PNEUMOCOCCUS 67 



Type I pneumococcus serum in the first and fourth tubes. Put Type II pneumo- 

 coccus serum in the second and last tubes. 



Serum is added in the proportion of i part serum to 29 parts of culture. 



Add salt solution sufficient to make the quantity of fluid in all the tubes 

 the same. Shake each tube to mix its contents and incubate at 37C. for 2 

 hours or longer. 



If agglutination occurs a whitish clump, like sputum, forms in the bottom 

 of the tube, the supernatant fluid being clear. If agglutination does not occur 

 there is no change in the appearance. 



When, for any reason, it is impossible or undesirable to obtain the offending 

 organism from the patient's sputum, a sterile glass syringe, fitted with a suitable 

 needle is used to withdraw fluid from the affected lung; fluid so obtained is 

 immediately transferred to a tube or flask containing bouillon and this is in- 

 cubated at 37C. for 12 to 18 hours; as growth appears the broth culture is. 

 employed the same as the washings from a mouse, in making agglutination test. 

 Blood cultures, when procured, may be used likewise. 



At the present time the identification of the form of pneumococcus producing 

 pneumonia is being made by mixing equal quantities of patient's urine and 

 serum. A positive reaction is indicated by turbidity within a few minutes 

 after mixture. This test should be made within a few minutes after the urine 

 has been withdrawn and after preliminary centrifugalization of the urine to 

 make it perfectly clear. 



SERUM THERAPY 



Cole believes serum treatment should not be employed until agglutination 

 tests have been made; that Type I serum should only be given to patients from 

 whom Type I organisms have been isolated and that Type II serum should only 

 be given to patients from whom Type II organisms have been isolated, that serum 

 treatment should not, at present, be attempted when Type III or Type IV 

 pneumococci are the offenders. 



When serum treatment is indicated, the earlier in the disease it is employed 

 the more beneficial its effect. 



"When admitted, the patient was given 0.5 cc. of serum subcutaneously to 

 discover if hypersensitiveness existed. As soon as the type of organism was 

 determined, from 50 to 100 cc. of the serum, diluted one-half with salt solution, 

 were injected intravenously. 



"The condition of the patient served as a guide in the later treatment. 

 Usually the serum was not administered oftener than every 12 hours. The 

 patients treated received totals of from 190 to 460 cc. of serum, except one, who 

 received a total of 700 cc. of serum." 



