PNEUMOCOCCUS INFECTIONS 261 



comes to a standstill in from three to four days. The facial cases, 

 of course, should not be included in an analysis of the results, as 

 they usually do well without serum treatment. In puerperal cases 

 the testimony is most conflicting. Some observers, such as Bumm, 

 Peham, and Burkard, thus speak quite favorably of its use (when 

 employed early), Burkard reporting 50 cases, of which twenty-nine 

 were pure streptococcus infections, without a single death, while 

 others deny having seen any good accomplished whatever. It is 

 in these very cases that I would advocate that the serum treat- 

 ment should be placed in the hands of experts who shall decide how 

 the serum is to be given, when it is to be given, and how much is to 

 be given. That even then there will be unfavorable results also is 

 to be expected, but it would stand to reason that the maximum 

 amount of good that could be accomplished would be obtained 

 under such conditions. 



Regarding the value of the serum in other streptococcus infections, 

 too little is as yet known to warrant any definite conclusions. Here 

 also is a large field for the expert, and until it is tilled by him the 

 results can hardly be expected to be what they should be. As I have 

 suggested, the best results may here be expected from serum treat- 

 ment and vaccine treatment conjointly. 



PNEUMOCOCCUS INFECTIONS. 



While the results which have been hitherto obtained in the serum 

 treatment of pneumococcus pneumonia have been rather disappoint- 

 ing, Neufeld and Handel have recently pointed out that this may 

 have been due in part to the administration of sera of too low a titer 

 and of insufficient amounts, in part to the administration by the 

 subcutaneous route, and in part to the use of sera which did not 

 correspond to the same strain as the infecting organism. The same 

 observers could show that the so-called polyvalent sera of commerce 

 were in reality not truly polyvalent, and possessed protective value 

 only against a certain group of pneumococcus strains, while they 

 were of no avail against other types. They emphasize that- no cura- 

 tive properties can be expected from a given serum unless this is 

 homologous for the type that is causing the infection. It will accord- 

 ingly be necessary to resume the serum treatment of pneumonia 

 from this standpoint, and to establish the type of the organism in 



