DISTRIBUTION OF BACILLI 483 



the pneumonic conditions following influenza. In some cases 

 influenza occurs in tubercular subjects, or is followed by tubercular 

 affection, in which cases both influenza and tubercle bacilli may 

 be found in the sputum. In such a condition the prognosis is 

 very grave. Regarding the presence of influenza bacilli in the 

 other pulmonary complications following influenza, much in- 

 formation is still required. Occasionally in the foci of sup- 

 purative softening in the lung the influenza bacilli have been 

 found in a practically pure condition. In cases of empyema 

 the organisms present would appear to be chiefly streptococci 

 and pneumococci ; whilst in the gangrenous conditions, which 

 sometimes occur, a great variety of organisms has been found. 



Pfelffer's observations on a large series of cases convinced him 

 that the organism was very rarely present in the blood that in 

 fact its occurrence there must be looked upon as exceptional. 

 The conclusions of other observers have, on the whole, confirmed 

 this statement, and it is probable that the chief symptoms in the 

 disease are due to toxins absorbed from the respiratory tract 

 (vide infra). In a recent work, however, Ghedini was able to 

 cultivate the organism from the blood and spleen during life in 

 over 50 per cent, of the cases examined : he found that its 

 occurrence in these situations was specially frequent during 

 marked fever. The bacillus may be present in some of the 

 lesions complicating influenza. Pfeiffer found it in inflammation 

 of the middle ear, and it has been frequently found in meningitis 

 following influenza. Care must, however, be taken in such cases in 

 differentiating the bacilli from closely allied organisms (vide p. 484). 

 Pfuhl considers that in these the path of infection is usually a 

 direct one through the roof of the nasal cavity. This observer 

 also found post mortem, in a rapidly fatal case with profound 

 general symptoms, influenza bacilli in various organs, both 

 within and outside of the vessels. In a few cases also the 

 bacilli have been found in the brain and its membranes with 

 little tissue change in the parts around. 



Extensive observations on the bacteriology of the respiratory 

 system show that influenza-like bacilli may be present in a great 

 variety of conditions ; we have, in fact, once more to do with 

 a group of organisms with closely allied characters, of which 

 Pfeiffer's influenza bacillus was the first recognised example. 

 These "pseudo-influenza" bacilli have been obtained from the 

 fauces, bronchi, and lungs in inflammatory conditions, and also in 

 various specific fevers. To this group belongs the bacillus which 

 has been cultivated from cases of whooping-cough by Spengler, 

 Jochmann, Davis, and others, and which is present in consider- 



