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(see p. t ). Dr. K.INNICUTT, in opening the discussion, said that, he had listened with great interest to Dr. Smith's presentation cf his ingenious theory in regard to the essential nature of pneumonia. Without entering upon a discussion of the exact pathological process produced in the lungs by the diplococcus lanceolatus, he was unable to accept Dr. Smith's rudolph's revenge online game explanation of the cause of the crisis. Experimental investigations in animals pointed rather to the gradual elaboration of an antitoxin capable finally of neutralizing the toxic products of pneumococcal life. With complete neu- tralization the crisis occurred. He could see no other way of explaining the immunity conferred upon sus- ceptible animals by the subcutaneous or intra injections of large quantities of filtered bouillon cul- tures of the pneumococcus, and also the immunity se- cured by the introduction into the blood of susceptible animals of the serum of animals already rendered im- mune. Within the past year loa had published the lined by himself in this field of investiga- tion, which were corroborative oi rudolph's revenge slot review those reported by other observers. He had used in his experiments cul- tures of the pneumococcus diluted with Lugol's solu- tion. He had succeeded by this method in immu- J rabbits to the degree that they withstOi injection of one hundred and sixty cubic centimetres of a culture of which one-two-thousandth had proved fatal to unprotected animals. Moreover, in si;. neons injections of virulent cultures and serum from immunized rabbits, the animal lived, and a similar result was obtained when the serum was injected into unprotected rabbits five hours subsequent to the intro- duction of the virulent cultures. If these observations were correct, they certainly seemed to demonstrate the elaboration of an antitoxin capable of neutraliz- ing the toxic products of pneumococcal life. Dr. Walter 1!. James doubted whether pneumonia could be excluded from the list to which the inflam- matory disease- of germ origin affecting other organs iged. The difference was due chiefly to a differ- ence in anatomical structure; the lung being more spongy was less pressed upon and less rudolph's revenge slot game damaged by the inflammatory exudate. No doubt this exudate did form a favorable culture medium, but when it was suggested to treat the disease by inhalation of bacteri- cidal substances the prospect seemed to be a cheerless one. The subject was important enough, however, to justify attempts at clearing it up by new theories as to the essential nature of pneumonia. Clinical Experience with Infectiousness of Pneu- monia. -Dr. John H. Girdner said his interest in croupous pneumonia dated back eighteen years, when he wrote a graduating thesis on the subject. " Is Crou- pous Pneumonia a Communicable Disease?'' He thought even at that early date thai it was. and pre- sented in favor of that theory the fact of its resem- blance in many respects to other known infectious dis- eases, such as typhoid fever. .Subsequent experience had convinced him of the correctness of that view. A young man to whom he was called was ill with the initial chill of pneumonia. He was attended by a nurse and an uncle, both of whom were in the habil of supporting him while raised in bed, to enable him to cough and expectorate. In this position the pa- tient repeatedly coughed in their faces. Dr. Girdner warned them of the danger. ( >n the fifth day of the young man's illness the nurse had a chill, the initial one of pneumonia, and died four days later, or three days after the death of the young man. The uncle also contracted pneumonia and died after five days' illness. Since then. Dr. Girdner had made it a rule to destro\ the sputa of pneumonia patients with the same care that he disposed of the discharges in typhoid fever. He took as much care in examining patients sick with pneumonia as in examining diphtheritic patients. Pneumonia Always Interesting. — Dr. A. Alexan- der Smith said that, studied from any standpoint, pneumonia was always interesting. Personally, he- had felt for a long time a great deal of interest in its study from the standpoint of the circulation, and he was under obligation to the author for bringing the subject up in this manner. The most direct statement which hail been made, and the one to which he would Ik- most inclined to take exception, was that pneumonia was a disease unaccompanied by in- flammation. He saw no objection to the view that the exudate thrown out was a culture medium. It was the life history of micro-organisms that they found a culture medium in which to develop, that they there produced a toxin, and he had long been of opinion that the disappearance of the constitutional disturb- ance was due to the action of an antitoxin when the decline was c\ the character seen in pneumonia. We had been told that two-thirds of healthy people had in their bodies the pneumococcus. which was ready to attack and multiply whenever favorable rudolph revenge slot conditions presented themselves. Men went on a spree, jumped oil 1 dock, were fished out. taken to a hospital, put to bed. and in twenty-four hours we were pretty certain to find e\ idences of pneumonia. He thought the au- thor hail made suggestions which offered .1 very plau- January 2, 1897] MEDICAL RECORD. sible explanation of the development of pneumonia under such circumstances. There was not only de- pression of the system, but engorgement of the pul- monary capillaries. Regarding treatment of pneu- monia by inhalations, he must confess to scepticism: still, having been sceptical before when subsequent experience had proven the value of remedies, he was willing to make the test with regard to this one. Dr. W. H. Porter was not willing to give up the inflammatory theory of pneumonia. The products were characteristic of inflammation. He had looked upon the bacteria and the culture side of the disease as belonging to the etiology rather than to the patho- logical process itself. There were, he thought, three factors in the rudolph's revenge game production rudolph's revenge slot game of pneumonia: 1, Lowering of the vitality: 2, chilling or other cause of congestion or injury of the lungs, producing slight oozing, this acting as a culture medium for the germs: 3, the de- velopment of toxins. When the pneumonia had run its course, the anatomical structure of the lung was such as to favor rapid disposal of the exudate. Dr. A. Jacobi said he was willing to try the treat- ment of pneumonia by inhalation of a mixture of sixty parts of chloroform and fifty parts of alcohol, as de- scribed by Dr. Smith, but there were reasons why he did not believe it would prove efficacious. The prin- cipal one was that the microbes lay in the lining cells and could not be reached unless the disinfectant or bactericide first destroyed the cell and the individual. This was true of the streptococcus in the throat, where one might suppose germs could be more effectually at- tacked than in the lungs. Regarding inflammatory exudative process, we need not be astonished at see- ing it in the lung, for we also saw it in the areolar tis- sues in streptococcic invasion of the throat, with en- larged glands, etc. As to etiology, pneumococci were not the only germs capable of causing pneumonia, and to treat all cases by inhalations successfully would re- quire an agent which would kill the several varieties of germs causing pneumonia. Usually these germs entered through the bronchi, but sometimes it was through the blood, as in pneumonia complicating puerperal fever or other diseases. The microbic cause was different, but in all there were the same results of inflammation, consisting in the migration of blood cells, throwing out of fibrin, etc. It seemed to Dr. Ja- cobi that the old treatment would still hold good, namely, to fortify the body and strengthen the heart until the antitoxin was formed, the progress of the dis- ease ceased, and the materia peccans was absorbed.

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