DEPORT OF THE DIRECTOR OF THE HOSPITAL

June, 1914.

  Owing to the brief period `interveniq since the laet meeting of the Board and
to the fact that the year is approaching a close, very little new work has been un-

dertaken in the hospital, and the activities of the Staff have been confined mainly to

tha completion of work reported as in progreee in the last report.

   Pneumonia   During the year 73 patient0 suffering from pneumonia have been

treated In the hospital.  A complete statistical study of these cases has not yet bees

r-da.  The type of organism concerned has been determined in all cases-
  In addition to the cases studied here, the type of organic hae also been deter-
Lined, by means of immune serum sent out from here, ,in the Kings County Hospital, in
Brooklyn by Dr Lyle, in the Brigham in Boston by Dr. Walker, and in the Penm~lmnb
tiospital in Philadelphia under the direction of Dr Lewie.   These observer have had
satisfactory results in determining the types of organism in about one hundred and fifty


cas0s.  Sera have beea sent also to other hospitals, but reports have not yet been reL

wived. VIfien this material is all collected, we shall have aoneiderable data as to
the relative frequency of occurrence of organisms of different types in different cities
                                                      

Dr. Lewis in Philadelphia is now immuniobg horses to the organiem of type I aad %ope ff
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aed expects next `year to carry out serum treatmeht in the Pennsy;vania Hospital actor-

ding to the method employed here.

The next important problem as regards therapy is the emprovenent of the method of

treating ca8ee due to organi- of type II. . Dhether this end will `6e attainted by Con-
                              
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centration, xx$rrrbult of the eeruu alone is not yet certain. Work is being continued
on methods of concentration, and tiile a cotieiderabie number of facts have been deter-
eieed in regard to the protein fractions &ich contain the protective substances, a
practical method of concentration has not yet been devised. Ve hope to do this during

the eurnzer.  It is probable, however, that an important factor in immunity against or-
ganisms of type I? and Paeumocoocus mucoeus met be supplied by the infected organimo
Efforts are being made to determine the nature of this factor-


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  Dr Avery has also conducted a number of experiments studying (a) the rate of dis-
appearance of antibodies in serum;(b) the effect of inactivation on immune serum and
the effect of the addition of complement on its efficacy;(c) the absorption of anti@

bidies in immune serum by means of homologous and heterologous types of organisms.

The ef feet of such absorption on agglutinina, precipitins, protective substances and

also the ef feet on complement deviation has been tested.  Experiments in regard to

the bacteriolytic effect of immune serum are now being carried out. The published re-

ports of these investigations will be made within a very short time.

  The second Important problem which we have had in mind in the studies on pneu-

monia is related to epidemiology.  It is evident that it is of great significance to

learn whether or not the fixed types of organisms are only present in the mouths of
those infected with the disease, and whether organisms of these types quickly dis-

appear during convalescence.  Lastly it is important to learn, ik possible, whether
transformation of the types of organisms ordinarily found in the mouth into the more

fixed types may or may not occur.  From Dr Dochezls study it may briefly be stated

that organisms of the fixed types are not ordinarily present in the mouths of healthy

individuals.  The patients who have been treated here for pneumonia are returning from
time to time, in order that it may be learned whether or not the type of organism found

during the disease persists. As previously stated, organisms of the fixed frypes have
persisted far from two to three months following an attack of pneumonia.. It is possibly
significant that in these cases where the fixed types have persisted, delayed resolution

has occurred.  It it ia shown by these studies that the fixed types are not ordinarily
Present in the mouths of healthy individual, though they may persist in the mouths of
convalescent patients, these persons then acting as carriers, it is evddent that these
observations may have considerable significance in devising means for the prevention

of this disease,  At present, however, these question are not fully answered, and it
has seemed of importance that we`extend these studies to a considerable degree in or-
der to obtain definite information in regard to these points.,  The problsm as to whethe-


transformation of the so-called atypical ty-pes into the more fixed types may occur in

the mouth or not, and whether the occurrence of the disease may be due to such trans-

format ion, is an extremely difficuit one to solve,  It' is hoped that by studying the

sntigonic properties of the organisms existing in the mouth during the disease and

thsse of the crganisms present during convalescence, some light may be shed on this

quest ion.  Such work 16 now in progress.

  D:. Cnic.kering has carried out studiee on the agglutinating po:er of the patients

tii 3od for the t-yps crganisms aad for organisms isolated from the patient's own sputum.

'ii, is zork is r.01 ready for publication.  Dr Chickering is also conducting some experi-

rznts to determine whether or not the antigenic properties of the organisms 6solated

from the sputum correspond to their agglutinating properties.  To do this has required

the immunization of a large number of small animals.

  Dr Avery is also carrying out an extended series of studies on the fermentative

reactions of pneumococc&p in order to determine whether or not the different type6 of

organisms show any difference in their fermentative reactions.

  The work on pneumococcus toxins and on the production of methaemoglobin by pneu-

cococci and on the haemolytic action of pneumococcihas been completed and very soon

will be ready for publication.
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   Diabetes:    The work in diabetes has been continued along the lines outlined

by Dr Allen in his extensive report at the last meeting.  So far there have been three

patients suffering from diabetes under treatment in the hospital, and the results Of

efforts to lower the total metabolism have been most encouraging.  All of the three

patients are now free from glycosuria and free of acidosis.  They have all been Clini--

tally unf avourable cases.  It is intended to continue this work quite actively during

the summer, a6 Dr Allen wfll remain here during the entire time.

  mhj.lis
       --I ,*    Dr Swift and Dr Ellis are now busy collecting all the material of

.iie work on @ syphilis since the opening of the hospital, and it is hoped to publrsh

2: is a p?oLx.bi:r as a monograph, during the cnmigg sl;~;onle~..