THE PNEUMOCOCCUS, PNEUMONIA, ETC. 55 



be transplanted every two or three days to a fresh tube. This is 

 one of its most characteristic features. 



Vaccine Treatment. — Pneumococcic infections are usually very 

 amenable to vaccine treatment. In acute lobar pneumonia good 

 results have been obtained by a small dose at the outset of the 

 disease ; 5 to 25 millions, the latter being a high dose, only to be 

 used for strong persons in whom the disease is seen early. In 

 this disease time is of great importance, and it is not, as a rule, 

 advisable to wait whilst the patient's own 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 subse- 

 quently 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 millions to 

 commence with) and frequently repeated, the amounts and inter- 

 vals 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 Pfeififer'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 unjustifiable, for the diseases 

 appear to be identical in clinical history ; and in cases 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 Micrococcus catarrhalis. In this uncertain state of 

 bacteriology the results of an examination of the sputum are 

 deprived of much of their value as a means of diagnosis, but the 



