SERUM TREATMENT OF LOCALIZED PNEUMOCOCCUS INFECTIONS 807 



The mixture should be injected into the spinal canal after the with- 

 drawal of the fluid by the gravity or syringe method and under blood- 

 pressure control, as previously described. The amount injected and the 

 number of injections depend upon the clinical condition of the patient, 

 and in general may be administered in the same way as is antimenin- 

 gitic serum. 



The initial dose may be 20 c.c., and is prepared as follows: 



Antipneumococcus serum (sterile) 4 c.c. 



5 per cent, aqueous solution of boric acid (sterile) 15 c.c. 



2 per cent, aqueous solution of sodium oleate (Kahlbaum's 

 or Merck's) (sterile) 1 c.c. 



THE SERUM TREATMENT OF OTHER LOCALIZED PNEUMOCOCCUS 



INFECTIONS 



Lamar has also suggested that mixtures of antipneumococcus serum, 

 sodium oleate, and boric acid may be used in the treatment of pneumo- 

 coccus pleuritis, peritonitis, or other localized infections, such as arthritis 

 and sinusitis, where the exudate may be removed and the serum be 

 brought into contact with the infected tissues. 



THE SERUM TREATMENT OF PNEUMONIA 



Acute lobar pneumonia, with its clear-cut clinical course, unsatis- 

 factory and difficult treatment, uncertain prognosis, and high mortality, 

 was one of the diseases in which the earliest efforts were directed toward 

 discovering a specific serum therapy. Since the pioneer work of the 

 Klemperers in 1891, numerous investigators have prepared serums that 

 have yielded either indifferent results or proved beneficial in but a limited 

 number of cases, so that there has been no well-established form of 

 specific therapy. 



Recent investigations by Neuf eld and Handel J in Germany, and by 

 Dochez, 2 Cole, 3 and Gillespie 4 in the Rockefeller Institute, have dis- 

 closed several reasons for the failure of serum therapy in pneumonia, 

 and have emphasized the importance of the following factors : 



1. The serum should correspond to the type of pneumococcus causing 

 the infection. 



1 Zeitschr. f. Immunitatsforsch. 1909, iii, 159; Arb. a. d. k. Gesundheitsamte, 

 1910, xxxiv, 169; ibid., 1910, xxxiv, 293; Berl. klin. Wochenschr., 1912, xlix, 680. 



2 Jour. Exper. Med., 1912, xvi, 665, 680, and 693; Jour. Amer. Med. Assoc., 

 1913, Ixi, 727. 



3 Jour. Exper. Med., 1912, xvi, 644; Arch. Int. Med., 1914, xiv, 56. 



4 Jour. Amer. Med. Assoc., 1913, Ixi, 727; Jour. Exper. Med., 1914, xix, 28. 



