SUGGESTIONS CONCERNING THE PREVENTION AND CURE OF ACUTE LOBAR PNEUMONIA

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of remarks made before the Conference of State and Provincial Boards of Health, at Washington, D. C., May 2, 1917. IT IS unnecessary for me to tell you, who are entrusted with the health of this country, of the importance of this disease. You know the statistics better than I do. How,ever, I should like to lay stress on one fact. By the public at large pneumonia is considered to be a disease affecting mainly the very young and the old and decrepit. As a matter of fact, over half the cases occur between the ages of 20 and 50, during the period of greatest activity. It is therefore of great economic importance, and is undoubtedly from every standpoint -the most important acute infectious -disease with which we have to deal. What we all desire is to lessen its incidence and cause the number of deaths to be decreased. Can the results of the newer studies aid us in accomplishing either of these objects? A very brief review of some late observations and conceptions may be of interest from this point of view. Probably the most important fact that has been established is that the pneumococci causing this disease are not all identical and that on the basis of their immunological differences, and to a less extent on their morphological characters, they may be divided into several groups or types. Pneumococci of Types I and II cause about 65 per cent. of the cases of pneumonia. The organisms of each of these types are immunologically quite distinct and have definite specific characters. In Type III are included the organisms which have very large capsules, form sticky exudates in animals, and are called Pneumococcus mucosus. These organisms alsopossess specific immunological properties. They cause pneumonia relatively infrequently, only about 10 per cent. of the cases being associated with pneumococci of this type. The remaining cases of pneumonia, about 25 per cent., are due to the organisms which have been included in Group IV. Each strain of pneumococcus of this type seems to be immunologically distinct, at least the different races possess no well-marked common immunological properties. The severity of the infection due to the organism of these various types seems to differ; at any rate, from the experience so far obtained, the mortality among the cases due to organisms of the first two groups is 25 to 35 per cent., that of the cases due to the pneumococci of the third group is much higher, 50 per cent. or more, while the cases due to organisms of the fourth group have a low mortality, 10 to 15 per cent. Further study has indicated that