Abstract
In a previous report 1 it was shown that clumping of encapsulated extracellular diplococci in pneumonic sputum could either occur spontaneously or be induced by the intravenous administration of specific horse- or rabbit-serum. Further evidence that antibody is responsible for the clumping has been obtained from a patient infected with type 8 pneumococci. Nine hours after the intravenous injection of 160,000 units of rabbit serum the clumped pneumococci in the sputum showed “Quellung” in preparations to which methylene blue alone had been added. At the present time, clumping has been induced after the administration of Types 1, 2, 3, 5, 7, and 8 serum. Spontaneous clumping, now believed to represent evidence of developing active immunity, has been observed in patients infected with Types 1, 2, 3, 4, 5, 7, 8, 12, 18, 19, 24 and 25 pneumococci.
The induction and maintenance of clumping has a direct bearing upon the outcome of the pneumonia, as shown in Table I. Sixty-nine roentgenographically proved cases of pneumonia were followed from the sputum by the method previously described. 2 All of the patients received either horse or rabbit antipneumococcic serum; 10 were given sulfanilamide† in addition to serum.
The 10 patients who either failed to develop or to maintain clumping, expired. In 47 of the 53 serum-treated patients who recovered, clumping in the sputum was induced and maintained throughout the acute stages of the disease. The remaining 6 recovered cases showed clumping of extracellular pneumococci in specimens of sputum obtained before serum therapy was instituted. Although clumping was induced and maintained in 6 patients, they failed to recover. One (Type 2) in the author's opinion, died of asphyxia. Another (Type 2) was convalescing and expired shortly after an attempted aspiration of an interlobar empyema.
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