364 PNEUMOCOCCIC INFECTIONS 



temperature, and the symptoms undergo a brief exacerbation, 

 followed by an improvement in the general condition. The 

 meaning of this phenomenon is somewhat doubtful, Wright hold- 

 ing that the rise is due to the presence of toxin in the serum. It 

 seems, however, more probable that it is due to a solution of some 

 of the streptococci and consequent liberation of endotoxin. It is 

 not a centra-indication to the use of the serum, though it may 

 suggest care in its use. If no obvious result follows the use of 

 the serum, the brand should be changed, another specimen being 

 administered forthwith. 



Antistreptococcic serum is, as a rule, not standardized, and the 

 initial dose should not be less than 10 c.c., whilst 20 to 25 c.c. is 

 not too much. Subsequently 10 c.c. may be given each day as 

 long as it appears to be of benefit. In a generalized infection it 

 seems reasonable to give the injections intravenously, but there is 

 no proof that the method is of more value than the ordinary 

 process of injecting it into the cellular tissue of the flank. 



Good results have been obtained in severe cases of scarlet fever 

 by the use of serum obtained by the use of streptococci obtained 

 from scarlatinal throats (5. conglomerate). It appears tolerably 

 clear in this disease that a homologous serum is of advantage, the 

 results being better than those got by the use of ordinary anti- 

 streptococcic serum. 



Pneumococcic Infections. 



The marked remote toxic symptoms frequently met with in 

 pneumonia would suggest that the pneumococcus forms an 

 exotoxin, and there is a certain amount of experimental support 

 for this supposition. The Klemperers made use of nitrates in 

 their experiments in the production of an antitoxic serum, and 

 found them fairly toxic, and possessed of undoubted immunizing 

 powers; and similar results have been obtained by Washbourn, 

 Isaeff, and others. But the potency of these filtrates is slight 

 compared with that of a true exotoxin, and the results obtained 

 are quite consistent with the supposition that they are due to 

 slight autolysis and liberation of an endotoxin. The fact that 

 lesions occur remote from the lung cannot be taken to suggest 

 that an exotoxin is produced, since we know that in pneumonia 

 considerable numbers of cocci make their way into, and are 

 destroyed in, the blood-stream. Vaccines of the dead cocci are 

 but slightly toxic. 



