THE SERUM TREATMENT OF PNEUMOCOCCUS MENINGITIS 753 



lysis and lipolysis fatty acids and soaps are produced that in themselves 

 seem to exert a destructive action upon the infecting bacteria. 



With these considerations in mind, Lamar investigated the influence 

 of soaps upon pneumococci. Solutions of 0.5 to 1 per cent, of sodium 

 oleate were found rapidly to kill pneumococci; much weaker solutions, 

 as, e. g.j 0.1 per cent., or even 1 part of soap in 10,000 parts of water, 

 were found to lessen their virulence, and, what is more important and 

 significant, to render the organisms peculiarly susceptible to lysis by a 

 homologous antipneumococcus serum. 



A serious drawback to the application of these discoveries was -that 

 protein constituents of serum and exudates were found to inhibit the 

 bacteriolytic and hemolytic action of unsaturated fatty acid soaps, as 

 was shown by Noguchi 1 and then by von Liebermann. 2 The latter and 

 von Fenyvessy 3 later found that this inhibition can be prevented in the 

 test-tube and also in the animal body by adding a minute quantity of 

 boric add, which prevents the union of soap and protein matter when the 

 latter is not too greatly in excess. 



The experiments of Lamar with mixtures of homologous antipneu- 

 mococcus serum, sodium oleate, and boric acid in the treatment of pneu- 

 mococcus meningitis in the monkey have yielded excellent results, 

 especially when used early in the infection. These experiments have 

 proved that sodium oleate lowers the virulence of pneumococci and 

 renders them peculiarly and highly susceptible to solution by bacter- 

 iolysins present in the serum, and that boric acid largely prevents the 

 inhibitory action of protein constituents upon this sensitizing action of 

 sodium oleate. 



Practical Applications. One drawback to the use of this method in 

 the treatment of human infections is the necessity of using an anti- 

 pneumococcus serum corresponding to the organism causing the infec- 

 tion. In the Rockefeller Hospital a method has been worked out where- 

 by the type of infection is quickly determined by agglutination reactions. 

 Fortunately, the number of types of pneumococci are relatively few, 

 and it is to be hoped that an efficient polyvalent serum will soon be made 

 available by the Rockefeller Institute. Until this desideratum is 

 attained, the commercial serums at present on the market may be used, 

 with the addition of sodium oleate and boric acid. 



It is highly desirable that the treatment be administered as early as 

 possible, when the exudate is largely serous or at most seropurulent. 



Loc. cit. 2 Biochem. Zeitschr., 1907, iv, 25 



3 Zeitschr. f. Immunitatsforsch., orig., 1909, ii, 436. 

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