604 BIOLOGY OF PNEUMOCOCCUS 



of antiserum, no change in the patient is likely to be observed, but 

 within eight to twenty-four hours after the first dose there is usu- 

 ally a marked improvement. This favorable response is likely to be 

 more pronounced in the case of Type I than in the case of Type II 

 infections and when patients are treated early. The patient be- 

 comes clearer mentally and begins to take an interest in his sur- 

 roundings. Cyanosis and dyspnea may be completely relieved. In a 

 large majority of the cases the temperature drops two or three 

 degrees or more and does not again reach its former level (Fig- 

 ure 1). At the same time, though less rapidly, there is a fall in the 

 rate of the pulse and respiration. In patients not treated with se- 

 rum, Sutliff and Finland 1862 found that a much smaller proportion 

 show symptomatic improvement and a sharp drop in temperature 

 during the course of the disease. Following this initial fall in the 

 temperature of serum treated cases, there may be a continued low- 

 grade fever and lesser complaints for several days. 



Studies by Sutliff and Finland on a series of serum treated 

 cases compared with others not so treated indicate that the aver- 

 age duration of the more acute symptoms measured from onset to 

 a persistent lowering of the temperature is shortened by about 

 thirty hours in the serum treated group. The average duration of 

 the low-grade fever following the relief of the more acute symp- 

 toms, however, is about the same in both groups. The disease runs 

 a milder course following serum therapy. 



An even more marked shortening of the acute illness in the 

 treated as compared with control cases is reported in Great Brit- 

 ain by the Therapeutic Trials Committee of the Medical Research 

 Council. 887 They find, on the average, that crisis occurred two and 

 one-half days earlier in the treated than in the control Type I 

 cases, and two days earlier in the treated than in the control Type 

 II cases. In other instances where the progress of cases was ana- 

 lyzed in a different way, they note that, compared with the control 

 cases, from four to seven times as many treated Type I cases show 

 defervescence on or before the fifth day of illness, and from three 

 to six times as many Type II cases. 



