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pneumoniae disclosed the true microbic nature of the infection. The pneumococcus is now recognized as the causative agent. Many and various have been the plans advocated for its cure, from bleeding to the use of vaccines and serums. Drugs with antitoxic or chemotherapeutical virtue have been eagerly sought. The establishment of the pneumococcus as the etiological factor of importance was a giant stride forward in this effort to find a specific temedy because treatment presu]5poses a correct diagnosis. It may be emphasized that the "early hours are the vital hours," often spelling success or failure at the very onset. Be alert to the signifi- cance of a chill, with fever, pain in the chest, etc., and act promptly. An accurate diagnosis includes knowledge of the type of the etiological agent present. To Rufus Cole, director of the Rocke- feller Institute, are we indebted for the knowledge of the types of this coccus. He has shown that there are four great groups of the pneumococcus, which have been numbered I. II, III, and IV. These groups differ mainly Cvs Pharmacy Cialis Price in their immunological reac- tion, no_ cultural difference having been detected. About sixty per cent, of the cases seen are of types I and II ; fifteen per cent, of Type III ; and twenty- five per cent, of Type IV. The highest mortality IS seen in Type III. As one third Cvs Pharmacy Cialis Price of all cases are of Type I, and as the specific serum recommended is especially effica- cious for this type, when used early and in large dose, it is evident that the type m'ust be known promptly if the serum is to be efficient. It is most Important to note that for the other two thirds, seruiu treatment is of no avail. Therefore, other methods must be used. It may be advisable to review some of the methods advocated by internists of large Cvs Pharmacy Cialis Price ability, great acumen, and recognized stand- ing, for all these methods have their good points, faking into consideration Cvs Pharmacy Cialis Price the personal equation, success will in a great measure depend upon the practitioner's knowledge of these methods, and his personal watchfulness, resourcefulness, and de- termination. /. The Rufus Cole treatment with specific scrum. — The use of this serum for pneumonia pre- supposes that the pneumococcus has been isolated by laboratory methods and proved to be of the Type I organism. The sputum must be obtained from the lungs, rusty sputum, that Cvs Pharmacy Cialis Price with a blood tinge, Cvs Pharmacy Cialis Price to be preferred. This sputum must be sent promptly to the laboratory and findings must be proved within eight to ten hours. Practically, it may be said that this method is successful mainly in a well equipped hospital. Should the pneumo- coccus prove to be Type I and the use of the serum decided upon, it is wise to test the patient for protein sensitization to horse serum. This is done by injecting intracutaneously a very small amount — 0.02 c. c. — of horse serum diluted in salt solution 1 :io; making the amount 0.002 c. c. To desensitize, 0.5 to one c. c. of horse serum is injected sub- cutaneously. The method of treatment is to inject the serum early in large doses of about ninety to 100 c. c. of serum intravenously, diluted with salt solution. This is repeated every eight hours until a definite effect has been obtained. The action of the serum is not bactericidal or antitoxic, it is believed, but renders the virulent pneumococcus susceptible to phagocytosis. Cole states that Cvs Pharmacy Cialis Price whereas before treatment of this type of pneumonia was under- taken twenty-five per cent, or more died, in the last 108 cases treated with the serum at the hospital of the Rockefeller Institute there were only eight deaths. Thus the dictum has gone out from tliis institute that the time is coming when no doctor will be justified in treating pneumonia without Cvs Pharmacy Cialis Price full knowledge of the type of pneumococci present. It may be noted that the Department of Health of the City of New York has made provision for the examination of pneumonic sputum at its re- search laboratory at the foot of East Sixteenth street. Manhattan. Sputum received before 10 Copyright, 1918, by A. R. Cvs Pharmacy Cialis Price Elliott Publishinfr Company. 482 lyES: CROUPOUS TYPE OP P.\EUMO.\'lA. [New Yoek Medical Journal. a. Cvs Pharmacy Cialis Price m. will be tested and a report of the pneumonic type returned to the practitioner within twelve hours. The serum for Tyi>e I can always be ob- tained from the Department of Health in bottles of 100 c. c. Inasmuch, however, as the serum treat- ment is not generally a])plicable, a review of other plans of recognized treatment is desirable. J. Tlie oplocliin mclhod. — Next to the specific serum treatment, the optochin method is worthy of serious consideration. In the hope of finding a chemical specific for Cvs Pharmacy Cialis Price the pneumococcus J. Morgen- roth and his pupils have reported favorable results Vvith the use of a quinine derivative called ethyl hydrocuprein, or optochin. The chemical fomiula of the drug is derived as follows: C19 Hjo N, OH OH, cuprein; Ci» H^o N, OH OCH3, quinine; C19 H22 ^'2 OH OCH3, Cvs Pharmacy Cialis Price methyl hydrocuprein ; C,,j H„2 N, OH OC2 H5, ethyl iiydrocujjrein. Morgenroth experimented extensively witli this drug on mice infected with the pneumococcus. These experi- ments led to the belief that the drug would be bene- licial in human infection. Alan M. Chcsney, of the Rockefeller Institute, has experimented extensively with this preparation and has formulated very favorable opinions as to its use. Its action, he proved, was to destroy the pneumococcus wherever found, both biologically