366 PNEUMOCOCCIC INFECTIONS 



and is often absent in the more localized infections. The disease 

 is recognized by the demonstration of the diplococcus. 



In acute pneumococcic infections (pneumonia, septicaemia, 

 peritonitis, etc.) attended with severe constitutional disturbance 

 the use of serum may be tried. Several have been prepared, the 

 methods used differing somewhat in the different cases ; but, with 

 the exception of that prepared by the Klemperers, the animals 

 used are immunized by the use of dead, and subsequently of living, 

 cultures. The best known are Pane's and Romer's. The latter is 

 markedly polyvalent, an important point, since various strains of 

 pneumococci probably differ largely inter se. This was very well 

 shown by Washbourn and Eyre, who found Pane's serum 

 protective against four cultures from different sources, but power- 

 less against a fifth. 



The results of the use of antipneumococcic serum have not 

 been such as to lead to its general use, although several observers 

 have reported very good effects. According to Tauber, the tem- 

 perature falls to normal after one to three injections of 20 c.c., 

 and there is marked mental and general improvement. Stress 

 is laid on this by other physicians, and it may perhaps be due to 

 the cutting off of the supply of endotoxins brought about by the 

 ingestion by the leucocytes of the pneumococci after opsonization 

 by the added serum. 



The results are sufficiently encouraging to lead us to hope that 

 the serum may become of more value in the future, possibly as a 

 result of the discovery of a method by which the dosage and 

 spacing of the injections and the time for bleeding may be more 

 scientifically determined. 



In general, the use of serum for localized lesions does not 

 appear to be of much value ; but great benefit has been claimed to 

 follow the use of Romer's serum in ulcus serpens of the cornea, 

 used either alone or, as Axenfeld recommends, in conjunction 

 with a vaccine. The serum is to be dropped into the conjunctiva 

 or injected beneath it. 



Vaccines have also been used in pneumonia and in pneumo- 

 coccal septicaemia with good results. Thus Eyre has reported 

 a case of the latter disease in which there were metastases 

 (purulent) in the subcutaneous tissues, the hip, the gluteal 

 muscle, etc., and which recovered after five injections. In another 

 case Eyre notes, what is of great importance, that no benefit 

 whatever was derived from a stock vaccine, and it was only when 



