500 PATHOGENIC MICROORGANISMS 



mistaken for diphtheria. Madison 35 collected from the literature 

 thirty cases in which influenza bacilli were present in the blood 

 during life. 



Influenza bacilli in the meninges have been described by Woll- 

 stein 36 and others and we have seen them in a number of cases in 

 they were associated in this location with streptococci. Influenza 

 bacillus meningitis is not uncommon in children. 



In diseases of the cavities of the skull, the antrum of Highmore, 

 the frontal sinuses etc., influenza bacilli may be chronically present 

 and have been held responsible for intermittent attacks of asthma. 



Wollstein has made an extensive study of the presence of in- 

 fluenza bacilli in children at the Babies Hospital in New York. In 

 the interepidemic periods, Wollstein has found them present fre- 

 quently in bronchopneumonia, less frequently in cases of lobar pneu- 

 monia. In thirteen cases of bronchopneumonia at autopsy she found 

 the organism three times. Six times she found them in connection 

 with tuberculosis. Other workers, as well as Wollstein, have fre- 

 quently found the organisms in whooping cough where they were 

 reported as being almost regularly present after the disease was 

 well established. In the lungs in measles, scarlet fever and diph- 

 theria their presence is very frequent. Wollstein states that she 

 has found the organisms rarely in the throats of healthy infants, 

 and that whenever it was present, it seemed to have a definitely 

 aggravating influence upon the existing disease. 



The carrier state may persist after infection with influenza bacilli 

 for long periods. During epidemics this seems to be particularly 

 important as found by the investigations of Pritchett and Stillman 37 

 and of Opie 38 and his collaborators. 



Varieties of the Influenza Bacillus. A great many investigators 

 have reported organisms almost identical with the influenza bacillus 

 which, however, they have regarded as sufficiently different to be 

 considered as distinct types. 



It is the opinion of the workers at the New York Department 

 of health, moreover, that the Gram-negative, hemophilic organisms 

 found in trachoma must be regarded also as belonging to the general 

 influenza bacillus type, and cannot be sharply separated. 



35 Madison, Amer. Jour. Med. Sc., 139, 1910, 527. 



36 Wollstein, Jour. Exper. Med., 1905, 7, 335. 



87 Pritchett and Stillman, Jour. Exper. Med., 29, 1919, 259. 



^Opic, et al, Surgeon General's Rep., Jour. A. M. A., 72, 1919, 168. 



