

 large series of cases treated without serum had not been deter- 

 mined. The average fatality rate from a small early series of un- 

 treated Type I pneumonias was estimated at 25 to 30 per cent, 

 and, convinced of the effectiveness of antiserum, Cole did not feel 

 justified in withholding the treatment in a control series. 



These fatality rates of cases treated with and without specific 

 therapy have since been confirmed, but only after a long period of 

 uncertainty on the part of the general medical profession. Unfor- 

 tunately others had less striking success than Cole, and Locke's 820 

 report in 1923 of a death rate of 17.2 per cent in 145 serum 

 treated cases (only 12 of which were treated in the first three 

 days) and practically the same death rate, 16.9 per cent, in 71 un- 

 treated cases raised serious doubts in the minds of many regarding 

 the merit of the procedure. These doubts were resolved by further 

 determination of the comparative results with and without anti- 

 serum in contemporaneous series and an analysis of the treated 

 group according to the time when specific treatment was begun. 

 Among others, Lord; Cecil and Sutliff; Park, Bullowa and Rosen- 

 bluth ; Finland ; Cecil and Plummer ; and Sutliff and Finland 

 showed that successful specific treatment depends largely on its 

 application early in the course of the disease. 



For several hours after the administration of the initial doses 



