INFLUENZA 59 



vaccine is prepared, but in most pneumococcic diseases this is 

 advisable. Vaccine treatment is especially indicated in cases 

 which are slow to resolve, or in which the lung does not clear 

 up after the crisis; a single dose is usually efficacious, often 

 within twenty-four hours. In bronchitis and nasal catarrh 

 several injections are usually required. The initial' dose may 

 be 5 to 10 millions, rising subsequently to 50 or 100 millions, 

 or even more. Pneumococcic secondary infections in phthisis 

 are not always amenable to treatment, but it is always worth 

 trying, and occasionally gives good results. 



Puerperal fever due to the pneumococcus should be treated 

 as early as possible. The doses should be small (2 to 5 mil- 

 lions to commence with) and frequently repeated, the amounts 

 and intervals being determined by a careful study of the 

 clinical symptoms. 



INFLUENZA 



In the first edition of this book, in treating of influenza, I 

 followed the usual teaching of bacteriologists and regarded 

 the disease as a specific one, and as being caused in all cases 

 by the influenza (or Pfeiffer's) bacillus. Recent observations, 

 both in England and on the Continent, have shown that this 

 view can no longer be upheld, unless we greatly restrict the 

 use of the term " influenza," and use it only for those cases in 

 which the bacillus in question is found. This is quite unjusti- 

 fiable, for the diseases appear to be identical in clinical history; 

 and in case,s in which we should be practically certain of finding 

 Pfeiffer's bacillus if they occurred a few years back, we now 

 find other organisms, especially the Micro coccus catarrhalis. 

 In this uncertain state of bacteriology the results of an exam- 

 ination of the sputum are deprived of much of their value as a 

 means of diagnosis, but the methods will be described, since 

 more information is required, and this information the general 

 practitioner is usually in the best situation to obtain. 



Methods. If possible, the sputum should be obtained in a 

 method similar to that recommended in pneumonia, as it 

 greatly facilitates the process and renders the results more 

 trustworthy if the sputum comes directly from the lungs, and 

 is not contaminated with bacteria from the mouth. The nasal 

 secretion may also be examined, and frequently contains the 

 organisms in pure culture and vast numbers; where the nose 

 is affected, better results will be obtained in this way than 



