Penetration of Antipneumococcic Horse Serum into the Consolidated Lung in Lobar Pneumonia

Abstract

In analyzing the action of antipneumococcic serum in the treatment of lobar pneumonia, the question of its penetration of the pneumonic lung is often raised. The clinical observation that specific therapy is effective early in the disease and ineffective late in the disease has sometimes been explained on the basis of the accessibility of the pneumonic area to circulating antibodies in the initial stages of consolidation and a lack of penetration after complete consolidation has taken place. Studies of the circulation in the pneumonic lung have usually supported this view. Mallory 1 believed from the study of pathological histology, that in the stage of gray hepatization the air sacs became distended and the capillaries compressed so that they no longer appear engorged. Kline and Winternitz, 2 using vital staining methods with trypan blue, concluded that there is a marked impairment of circulation in the pneumonic lung, resulting from the wide distribution of capillary fibrin thrombi formed early in the consolidated area, and that this impairment of circulation in the pneumonic lung seriously interferes with the action of intravenous therapy upon the local lesion. Gross, 3 using injections of a barium sulphate emulsion in gelatine, noted that the consolidated lung of lobar pneumonia shows poor injection with compensatory injection in the non-consolidated lung. Coryllos and Birnbaum, 4 however, using iodized oil for arterial circulation and Ringers' solution and india ink for capillary circulation in the consolidated lung of the dog, concluded that “Only the capillary circulation was involved.