PNEUMOOOCCTJS INFECTIONS IN MAN 465 



is important in this respect since the mortality of type II cases in 

 the blood in his experience is 73.4 per cent, and of type III cases 

 in the blood, 100 per cent, whereas, in type IV cases a mortality of 

 only 52.3 per cent, and the low percentage, 26 per cent, in type I 

 blood culture cases, he attributes to the effect of serum treatment. 



Aside from lobar and lobular pneumonia, the pneumococcus may 

 cause a number of other types of infection in human beings either 

 subsequent to a preliminary pulmonary infection, or primary in 

 nature. 



The most common complications of pneumococcus infection of 

 the lung are empyemia, endocarditis, and pericarditis, meningitis 

 and arthritis. Meningitis may occur as a primary disease especially 

 in children without previous traceable pneumonia. The same may 

 be said of arthritis. 



Empyema was a very frequent and fatal complication of the 

 war pneumonias, and pneumococci can be easily obtained by ordinary 

 cultural methods from puncture fluid. It has recently been sug- 

 gested that empyema is more apt to follow in cases which have been 

 treated with serum, perhaps because of its effect in localizing the 

 infection. This point has not been settled, but it would seem to 

 us that the only manner in which such a result could eventuate 

 would be by just such localizing effect, and this would mean that had 

 not the serum localized the infection the outcome might have been 

 fatal, a consideration which all the more persuades us of the wisdom 

 of treating type I cases with serum whenever possible. Pneumo- 

 coccus meningitis, whether primary or secondary, is a very fatal 

 disease from which recovery is rare. Direct serum treatment should 

 always be tried if it is a type I case, and intravenous treatment 

 to forestall a possible septicemia should also be applied. 



Pneumococcus peritonitis occurs particularly in children. 



The pneumococcus also causes a very severe form of corneal 

 ulceration which presents great difficulties to successful therapy. 

 The bacteriologist confronted with severe ulcerative infections of the 

 eye, in which ulcerations are especially localized on the cornea, 

 should search particularly for pneumococci. 



Typing from all these various lesions should be done if for no 

 other reason in the interest of statistical knowledge. From the 

 statistics furnished by the Rockefeller Hospital studies, as well as 

 additional information which the past five years have furnished 

 over all the United States and Europe, it seems fair to assume that 



