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experiment with mice, but in our experience the ag- glutination and protection tests always give corre- sponding results. There are two additional reasons why the employ- ment of immune sermn, as it was carried out in the past, were not likely to produce favorable results. In the first place it was not used in sufficiently large Trental Generic amounts. It has been definitely shown that for im- mune serum to be effective in animals, it must be given in sufficiently large doses so that, after dilu- tion in the blood and body fluids, the immune sub- stances are still present in considerable concentra- tion. This means that for large animals or man the dose must be very much greater in proportion to the grade of infection than in small animals. Judging from the Generic Trental protective doses in small animals, the dose of fifteen to twenty c. c. previously employed in man could have but little effect, even though the serum was at its maximum efficiency and the degree of in- fection slight. Lastly, on theoretical grounds it is important that the serum should be administered early, before the degree of infection is too great, certainly before there is a high degree of general infection. In ani- mals, even if the treatment is given at the time of Buy Trental infection, there is found to be a degree of Purchase Trental Online infection against which no amount of serum, however large. is able to protect. Trental Cost However, in mice and especially in guineapigs, which are not so susceptible to pneu- mococcus infection as mice, and in which the condi- tions, therefore, more nearly resemble those in man, not only is highly immune serum protective, but it is also curative if treatment is not too long delayed. One may conclude, therefore, that, even in man, if the treatment is given in large amounts and not too late Trental Price in the disease, there are quite definite experi- mental and theoretical grounds for believing that it might be effective. In discussing the possibility of employing im- mune serum in the treatment of pneumonia, it is important that we consider the two types of cases and Trental 400 the corresponding kinds of serum separately. As I have before suggested, it seems that we should come to Buy Trental Online regard the disease as produced by these dif- ferent types of organisms as distinct entities. We undoubtedly shall come to so regard them, as soon as the development of clinical bacteriological labora- tories renders it feasible to do so. The probable number of cases of pneumonia of all types occur- ring in New York last year was over 15,000. Of these, judging from our small number of observa- tions, probably one third at least, or 5,000, were due to organisms of Type i. Of the deaths due to pneu- monia, probably 1,500 were of this type. This num- ber of deaths is considerably more than all the deaths from typhoid fever, scarlet fever, and cerebrospinal fever combined during the same period of time. This one type of pneumonia, therefore, is quite important enough for us to give it independent consideration. To influence this one Order Trental type of pneumonia by specific measures would, of itself, be of Buy Cheap Trental very great impor- tance. The method of treatment carried out has been as follows : As soon as it is determined that we are dealing with an infection due to pneumococci of Type I, treatment with immune serum is begun. The serum is injected intravenously. Usually eighty to ninety c. c. of the serum is injected, and this is re- peated in twelve hours. Usually these doses are repeated on the following day and this is continued so long as the patient's condition indicates that it is advisable. The treatment has so far been car- ried out in only a small Trental 100 Mg series of cases of pneumonia due to organisms of Type I occurring in the Hos- pital of the Rockefeller Institute, and the Trental Tablets number of cases is Trental Online still much too small to enable us to draw conclusions as to the efficacy of the serum from mortality statistics alone. In the small number of cases the results have been extremely encouraging, both as regards the effect on the clinical course, and on the outcome, but so far as possible we have avoided drawing conclusions from mortality Trental Injection statis- tics and prefer to lay especial stress on the follow- ing observations. First, in a considerable number of the treated patients, the blood cultures, before beginning treatment, have been positive. In some of them the degree of general infection as indicated by the number of Pentoxifylline Trental colonies per c. c. was quite high. .\ high grade of general infection is undoubtedly of bad prognostic import. The two main conditions associated with death of patients with pneumonia are increasing invasion of the blood by pneumococci and extension of the local lesion. Now in every treated case in which the Trental Indications culture from the blood was ]iositive Order Trental Online before the first injection of the serum, fol- lowing one injection, and before the second one was made, the culture of the Trental Mg blood was negative, and re- mained so. Second, it has been demonstrated that the process of recovery in pneumonia is associated with the appearance Purchase Trental in the blood of substances which are able to protect mice against infection with pneu- mococci. Whereas in the untreated patients these substances appear only late in the disease, at or fol- lowing the crisis, in treated cases their appearance is very appreciably earlier, usually shortly after

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