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curs in tiiose who have been made hypersensitive by previous serum injection. Sensitization never develops in less than ten days, and its duration is not known, but Cialis De 50 Mg there is reason to believe that it \aries and may persist for life. There is no par- ticular time after which sensitiveness is likely to have disappeared or diminished. The serum sick- ness in this type may be precisely like that just described, but commonly it difl'ers in one or more respects. The conunonest change is shortening of the latent j^eriod, seventy-one out of 129 of such reactions having occurred cither on the same day or on the day following the injection; that is, fifty- five per cent, had a latent period of less than two days. The reaction may be immediate (within six hours) or accelerated, the latter being the more frequent, and both may occur in the same patient. The second point of difference is that they mav be much more intense and the mucosa* of the respira- tory and digestive tracts may be involved in the urticaria. The third ])oint of difi'erence is the oc currence of such unusual syn)ptoms as rigors, mus- cular twitching, Cialis De 50 Mg convulsions, drowsiness, dyspnea, collapse, vomiting, and high temperature. The third class of serum reactions resembles closely the second in all respects, except that the victims have never before received serum. The persons so involved seem to have a sensitiveness to horse [>roteins. an>l many have horse astluna. Such cases are, fortu- natelv, rare. Serum Sickness and Anaphylaxis. — E. W. ( Joodall (Lancet, March 9, 1918; says that there has been a disposition to include ordinary serum sickness among the examples of anaphylaxis. He points out that the symptoms of anaphylaxis are constant for any given sjjecies of animals, irrespec- tive of the protein used for sensitization and rein- jection. Anaphylaxis is known to occur only in I)rtviously sensitized animals, while the ordinary form of serum sickness occurs without any evidence of previous sensitization. Only that form occurring after an interval following a previous injection of the same serum should be rightly classed as true anaphylaxis. This form has definite symptoms and manifestations which may be taken as typical of the InuTian anaphylactic reaction. These symptoms in- clude urticaria, blotchy erythema, edema of the skin, occasionally edema of the mucous Cialis De 50 Mg membranes, respiratory embarrassment, and occasionally col- lapse. Such .symptoms are also encountered in some cases of food poisoning and insect bites. Cialis De 50 Mg Such man- ifestations as sometimes follow severe burns, some of the symptoms in exophthalmic goitre, migraine, and epilepsy, and certain instances of drug suscepti- Ijility have been regarded by many as ana[)hylactic, but this is not justified by the Cialis De 50 Mg symptoms or the facts associated with true anaphylaxis. The symptoms of acute infectious diseases have been explained as due to anaphyla.xis from sensitization to the bacteria (luring the incul;ation fx-riod, but the nature of the symptoms is more or less specific for each disease, is not unifonn, and they do not resemble those of true anaphylaxis. This view would therefore seem to be unwarranted. The occurrence of the so called secondary rashes in Cialis De 50 Mg the acute infectious diseases, however, docs fit the description of true anaphylaxis, and those rashes are probably instances of that con- dition. The Pneumonias: Streptococcus and Pneumo- coccus Groups. — James G. Cumming, Charles B. Sjiruit and C liarles Lynch (Journal Cialis De 50 Mg A. M. A.. April 13, 1918) present the results of their investigation of the pneumonias with reference to the causative organisms. Cultures were made from the throats in measles cases, and 187 of the 291 cultures showed streptococci of the hemol)'tic Types I and II. Twen- ty-five of these patients developed complications, among which there were five cases of broniopneu- inoiiia. Of 104 swab cultures showing Type III hemolytic streptococci, fifty-one developed compli- cations, there being bronchopneumonia in thirty- four, empyema in nine, lobar pneumonia in one. and one case of pleurisy with effusion. That is among the measles patients thirty-five [>er cent, were carriers of the hemolytic streptococcus, and of these thirty-three per cent, developed streptococcus pneu- monia. Cialis De 50 Mg There were only six per cent, of hemolytic streptococcus carriers among seventy average throats. Positive blood cultures of the hemolytic streptococci, were obtained in seveiUecn per cent. of the measles pneumonia cases. Of forty-one lobar pneumonia cases streptococcus. Type III hemolysis was obtained in Cialis De 50 Mg fifty-nine per cent, of the cultures of the pleural exudate taken during life, and forty- 954 MISCELLANY FROM HOME AND FOREIGN Cialis De 50 Mg JOURNALS. [New York Medical Journal. Cialis De 50 Mg seven per cent, showed pncuniococci. Eighty-six per cent, were streptococcic among the cases of bronchopneumonia. At necropsy in thirty-one cases of lobar pneumonia, bronchopneumonia, and mea- sles pneumonia the streptococcus was isolated in jnirc culture in eighty-four per cent., and along with the pneumococcus in just under ten per cent., or in ninety-four per cent, of all the necropsies. The hem- olytic streptococcus seemed to have been the cause of death in ninety-four per cent, of the thirty-one au- topsied cases, including those of lobar pneumonia. Either throat swab or sputum cultures were Cialis De 50 Mg posi- tive in lOO per cent, of cases of pneumonia follow- ing measles, the former being positive in seventy- six per cent., the latter in eighty-seven per cent., and both in fifty-five per cent. These observations show the great importance of the recognition of the hemolytic streptococci in pneumonia of all forms, and this recognition is not possible when the mouse test for pneumococcus type determination is em- ployed. It is possible only by culture of the strep- tococcus. The findings would seem to demand the reclassification of pneumonias into the streptococcic and the pneumococcic, with the further subdivision of the latter into its four types. Efiforts have been inaugurated to classify the hemolytic streptococci, and treatment of the pneumonias by prophylactic inoculation of hemolytic streptococcus vaccine or use