Intramuscular Administration of Anti-Pneumococcal Serum in Infants and Children

The intramuscular administration of a single dose of antipneumococcal serum in the treatment of pneumonia in childhood was attempted in an effort to obtain the advantages of serum-therapy without the dangers and technical difficulty inherent in intravenous administration. A very severe reaction with a marked chill and a rise in temperature to 108.6° followed the intravenous administration of serum to a child 7 years of age ill with Type I lobar pneumonia, and although she recovered we did not feel that in a disease which carried such a low mortality we were justified in jeopardizing the patient's chances of recovery. Nemir reports 2 deaths which she believes were due to the intravenous administration of the serum. The above experiences with the intravenous route are not uncommon in institutions where a great deal of serum-therapy is used. Without serum-therapy the mortality varies from 4 to 7%. Trask reported a mortality of 6% in type specific pneumococcal pneumonias studied at New Haven. Holt and McIntosh stated that of 1482 cases (over 3 years of age) taken from hospital practice the mortality was 4%. 497 cases (all ages) observed in our hospital from 1928 to 1936 showed a mortality of 7%. Secretion for typing was obtained by means of a pharyngeal swab. In some of our cases, 24 to 48 hours elapsed before material containing pneumococci could be obtained for satisfactory typing. Later, a special laryngeal cannula with a syringe attached was devised by one of us (V.R.). This enabled us to get tracheal pneumococcus-containing sputum which in most instances was adequate for satisfactory typing at the first attempt.