Mortality Diminishes Fifty per cent. After Serum Administration; British Measures In view of the wide lay interest in medical matters today, a survey of progress in the treatment of lobar pneumonia has been made by "Discovery" Although nothing spectacular like the treatment of respiratory failure in infantile paralysis by the so-called "iron lung" has evolved, real advances in treatment have been made.
Pneumonia is among the most serious infectious diseases affecting mankind, It is prevalent in all civilized countries, In Manchester alone, 1,268 cases occurred in 1937, of which 420 died. It affects men twice as frequently as women. It is particularly common, and particularly fatal, in infants and in the elderly. In alcoholics and in pregnant women, the disease is specially dan-
Its onset is sudden, with cold sharp chest pains and brown sputum. Profound toxaemia or poisoning and delirium rapidly follow. Breathing is rendered difficult by excessive fluid secretions accumulating in the lungs, and the patient dies usually of oxygen lack, literally drowned in his own lung fluids.
Fortunately, now, the old statement that "pneumonia will run its course uuninfluenced by medicine, and no means can cut short that course or about it," is no longer true. Modern ife serum has greatly re-
This method is the basis of all serum treatment of diseases. The blood serum of animals, usually horses, which have been immunized against a certain disease, when given to a patient with that disease, holds it in check; the antitoxins in the serum neutralize the bacterial poisons in the patient's blood and thus ease the task of his fighting forces, which then are more easily able to overcome the infection. Von Behring introduced such serum treatment for diphtheria with now historic success, the reduced mortality rate being a monument to the method.
The first anti-pneumonia serum was produced about 1897, but not until 1909 was a really effective product available. Then Neufeld and Handel prepared a polyvalent serum which gave a number of good results. It was found that the Diplococcus, the organism which produced pneumonia, existed in a number of different strains or types (as, Yor example, the varieties or strains of lupino in the garden), the virulence ai which differed.
Anti-sera were usually made from e mixture of these types, polyvalent sera. À more effective and concentrated serum was devised by Felton in 1924, but frequent failures from the use of such serum tended to bring it into disrepute.
However, anti-serum was effective only against the same type or strain of Pneumococcus and had little acving a healthy person a dose not quite sufficient to produce real illness, the body de-
and a high degree of n ore Tob aes of reswtance Lore to that disease results. This is called active immunity, the pollent "conscripting" and organizing is own defence system. Alternatively an animal such as the horse may be so treated, and its blood, now richer than normal in antidotes to the bacteria and their poisons, withdrawn and given to a patient to augment his own body defences against the disease.
"Such is passive immunity—the patient not assisting in making antidote substances, just receiving ready-made ones—and this is usually shorter lived than active immunity, tion on other types. For example. the commonest types are 1 and 2. A type 2 serum would be largely useless in a type 1 infection. This explained the poor results, it being realized that in using a polyvalent serum only part was being effective and so actually inadequate doses were being given.
Because of this specificity of the antisera, it is necessary to ascertain the type of Pneumococcus responsible for the infection so that the correct serum could be used. This usually meant sending the patient to hospital where a bacteriological examination of the sputum could be made. As the early use of serum is essential, such delays in diagnosis might easily ruin chances of success. So, in order fo avoid delay, the "typing" of the bacteria responsible for the disease was often omitted, and polyvalent preparations injected as early as possible. As, then, even with massive doses of serum, only a fraction was usually effective, results were disappointing, and the reputation of serum treatment suffered until the importance of type-specific therapy was realized.
Thirty Types of Pneumonia Most pneumonias are types 1, 2 or 2, and sera for these were soon available, However, matters were again complicated by the recognition of some thirty more types of Pneumococcus. Specife sera for these, too, are available now. "Typing" obviously was now a considerable problem. Fortunately, 60 per cent. or so cases are 1 or 2 or a mixture of these, but the other types are met and must be recognized if serum treatment is io succeed.
Recently, by the work of Neufeld and Sabin, a rapid and simple method of "typing" has been evolved. By means of this test even comparatively inexperienced workers. can "type" a pneumonia in a few minutes. Thus early diagnosis is ensured and specific treatment can be begun immediately with greatly increased chances of success—a notable advance.
The basis of flits method is as follows:
The Diplococcus of pneumonia is surrounded by a fine gelatinous capsula ordinarily barely visible under the microscope. When to a sample of sputum containing such pneumococci, a type-specific antiserum is added, typical changes occur in the capsules, which swell and develop a refractile appearance like ground glass.
This "Quellung" phenomena is quite characteristic; the test is delicate and a positive result is unmistakable. The results of specific serum treatment depend on the type responsible for the disease. Thus, in 1,200 cases of type 1 infection treated with serum the mortality rate was 15 per cent, compared with 25 per cent in a group' treated without serum. The mortality was therefore deezeased by 40 per cent. With 700 cases of type 2 infection, the mortality was reduced from 37 to 30 per cent; that is, a reduction of 19 per cent. in mortality. The average mortality of all cases fell nearly 50 rer cent, after the introduction of serum treatment.
Meanwhile, other methods of treating pneumonia, by synthetic drug. have been tried. A chemical compound, known as S.U.P. 36, was found to be beneficial in many respiratory infections coupled with fever. Injected intramuscularly good results were obtained from it in such conditions as influenza and bronchitis. For bronchial pneumonia it seemed almost a specific cure: and in lobar pneumonia fever was relieved and uneventful recovery usually followed. The drug appears to act by building up and augmenting the body defences.
Text read from the printed page and cleaned; old type leaves the occasional error.