SERUM TREATMENT OF LOCALIZED PNEUMOCOCCUS INFECTIONS 759 



Action of Antipneumococcus Serum. The curative and protective 

 value of this serum depend mainly upon bacteriolysins, bacteriotropins, 

 and antitoxins. The first are readily demonstrated in protection ex- 

 periments and also in pneumonic patients when pneumococci in the 

 blood-stream are destroyed. Bacteriotropins may likewise be demon- 

 strated experimentally and in the blood of patients if the corresponding 

 organism is used in the tests (Neufeld, Strouse). The antitoxic prop- 

 erties are shown clinically and also in vitro by neutralization of the hemo- 

 toxic poison obtained by dissolving pneumococci in bile. 



Administration of Antipneumococcus Serum. To obtain the best 

 results, the serum should be given as early as possible and intravenously. 

 In young children, when the giving of an intravenous injection is quite 

 difficult or impossible, the muscles of the buttocks should be substituted. 

 Certainly small doses given subcutaneously are almost devoid of effect. 

 The procedure in use iri the Rockefeller Institute consists in injecting 

 0.5 c.c. of serum subcutaneously to discover if hypersensitiveness exists 

 and to produce anti-anaphylaxis. As soon as the type of organism has 

 been determined, from 50 to 100 c.c. of the serum, diluted one-half with 

 salt solution, are injected intravenously. The condition of the patient 

 serves as a guide in the later treatment. Usually the serum is not ad- 

 ministered oftener than once every twelve hours. 



It has been shown experimentally that, in the presence of a maximum 

 degree of infection, no amount of serum, however large, is effective. 

 This suggests that the body must furnish a second substance to act with 

 the antibodies in the serum, and indicates the early administration of 

 serum before the infection has reached too extreme a grade. I would 

 also suggest that the body may be deficient in bacteriolytic complements, 

 and that the effect of a serum may be enhanced by adding fresh sterile 

 guinea-pig serum say 5 c.c. to each 100 c.c. of immune serum just 

 prior to administration. 



Results in the Serum Treatment of Pneumonia. It is hardly neces- 

 sary to review the numerous reports that have been made in past years, 

 because in most instances the serum was administered subcutaneously 

 and in too small doses to be of value, even granting that it contained 

 antibodies for the particular infection. Of 23 patients, all seriously ill, 

 treated in the Rockefeller Institute during the past year, the results 

 were as follows: Of 15 cases due to pneumococcus 1, all recovered but 

 one a mortality of 6.6. per cent., as compared with the mortality of 

 24 per cent, among 34 patients not receiving serum treatment; of 8 

 cases due to Type 2, all recovered but two, one of these refusing to con- 



