Omaha daily bee., 1919-06-05
Four Pneumonia Tgpes
London Times.


The study of pneumonia has received . very
great stimulus during these last months, and the
public interest in this dreadful disease has been
quickened. Every one realizes now our efforts
to cope with the plague were, on the whole, I'm
satisfactory, and that, in spite of long years of
experience, we lacked any weapon OF defense
upon which trust could be placed.
It is for this reason that we welcome the con-
tribution to the study of the disease which has
Just been made by the Rockefeller institute.
This contribution comes from the hospital of
the institute, and bears the names OF Avery,
vance is marked in our knowledge.
The type of pneumonia studied was that
known as 'Iobar"-ie, that which attacks the
lobes of the lungs. The authors have come to
the conclusion that, though the disease may
appear as one sharply differentiated condition,
which has the same sign. but each of which is
produced by different type Of germ.
The vast Importance of this is recognized at
once when it is recalled that until the medical
research committee discovered that cerebro-
spinal fever was of four types, each due to a
of that malady was made. So long as serums
able to destroy one type were being used to de-
stroy another type against which they were i'm
potent, patients continued to be lost and serum
treatment to be discredited. When, however,
the types were recognized and differentiated it
particular type, and the death rate fell at once.
A similar state Of matters would seem, from
this new work. to prevail in the case of pneu-
MONA. The germ belongs to the same class, it
looks the same, but it is in reality different
in different infections, just as the typhoid bacil-
lus differs from the paratyphoid A and
bacilla.
Four types Of the pneumococci can be dis
tinguished. Type l is stated to be the most
common cause Of infection in man, giving rise
to one-third of the total cases in the areas
where study has been carried on. 1t is against
at present in use is valuable. Types g. 3 and 4,
indeed, are not affected by this serum at all
Unhappily, serums made against them have, for
some reason or another, failed to give very good
results.
As result of the work it is not advised that
should be given in every case Of pneu-
monia, as can be done in cerebro-spnal
meningitis. The first step should be the de-
termination Of the type which is present. This
is highly technical matter requiring the help
of laboratory. Then if type is present serum
treatment should be begun forthwith, the serum
being given into a vein with certain due pre-
cautions
The authors state that when administered
in this scientific fashion serum has proved very
beneficial. There is at once definite improve
ment in the general condition of the patient,
the consolidation OF the lung ceases TO cXtenQ,
invasion of the blood of the pneumococcus is
prevented or ended and the blood becomes i'm
mune. Major Nichols of the United States
army, who treated cases occurring among troops
on the Mexican border, reported mortality of
8 per cent in cases treated with serum as op-
posed to mortality of 80 per cent in cases not
so treated.
In commenting on the work, the Lancet adds
a word of caution which deserves to be noted.
1t says:
THE findings Of these American investi-
gators are of the utmost Importance, but con-
hrmation is required before they be gener-
ally applied in this country, for we have evil
dence that the types of pneumococci differ in
different localities. To carry the work out
lined above into effect will necessitate not only
the storing and distribution Of large supplies of
serum of standard potency available at short
notice, but special provision will have to be
made in private and hospital laboratories and in
public health Laboratories for carrying out at all
hours the technical procedures involved in de-
termining the type of pneumococcus response
bic in any individual case"