PNEUMONIA 247 



regard to the sputum, if a bacteriological examination is 

 made, it must be remembered that it was in healthy sputum 

 that the micrococcus was first found, and that its presence 

 in small numbers would not therefore be conclusive. The 

 diplococci may be found in the blood a day or two before 

 the appearance of the ' rusty sputum.' 



Pathogenesis. — Both of these organisms have been found 

 to be the cause of pleurisy, endocarditis, pericarditis, 

 meningitis, etc. In its clinical features pneumonia presents 

 strong resemblances to the specific fevers, and though 

 isolated cases are most common, epidemics do occasionally 

 occur. Great alternations of heat and cold, chronic 

 alcoholism, syphilis, and plumbism, all predispose to 

 pneumonia by lowering the general health. The micro- 

 coccus of Sternberg is very fatal to mice on inoculation, 

 less so to rabbits, while pigeons and fowls are immune. 



Serum Treatment. — Washbourn (British Medical Journal, 

 February 27, 1897) was the first to publish an account of 

 the preparation of an antipneumococcic serum on a large 

 scale, and to describe a method by which its strength could 

 be accurately estimated. Pane, also, in a communication 

 made before the Medical and Chirurgical Academy of 

 Naples (March 14, 1897), described an antipneumococcic 

 serum which he had obtained from a cow and a donkey, 

 and with which he had successfully treated a number of 

 cases of pneumonia in the human subject. 



In Dr. Washbourn's experiments a pony was the animal 

 selected for the preparation of the serum. After nine 

 months' treatment, first with living and then with dead 

 cultivations, the serum was found to possess marked pro- 

 tective powers. 



To accurately standardize the serum he found that it was 

 necessary to determine the minimal fatal dose of the test 

 cultivations, and this entailed the devising of a method for 



