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The President, Dr. F. H. Williams, of Boston, in the Chair. (Continued from page Buy Acillin 268.) A Study of the Empyemas at Camp Upton. — This paper was presented by Major H. Brooks, M. R. C, and Major R. L. Cecil, M. R. C. Purchase Ampicillin Major Brooks said that his coworker had undertaken a very extensive study of the laboratory side of the problem. They had had a very virulent type of enipyema. The cases were all associated with pneu- monia. The disease had also been associated with measles but not with mumps. The causative germ had been the streptococcus in fifty per cent., in the other fifty per cent, the pneumococcus. Cases of pneumococcus empyema had recovered after opera- tive treatment. There were forty-nine cases of streptococcus empyema with a mortality of sixty- one per cent. Of four streptococcus viridans cases, three died ; four mixed infections with streptococcus and pneumococcus, no deaths ; of thirty-five hemo- lytic streptococcus cases, twenty-two died. The empyema seemed in each case to be a concomitant infection of the pleural sac. With the entrance into camp of a large contingent of colored troops the percentage of hemolytic streptococcus infections in- creased. The question arose as to whether this dis- ease was transmitted directly from soldier to soldier, but with very careful isolation of cases there ' was found to be no diminution of occurrence. Still, the isolation was Ampicillin 500 Mg being carefully maintained. In the bronchial type there was very little cough, very little sputum raised, and Httle pleuritic pain, the chief symptom throughout being prostration. The diagnosis was made by aspiration and confirmed by the X ray findings, also the changes in percussion were important signs. The exudate in these cases iiad the appearance of alkaline urine and generally contained streptococci. Pericarditis usually devel- oped early, and was progressive, but there was lack of metastases elsewhere. Of twenty-seven cases that came to autopsy, twenty-three were strepto- coccus cases. The pulmonary lesion showed inter- stitial bronchopneumonia, of the type described by Cole. Pneumothorax was also present. As regards treatment, it had been found that it was essential to wait till the pus became cellular in character, when operation could be safely performed. Dr. H. A. Christian remarked that, in civil Order Ampicillin Online Ampicillin practice they had had practically the same experi- ence as had been reported in army cases, and ex- perience showed that fatalities occurred from too early operative interference. Dr. E. LiBMAN said that Fraenkel had drawn attention to the fact that during epidemics of grippe the pneumonias and empyemas followed a devious course. "During such epidanics it was found that primary empyemas occurred. This form of the disease had been named pleiiritis acutissima. The apex had to be watched for acciunulation of fluid. His experience had been that the x ray would help in detection of empyema, but that it failed when the Ampicillin 500mg empyema was localized between the lobes and under the axillae. Major W. H. Buy Ampicillin Welch said investigations made by Zinsser and Dochez brought out clearly that the strei)tococcus was the most important cause in these infections. At one camp the cases seemed to be due to the streptococcus viridans, and it was a ques- tion as to what had played a Ampicillin 500 part in enhancing the virulence of this streptococcus. It was necessary that groups Cheap Ampicillin of experts should give undivided atten- tion to the better control and management of the disease. Men all over the countrv should unite in comparing their investigations so that medical offi- cers should have the necessary knowledge for con- trolling disease among the troops. MacCallum had thrown much light on the problem of the lesion in the lung as seen at autopsy. The pulmonary lesion was frequently so mild as not to be recognized. In the infection through the respiratory tract the streptococci made wav rapidly to the pleural pass- ages, but no doubt they left Buy Ampicillin Online small foci of disease which could be detected on careful examination. Major R. L. Cecil, M. R. C, spoke about the bacteriological aspect of these cases. In regard to the pneumococcus, cases were found with Type IT in the sputum and Type IV in the pleural fluid. Of the streptococcus group four cases had shown non- hemolyzing streptococci. These were recognized as 398 PROCEEDINGS OF NATIONAL AND LOCAL SOCIETIES. [New York

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