SPUTUM SEPTICEMIA 393 



in true lobar pneumonia, and as said, denominated "the 

 crisis," constitute one of the dramatic phenomena of clinical 

 medicine. As if by magic, often within a few hours, a patient 

 apparently in extremis, may be found in comparative comfort 

 and progressing steadily to recovery with little or no return 

 of the distressing symptoms. It is needless to say that this 

 is not the history of every case, but it is so frequently seen 

 in non-fatal cases as to fairly characterize the course of a 

 case destined to recover. 



What are the forces that work this remarkable change for 

 the better? It cannot be that the pneumococci causing the 

 trouble are suddenly killed off and their hurtful action in 

 this way terminated; for we have seen that long after the 

 crisis they may be found in the sputum of the patient alive, 

 fully virulent and in almost countless numbers. It has been 

 suggested that after about a week there develops in the 

 tissues of the body a sufficient amount of antibodies to 

 neutralize the poison of the pneumococci and that coincident 

 with this neutralization there is a cessation of the evil 

 effects, i. e., the crisis occurs. Vague as this may appear 

 it is probably as satisfactory as any other explanation 

 available at this time. There are objections or criticisms 

 that may, however, be offered in discussing it. If that be 

 the correct explanation of the crisis, one might reasonably 

 expect to detect in the blood of convalescents from pneumonia 

 protective antibodies in sufficient amount and with such 

 constancy as to support the view, but such is not always 

 the case. In some instances antibodies are found in the 

 blood immediately after the crisis in such amounts that a 

 fraction of 1 cubic centimeter of the serum will protect 

 a tnouse from infection by a hundred fold the ordinary 

 fatal dose of virulent pneumococci; in other cases no such 



