812 PASSIVE IMMUNIZATION SERUM THERAPY 



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. As shown 

 recently by Bull, 1 the agglutinins in the serum may play a very active 

 role by producing an agglutination of the cocci in the blood-stream 

 followed by phagocj^tosis. 



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 in 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 (see page 308), 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 administered 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 baoteriolytic 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- 

 tinue the treatment a mortality of 25 per cent, as compared to 61 per 

 cent, among 13 patients not receiving serum. More recent reports 

 indicate that the percentage of predominating types of pneumococci 

 1 Jour. Exper. Med., 1915, 22, 466. 



