IV 



whieh are heterogeneous and must, provisionally, be grouped 

 bher as • atvpical." Further, they have prepared an anti- 

 serum which they have found to be of high therapeutic value 

 in the treat DM n\ of pneumonia due to infection with their Type I. 

 -.« results form a distinguished record of scientific progress. 

 The difficulties which have not yet been overcome are, however, 

 serious. In pneumonia due to Tj^pe I, prompt diagnosis of 

 type is needed if the anti -serum is to be used effectively ; and 

 special skill is required in the administration of the relatively 

 large doses intravenously. The requisite facilities are not 

 generally available. Again, in the experience of the Rockefeller 

 staff, it has not been possible to prepare a serum which will be 

 useful in the treatment of any case of pneumonia not due to 

 Type I. How are these difficulties to be met? Can they be 

 overcome by further pursuit of the same fine of investigation? 

 Or must some new methods be devised ? These are the research 

 problems of to-day in this subject. 



7. The first task is to level up to the American work. What 

 is the condition, as regards serological type, of the pneumo- 

 cocci responsible for pneumonia in this country ? In a series 

 of 150 cases of lobar pneumonia taken mainly from the London 

 area, Dr. F. Griffith finds that the American Types I, II and III 

 occur in about the same proportions as in the United States ; 

 he agrees with the Rockefeller workers that these types are 

 serologically distinct, and that there remains a large number 

 of strains which differ from these three types and present many 

 varieties amongst themselves. His own observations have also 

 led him to concur with the opinion, expressed by several of the 

 Americans, that further work is necessary before a final conclusion 

 can be drawn as to the mode of action of anti -pneumococcal serum. 

 In this levelling up process the participation of many investigators 

 is needed, in Great Britain, in the rest of Europe, and in other 

 countries where skilled pathologists are available. As the result 

 of such combined enquiry, and with the support of the Health 

 Committee of the League of Nations, it should be possible to 

 place on record the characters and distribution of the more 

 important types of pneumococci throughout the world. The 

 American Types I, II and III form the starting point ; it is 

 for other countries first to ascertain the distribution of these 

 three types and then to add any others which may be found 

 to be of epidemiological importance in the pathogenesis of 

 pneumonia. In this research the results of different workers 

 must be comparable ; therefore the technique, which Dr. Griffith 

 discusses with particular care, should be identical in all essential 

 respects. It follows that there must also be uniformity o£ 

 nomenclature. When this stage has been reached, what next ? 

 The ground will then have been cleared for more concerted 

 attack upon the many and difficult problems of pneumococcal 

 immunity which the ingenuity of the Rockefeller staff has not 

 yet been able to solve. 



