EMPLOYMENT OF BLOOD SERUM 257 



Type II antiserum, however, is much less efficacious and thus far its 

 therapeutic value is questionable. The Types III and IV antisera 

 have no clinical value. Dochez reports sixty-five cases treated with 

 Type I serum, with a mortality of 6.6 per cent., as compared with a 

 mortality of 25 per cent, in Type I cases not treated with serum. 

 Type II cases treated with serum have a mortality of 25 per cent, 

 as compared with 61 per cent, without the use of specific sera. When 

 patients are treated early, they do well, and large doses of serum 

 should be given as soon as the type of infection has been determined. 

 Cole advises an intravenous injection of 80 to 100 c.c. of serum diluted 

 with an equal amount of salt solution and repeated every twelve hours 

 until improvement occurs. The average total amount of serum required 

 in the Hospital of the Rockefeller Institute was about 250 c.c. The 

 injection of such large doses of serum is not entirely without possible 

 harm to the patient because of reaction to the foreign protein. The 

 possibility of severe serum .sickness should further be taken into con- 

 sideration. From evidence recently collected, more particularly in the 

 United States Army, the value of anti-pneumococcus sera has been 

 questioned. Parallel series of cases showed no important difference 

 in mortality between series receiving anti-pneumococcus serum, normal 

 horse serum or no serum whatever. The patients were young men who 

 had passed rigid physical examinations and therefore were good risks 

 in acute infections. It does not follow that other classes of patients 

 would show the same results. There is also great variation in the mor- 

 tality of different epidemics, and also normally in different ages, so 

 that only a sufficiently large number of treated cases extensively con- 

 trolled will form a trustworthy basis of actual comparison as to the 

 death rate, which is, after all, the final criterion as to the actual value 

 of the serum. Cecil and Blake have recently examined the question 

 on the basis of experiments with monkeys. They find that the admin- 

 istration of normal horse serum has no beneficial effect on experimental 

 pneumococcus Type I pneumonia but that the intravenous administra- 

 tion of specific Type I antiserum, particularly if given early and fre- 

 quently, " exercises a specific therapeutic effect, frees the blood 

 promptly and permanently from pneumococci, shortens the course of 

 the disease and greatly moderates its severity." The treatment of 

 lobar pneumonia with Cole's serum at present is best carried out in 

 institutions where it is possible to make accurate bacteriological diag- 

 nosis and differentiation of the types of the cocci, and where intra- 

 venous administration of large doses of sera can be accomplished with 

 the largest margin of safety to the patient. 



Kyes has carried out extensive investigations on the clinical value of 

 a serum produced by injecting massive doses of virulent pneumococci 

 into the domestic fowl. The reason for the selection of the fowl as 

 supply animal is that no matter how virulent pneumococci are for other 

 species, they do not occasion disease in fowls, and therefore large doses 

 can be injected with impunity. The initial dose in most instances is a 

 surface growth equal to that of 240 test-tube slants. The average 

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