80 



It will be observed, on comparing this Table 3 with Table 1, 

 that the percentage of positive culture from the sputum of cases 

 of influenza is not appreciably greater than from cases of lobar 

 pneumonia and that the percentage of positive results from the 

 nasopharyngeal swabs is within the range of positive results 

 with swabs from normal persons ; in the case of the influenza 

 patients, however, the percentage of positive nasopharyngeal 

 swabs is certainly too low : many were acutely ill, rendering 

 the taking of the swab difficult and unsatisfactory. 



Further, it is to be noted that the material for examination 

 was obtained late in the disease in a considerable percentage of 

 both groups. Among the 1918 cases 16 were examined within 

 the first week of illness with four positives, 24 in the second week 

 with six positives, and 6 in the third week with four positives. 

 Among the 1922 cases 10 were in the first week of their disease 

 with eight positives, and 10 had been ill from one to three weeks 

 with five positives. 



The data exhibited in these three tables indicate fairly 

 clearly that the presence of the influenza bacillus in the 

 sputum in inflammations of the respiratory apparatus may 

 well be merely the consequence of its normal presence in the 

 upper respiratory mucosa. It is true that its presence in the 

 diseased lung post mortem might have more significance, but 

 I have had no opportunity of arriving at an estimate of the 

 frequency with which the bacillus may be found in the lung of 

 persons dead from other causes : it is probable that its presence 

 in the lung post mortem is not confined to cases of respiratory 

 inflammation. Even its greater abundance in the expectorations 

 of many of the cases of respiratory inflammation, as compared 

 with the normal respiratory mucus, may be merely a consequence 

 of the diseased condition and have no causal connection. It is 

 evident that during epidemic and the shorter inter-epidemic 

 periods influenza bacilli are so commonly found in the respiratory 

 mucosa of the general population that no certain deduction in 

 favour of their pathogenic activity can be drawn from their 

 presence, even in abnormal numbers, in the discharges or local 

 lesions of respiratory disease. 



Association with Pneumococci. 



The specimens from cases of pneumonia which were examined 

 by me for influenza bacilli were also examined by Dr. F. Griffith 

 for pneumococci, so that, by his courtesy, I may make a note 

 on the association of these two micro-organisms in inflammations 

 of the lung. 



Of 161 specimens from lobar pneumonia, examined both for 

 pneumococci and influenza bacilli, 84 yielded both, 64 yielded 

 pneumococci only and 13 influenza bacilli only; making no 

 allowance for accidental failures to isolate one or the other micro- 

 organism, we still found both present in at least 52 per cent, of 

 cases of lobar pneumonia. The great majority of the specimens 

 were received during a period when influenza was not prevalent : 

 in the earlier part of this period it was noted that, when " type " 



