  1. Abrahams, Hallows, Eyre, and French: Purulent Bronchitis; Its Influenzal and Pneumococcal Bacteriology;—Lancet, 1917, 193, 377. 2. Abrahams, Hallows, and French: A Further Investigation into Influenzo-Pneumococcal and Influenzo-Streptococcal SepticÆmia;—Lancet, 1919, 196, 1. 3. Askanazy: Über die VerÄnderungen der grossen Luftwege, besonders ihre Epithel-Metaplasie bei der Influenza;—Corr. Blatt f. Schweizer Aerzte, 1919, 49, 465. 4. Averill, Young, and Griffiths: The Influenza Epidemic in a Camp;—Brit. Med. J., 1918, 2, 111. 5. Avery, Chickering, Cole, and Dochez: Acute Lobar Pneumonia;—Monograph of the Rockefeller Institute, No. 7. 6. Ballin: Empyema Following Influenzal Pneumonia;—J. A. M. A., 1919, 72, 335. 7. Beals, Blanton, and Eisendrath: Abdominal Complications of the Influenza Epidemic at Camp Custer;—J. A. M. A., 1919, 72, 850. 8. Berkley and Coffen: Generalized Interstitial Emphysema and Spontaneous Pneumothorax;—J. A. M. A., 1919, 72, 535. 9. Bernhardt: Zur Aetiologie der Grippe, 1918;—Med. Klin., 1918, 14, 683. 10. Bircher: Zur Grippe Epidemie;—Corr. Blatt f. Schweizer Aerzte, 1918, 48, 1338. 11. Bland: Influenza in Relation to Pregnancy;—Am. J. of Obs., 1919, 79, 184. 12. Blanton and Irons: Recent Epidemic Respiratory Disease at Camp Custer;—J. A. M. A., 1918, 71, 1988. 13. Blanton, Burhans, and Hunter: Studies in Streptococcic Infections at Camp Custer;—J. A. M. A., 1919, 72, 1520. 14. Bloomfield and Harrop: Clinical Observations on Epidemic Influenza;—Bull. Johns Hopk. Hosp., 1919, 30, 1. 15. Borst: Pathologisch-anatomische Beobachtungen zur “spanischen Grippe” 1918;—MÜn. med. Wchnschr., 1918, 65, 1342. 16. Bradford, Bashford, and Wilson: Preliminary Report on the Presence of “Filter Passing” Virus in Certain Diseases;—Brit. Med. J., 1919, 1, 127. 17. Brem, Bolling, and Casper: Pandemic Influenza and Secondary Pneumonia at Camp Fremont;—J. A. M. A., 1918, 71, 2138. 18. Brewer: Report of Spanish Influenza which Occurred at Camp A. A. Humphrey, Va.;—J. Lab. & Clin. Med., 1918, 4, 87. 19. British Med. Res. Com: Abstracts of Foreign Literature on Influenza;—J. A. M. A., 1918, 71, 1573. 20. Bureau of Census Report: (Sept. 14,-Nov. 30, 1918) Science; 1918, 48, 594. 21. Bureau of Census Report: (Sept. 14,-Jan. 25, 1919) Science; 1919, 49, 142. 22. Camp Lewis Pneumonia Unit: The Relation of Bronchopneumonia to Influenza;—J. A. M. A., 1919, 72, 268. 23. Champtaloup, S. T., and Drennan, A. M.: A Preliminary Report on the Recent Influenza Epidemic in Dunedin, New Zealand;—Med. J. Australia, 1919, 1, 63. 24. Cheesman, T. M., and Meltzer, S. J.: An Experimental Study of the Direct Inoculation of Bacteria into the Spleen of Living Animals; and a Contribution to the Knowledge of the Importance of a Lesion in Animal Tissue for the Lodgment and Multiplication of Bacteria within it;—J. Exp. Med., 1898, 3, 533. FIG. LIII. AUTOPSY NO. 163. PULMONARY EMBOLUS. FIG. LIV. (AUTOPSY NO. 20. U. S. GENERAL HOSPITAL.) ILLUSTRATES THE CHANGE IN THE BRONCHIAL LYMPH GLANDS. NOTE THE PHAGOCYTOSIS WITHIN THE SINUSOIDS AS WELL AS THE MEGALOKARYOCYTES AND THE MITOTIC FIGURES IN THE CELLS LINING THE CHANNELS. 26. Christian: Incorrectness of Diagnosis of Death from Influenza;—J. A. M. A., 1918, 71, 1565. 27. Clark and Synnott: Influenza-Pneumonia Showing Gas in Facial Tissues;—Am. J. Med. Sci., 1919, 157, 219. 28. Coray: Ueber kruppartige Affektionen bei Influenza;—Corr. Blatt f. Schweizer Aerzte, 1919, 49, 474. 29. Corper, H. J., and Downing, E. D.: The Influenza Epidemic in a Tuberculosis Hospital;—Am. Rev. Tuber., 1919, 3, 10. 30. Darling: Bacteriology and Epidemiology of Influenza;—Am. J. Pub. Health, 1918, 8, 751. 31. Davis: Influenza and Influenzal Pneumonia;—Arch. Int. Med., 1908, 2, 124. 32. Dever, Boles, and Case: Influenza at the U. S. Naval Hospital, League Island, Pa.;—J. A. M. A., 1919, 72, 265. 33. Dick and Murray: Morphology of Influenza Bacillus;—J. A. M. A., 1918, 71, 1568. 34. Dietrich: Pathologische-anatomische Beobachtungen Über Influenza im Felde;—MÜn. med. Wchnschr., 1918, 65, 928. 35. Ecker: Isolation of Pfeiffer’s Bacillus from Sputum;—J. A. M. A., 1918, 71, 1482. 36. Eichhorst: Ueber das Influenza Herz;—Corr. Blatt f. Schweizer Aerzte, 1919, 49, 225. 37. Ely, Lloyd, Hitchcock, Nickson: Influenza as Seen at the Puget Sound Navy Yard;—J. A. M. A., 1919, 72, 24. 38. Erdheim: Der pathologische-anatomische Bild der Grippe;—Wien. med. Wchnschr., 1918, 31, 1971. 39. Farrar, L. K. P.: The Visitations of Influenza and its Influence upon Gynecologic and Obstetric Conditions;—Am. J. Obs., 1919, 79, 229. 40. Fildes, Baker, and Thompson: Provisional Notes on the Pathology of the Present Epidemic;—Lancet, 1918, 195, 697. 41. Fischer: Pathologische Anatomie der epidemischen Grippe;—MÜn. med. Wchnschr., 1918, 65, 1303. 42. Flusser: Pathologie und Klinik der Grippe 1918;—Wien. klin. Wchnschr., 1918, 31, 1133. 43. Forbes and Snyder: Study of the Leucocytes in an Epidemic of Influenza;—J. Lab. & Clin. Med., 1918, 3, 758. 44. French, H.: “Influenza” (Clinical Lecture);—Guys Hospital Gazette, 1919, 33, 118. 45. Friedlander, McCord, Sladen, and Wheeler: The Epidemic of Influenza at Camp Sherman;—J. A. M. A., 1918, 71, 1652. 46. Gibson, Bowman, and Connor: A Filterable Virus as the Cause of the Early Stage of the Present Epidemic of Influenza; Prelim. Rep.—Brit. Med. J., 1918, 2, 645. 47. Glaus and Fritzsche: Über den Sektion befund bei der GegenwÄrtigen Grippe Epidemie unter besonderer BerÜcksichtigung der Mikroskopischen Befund;—Corr. Blatt f. Schweizer Aerzte, 1919, 49, 72. 48. Goodpasture: Bronchopneumonia due to Hemolytic Streptococci following Influenza;—J. A. M. A., 1919, 72, 724. 49. Gotch and Whittingham: A Report of the Influenza Epidemic of 1918;—Brit. Med. J., 1918, 2, 82. 50. Gruber and SchÄdel: Zur pathologischen Anatomie und zur Bakteriologie der influenzaartigen Epidemie im Juli, 1918;—MÜn. med. Wchnschr., 1918, 65, 905. 51. Hall and Dyas: Appendicitis at Camp Logan as a Sequel to Influenza and Pneumonia;—J. A. M. A., 1918, 72, 726. 52. Hall, Stone and Simpson: Epidemic of Pneumonia following Influenza at Camp Logan;—J. A. M. A., 1918, 71, 1986. 53. Hamilton and Leonard: Acquired Immunity to Influenza;—J. A. M. A., 1919, 72, 854. 55. Hammond, Rolland, and Shore: Purulent Bronchitis;—Lancet, 1917, 193, 41. 56. Harris, D. T.: Some Observations on the Recent Influenza Epidemic;—Lancet, 1918, 195, 877. 57. Harris, J.: Influenza Occurring in Pregnant Women;—J. A. M. A., 1919, 72, 978. 58. Hedinger, E.: Zur Pathologie und Bacteriologie der Grippe;—Corr. Blatt f. Schweizer Aerzte, 1919, 49, 554. 59. Hewlett and Alberty: Influenza at a Navy Base Hospital in France;—J. A. M. A., 1918, 71, 1056. 60. Hirsch and McKinney: Epidemic of Bronchopneumonia at Camp Grant, Prel. Bact. Rep.;—J. A. M. A., 1918, 71, 1735. 61. Hirschbruch: Ueber die Ansteckende LungenentzÜndung;—Deut. med. Wchnschr., 1918, 44, 935. 62. Howard, S. E.: Bacteriological Findings in Epidemic Influenza;—Bull. Johns Hopk. Hosp., 1919, 30, 13. 63. Howard, Wm. T.: Bull. Johns Hopk. Hosp., 1919, 30, 111. 64. Hunt: Notes on Symptomatology and Morbid Anatomy of so-called Influenza with Special Reference to the Diagnosis;—Lancet, 1918, 195, 419. 65. Influenza Committee of the Advisory Board to the D. G. M. S., France; The Influenza Epidemic in the British Armies in France;—Brit. Med. J., 1918, 2, 505. 66. JaffÉ: Zur pathologische Anatomie der Influenza 1918;—Wien. klin. Wchnschr., 1918, 31, 1203. 67. Keegan: The Prevailing Pandemic of Influenza;—J. A. M. A., 1918, 71, 1051. 68. Kinsella: Bacteriology of Epidemic Influenza and Pneumonia;—J. A. M. A., 1919, 72, 717. 69. Kline, B. S.: Experimental Study of Organization in Lobar Pneumonia;—J. Exp. Med., 1917, 26, 239. 70. Kline, B. S., and Winternitz, M. C.: Studies upon Experimental Pneumonia in Rabbits;—J. Exp. Med., 1915, 21, 311. 71. Knack: Das Verhalten der Nieren bei der Grippe;—Med. Klin., 1918, 14, 902. 72. Kosmak: Occurrence of Epidemic Influenza in Pregnancy;—Am. J. Obs., 1919, 79, 238. 73. Krumbhaar, E. B.: The Bacteriology of the Prevailing Epidemic;—Lancet, 1918, 195, 123. 74. Lacy: B. influenzÆ in Sinusitis and Meningitis;—J. Lab. & Clin. Med., 1918, 4, 55. 75. Lamar, R. V., and Meltzer, S. J.: Experimental Pneumonia by Intrabronchial Insufflation;—J. Exp. Med., 1912, 15, 133. 76. Lamb: Primary and Post-Influenzal Pneumonia;—J. A. M. A., 1919, 72, 1133. 77. Lamb and Brannin: The Epidemic Respiratory Infection at Camp Cody;—J. A. M. A., 1919, 72, 1056. 78. LeCount: The Pathologic Anatomy of Influenzal Bronchopneumonia;—J. A. M. A., 1919, 72, 650. 79. LeCount: Disseminated Necrosis of the Pulmonary Capillaries in Influenzal Pneumonia;—J. A. M. A., 1919, 72, 1519. 80. Leslie, R. M.: Discussion on Influenza;—Proc. Royal Soc. Med., 1919, 12, 67. 81. Levy: HÄmatologisches zur Grippe-Epidemie;—Deut. med. Wchnschr., 1918, 44, 972. 82. Leichtenstern: Influenza;—Nothnagel’s Specielle Pathologie, 1896. 83. Little, Garofalo, and Williams: Absence of B. influenzÆ from the Upper Air Passages in the Present Epidemic;—Lancet, 1918, 2, 34. 84. Locke, RÖnne, and Lande: Clinical Aspects of the Recent Influenzal Epidemic;—Boston Med. & Surg. J., 1919, 180, 124. 85. Lord: The Etiology of an Epidemic of Influenza;—J. Med. Res., 1908, 19, 295. 86. Lord: Influenza;—Osler and McCrae, Modern Medicine, Vol. 1. 87. Lord: Eleven Acute and Eighteen Chronic Cases of Influenza;—Boston Med. & Surg. J., 1902, 147, 662. FIG. LVI. AUTOPSY NO. 135. ACUTE HEMORRHAGIC MYOSITIS (ZENKER’S NECROSIS). 89. LÖwenfeld: Pathologisch-anatomische und bacteriologische Befund bei der Spanischer Grippe;—Wien. klin. Wchnschr., 1918, 31, 1274. 90. Lyon: Gross Pathology of Epidemic Influenza at the Walter Reed General Hospital;—J. A. M. A., 1919, 72, 924. 91. Lyon, I. P., Tenney, and Szerlip: Some Clinical Observations on the Influenza Epidemic at Camp Upton;—J. A. M. A., 1919, 72, 1726. 92. MacCallum: Pathology of the Pneumonia following Influenza;—J. A. M. A., 1919, 72, 720. 93. MacCallum: The Pathology of the Pneumonia in the United States Army Camps during the Winter of 1917–1918;—Monograph of the Rockefeller Institute, No. 10. 94. MacKenzie: Influenza as Affecting the Respiratory System;—Practitioner, 1919, 102, 53. 95. Malloch: Discussion on Influenza;—Proc. Roy. Soc. Med., 1919, 12, 45. 96. Manges, M.: Symptomatology of the Prevailing Epidemic “Influenza”;—N. Y. Med. J., 1918, 108, 722. 97. Matthews: Preparing Medium for the Culture of Pfeiffer’s Influenza Bacillus;—Lancet, 1918, 195, 104. 98. McIntosh: The Incidence of B. influenzÆ in the Present Influenza Epidemic;—Lancet, 1918, 195, 695. 99. McMeekin: The Present Epidemic of Influenza;—Med. J. Australia, 1919, 1, 209. 100. Medalia and Major: Influenza Epidemic at Camp McArthur: Etiol., Bact., Path., and Sp. Ther.;—Boston Med. & Surg. J., 1919, 180, 323. 101. Menetrier, M. P.: Bronchopneumonia À B. de Pfeiffer; Bull. de l’Acad. de Med., 1919, 81, 99. 102. Mix, C. L.: Spanish Influenza in the Army;—N. Y. Med. J., 1918, 108, 709. 103. Moore, Sir John: Influenza from a Clinical Standpoint;—Practitioner, 1919, 102, 26. 104. Nammack, C. E.: Clinical Features of the Recent Influenza Epidemic;—Med. Rec., 1918, 94, 1103. 105. Netter, M. A: L’Epidemie d’Influenza de 1918;—Presse Med., 1918, 26, 511. 106. Nicolle and Lebailly: Le Microbe de la Grippe; Communication À l’Academie des Sciences par l’intermediare de M. le Professeur Roux;—Presse Med., 1918, 26, 537. 107. Nuzum, Pilot, Stangl, and Bonar: Pandemic Influenza and Pneumonia in a Large Civil Hospital;—J. A. M. A., 1918, 71, 1562. 108. Oberndorfer: Ueber die pathologische Anatomie der Influenza-artigen Epidemie;—MÜn. med. Wchnschr., 1918, 65, 811. 109. Opie, Freeman, Blake, Small, and Rivers: Pneumonia at Camp Funston:—J. A. M. A., 1919, 72, 108. 110. Opie, Freeman, Blake, Small, and Rivers: Pneumonia following Influenza;—J. A. M. A., 1919, 72, 556. 111. Orteconi, Barbie, et LeClerc: Contribution À l’Etude de la Flore Microbienne de la Grippe;—Presse Med., 1918, 26, 508. 112. Orth: Thrombosen bei der Spanischen Krankheit;—Deut. med. Wchnschr., 1918, 44, 1298. 113. Park, Wm. H.: Bacteriology and Possibility of Influenzal Vaccine as a Prophylactic;—N. Y. Med. J., 1918, 108, 621. 114. Park, Wm. H., and Williams, A. W., et al: Studies on the Etiology of the Pandemic of 1918;—Am. J. Pub. Health, 1919, 9, 45. 115. Parker, J.: A Filterable Poison Produced by B. influenzÆ;—J. A. M. A., 1919, 72, 476. 116. Peacock: Influenza;—Boston Med. & Surg. J., 1919, 180, 185. 117. Peacock, T. B: Review of the Influenza or Epidemic Catarrhal Fever of 1847–1848;—The British and Foreign Medico Chirurgical Review, 1849, 7, 90. 119. Pfeiffer, R.: Die Aetiologie der Influenza;—Zeit. f. Hyg., 1893, 13, 357. 120. Pfeiffer, R., and Beck, M.: Weitere Mittheilungen Über den Erreger der Influenza;—Deut. med. Wchnschr., 1892, 18, 465. 121. Pritchett and Stillman: Occurrence of B. influenzÆ in Throats and Saliva;—J. Exp. Med., 1919, 29, 259. 122. Rapoport: The Complement Fixation Test in Influenzal Pneumonia;—J. A. M. A., 1919, 72, 633. 123. Review of War Surgery and Medicine, Washington;—2, No. 1, 49. 124. Robertson and Elkins: Report on an Epidemic of Influenza Occurring at the Royal Asylum, Morningside, Edinburgh;—Brit. Med. J., 1890, 1, 228. 125. Rosenow: Prophylactic Inoculation against Respiratory Infection;—J. A. M. A., 1919, 72, 31. 126. Rosenow: Studies in Influenza and Pneumonia;—J. A. M. A., 1919, 72, 1604. 127. Schinz: Die Influenza Epidemie bei der Guiden-Abteilung 5;—Corr. Blatt f. Schweizer Aerzte, 1918, 48, 1329. 128. Schmorl: Pathologische-anatomische Beobachtungen bei der jetzt herrschenden Influenza Epidemie;—Deut. med. Wchnschr., 1918, 44, 937. 129. Schorer, E. H.: Influenza at the Port of Embarkation (Bacteriology);—N. Y. Med. J., 1918, 108, 641. 130. Shera: Influenza Epidemic of Spring of 1915;—Lancet, 1917, 192, 450. 131. Simmonds, M.: Zur Pathologie der diesjÄhrigen Grippe;—MÜn. med. Wchnschr., 1918, 65, 873. 132. Slye, Holmes, and Wells: Primary Spontaneous Tumors of the Lung in Mice;—J. Med. Res., 1914, 30, 417. 133. Smith: Influenzal Intra-abdominal Catastrophies;—Lancet, 1919, 196, 421. 134. Soper: Pandemic in the Army Camps;—J. A. M. A., 1918, 71, 1899. 135. Speares: Influenza;—Boston Med. & Surg. J., 1919, 180, 212. 136. Spooner, Scott, and Heath: Bacteriological Study of the Influenza Epidemic at Camp Devens;—J. A. M. A., 1919, 72, 155. 137. Spooner, Sellards, and Wyman: Serum Treatment of Type I Pneumonia;—J. A. M. A., 1918, 71, 1310. 138. Stone and Swift: Influenza and Bronchopneumonia at Fort Riley;—J. A. M. A., 1919, 72, 487. 139. Strouse and Bloch: Notes on Present Epidemic of Respiratory Disease;—J. A. M. A., 1918, 71, 1568. 140. Symmers: A Note on the Pathology of the Prevailing Pandemic Influenza;—N. Y. Med. J., 1918, 108, 621. 141. Symmers: Pathologic Similarity between Pneumonia of Bubonic Plague and of Pandemic Influenza;—J. A. M. A., 1918, 71, 1482. 142. Symmonds, C. P.: Nephritis in Relation to the Recent Epidemic of Influenza;—Lancet, 1918, 195, 664. 143. Synnot and Clark: The Influenza Epidemic at Camp Dix;—J. A. M. A., 1918, 71, 1816. 144. Talbot: Influenza among Children;—Boston Med. & Surg. J., 1918, 179, 779. 145. Thayer: Discussion on Influenza;—Proc. Roy. Soc. Med., 1919, 12, 28 & 61. 146. Thomas, H. M., Jr.: Rupture of Encapsulated Empyema into Pleural Cavity;—J. A. M. A., 1919, 72, 29. 147. Thompson: Influenza as it Affects the Air Passages;—Practitioner, 1919, 102, 12. 148. Titus and Jamison: Pregnancy Complicated by Epidemic Influenza;—J. A. M. A., 1919, 72, 1665. FIG. LVII. AUTOPSY NO. 150. ORGANIZATION OF THE INFLAMMATORY EXUDATE AND REGENERATION OF THE MUSCLE FIBERS AFTER AN ACUTE HEMORRHAGIC MYOSITIS. COMPARE FIGURE LVI. 150. Uhlenhuth: Zur Bacteriologie der Influenza;—Med. Klin., 1918, 14, 777. 151. U. S. Pub. Health Reports, 1919, 34, 1. 152. Valentine: Study of Agglutination Reactions of B. influenzÆ;—Bureau of Lab., N. Y. Board of Health Report, 1918. 153. Vaughan: The Bacteriology of Influenza (Editorial);—J. Lab. & Clin. Med., 1918, 4, 83. 154. Wadsworth, A. B.: A Study of Experimental Organizing Pneumonia;—J. Med. Res., 1918, 39, 147. 155. Wanner, F.: La Grippe À l’HÔpital d’isolement de Vevey en Juillet-AoÛt, 1918;—Corr. Blatt f. Schweizer Aerzte, 1918, 48, 1729. 156. Wegelin: Pathologische-anatomische Beobachtungen bei der Grippe Epidemie von 1918;—Corr. Blatt f. Schweizer Aerzte, 1919, 49, 65. 157. Whittingham and Sims: Bacteriology and Pathology of Influenza;—Lancet, 1918, 195, 865. 158. Winternitz, M. C.: Anatomical Changes in the Respiratory Tract Initiated by the Inhalation of Irritating Gases;—Military Surg., 1919, 44, 476. 159. Winternitz, M. C.: Collected Studies in the Pathology of War Gas Poisoning;—Yale University Press, 1919. 160. Winternitz, M. C., and Hirschfelder, A. D.: Studies upon Experimental Pneumonia in Rabbits;—J. Exp. Med., 1913, 17, 657. 161. Winternitz, M. C., and Smith, G. H.: Intrapulmonary Irrigation;—Proceed. Soc. Exp. Biology & Med., 1919, 16, 55. 162. Wolbach, S. B.: Comments on the Pathology and Bacteriology of Fatal Influenza Cases Observed at Camp Devens, Massachusetts;—Bull. Johns Hopk. Hosp., 1919, 30, 104. 163. Wollstein, Martha: An Immunological Study of Bacillus influenzÆ;—J. Exp. Med., 1915, 22, 445. 164. Wollstein and Goldbloom: Epidemic Influenza in Infants;—Am. J. Dis. Children, 1919, 17, 165. 165. Woolston and Conley: Epidemic Pneumonia (Spanish Influenza) in Pregnancy;—J. A. M. A., 1918, 71, 1898. 166. Yanagisawa: Experimental Study on the Mixed Injection of Bacillus influenzÆ and Various Species of Cocci;—Kitasato Arch. Exp. Med., 1919, 3, 85. FIG. LV. AUTOPSY NO. 146. ACUTE HEMORRHAGIC ENTERITIS ASSOCIATED WITH MULTIPLE BACTERIAL EMBOLI IN THE CAPILLARIES OF THE INTESTINAL MUCOSA. 1. The history of the epidemics of influenza cannot but impress one with the difficulties of medical progress. Beyond the fact that the descriptions of the epidemics are such that the disease is recognizable as being the same, there is little of real value in the literature until the beginning of the 19th century. In the 18th century the infectious nature of the malady had been recognized. The results of study in the first half of the 19th century are shown in the literature of the epidemic of 1847–49. In it, exceptionally good clinical descriptions and epidemilogical studies are published. In the next forty years great strides were made in Pathology and in the essentially new science of Bacteriology. With those two aids in the study of infectious disease, it is only reasonable to expect an increase in knowledge of influenza after the epidemic of 1889–90. Such is the fact and a comprehensive review of both the Bacteriology and Pathology of this disease is offered in Nothnagel’s Specielle Pathologie, 1896, Bd. IV, by O. Leichtenstern. 2. Early in the epidemic, Nicolle (106) and his co-workers described a filterable virus as the probable etiological agent in influenza. Several investigators have corroborated this work. Chief of these are: Gibson, Bowman, and Connor (46); Bradford, Bashford, and Wilson (16). The latter investigators independently isolated a filterable virus which may be cultivated by the Noguchi method and which, when inoculated into monkeys, produces a general reaction with specific respiratory lesions which, they think, are comparable to those of man in influenza. While these results must be confirmed, they offer greater promise than any other. 3. A marked fibrinous exudate in the lower trachea with the formation of a pseudomembrane was noted by Oberndorfer (108), Lubarsch (19), Coray (28), Borst (15), and Schmorl (128). Schmorl studied the bacteria from the trachea and found in sections streptococci, pneumococci, and staphylococci, but not B. influenzÆ or B. diphtheriÆ. 4. Simmonds (131), Bernhardt and Meyer (19) note that perichondritis may be present, but do not give a detailed description of the lesion. Gruber and SchÄdel (50) found this perichondritis to be associated with abscess formation. 5. Two examples of fresh endocarditis are reported by Malloch (95) and one by Dietrich (34), all of which were due to B. influenzÆ. Acute myocarditis was observed by Blanton and Irons (12) and Gruber and SchÄdel (50). Glaus and Fritzsche (47) report a case with multiple hemorrhages, necrosis, and leucocytic infiltration of the heart muscle and also one of Zenker’s degeneration of the myocardium. Cases of both myocarditis and endocarditis are included by Leichtenstern (82) in a review of the epidemic of 1889–1890. 6. The picture is not unlike that of the interstitial pneumonia after measles as described by MacCallum (93). 7. Pneumothorax as a complication following influenzal pneumonia is mentioned in association with marked emphysema in the epidemic of 1889–90 by Leichtenstern (82). It has been found by X-ray examination in two cases of interstitial emphysema by Berkley and Coffen (8) and also has occurred at Camp Dix according to the report of Synnot and Clark (143). 8. The rarity of empyema has been commented upon by LeCount (78) and Torry and Grosch (149). The condition was found in a small number of cases by Wegelin (156), Malloch (95), Lyon (90), Chickering (25), and Thomas (146), while Goodpasture (48) described it in eleven out of sixteen cases of streptococcus hemolyticus pneumonia. 9. Fibrinopurulent pericarditis has been described by Simmonds (131), Stone and Swift (138), Lyon (90), Fildes et al (40), JaffÉ (66), Glaus and Fritzsche (47). 10. The types of consolidation described as having been encountered at the post-mortem table apparently vary somewhat with the locality and the interpretation of the observers. The lobar type has been frequently found by Opie et al (110), Wollstein and Goldbloom (164), Stone and Swift (138), and others. The pseudolobar pneumonia has been mentioned by Abrahams et al (2), Keegan (67), and Speares (135), while the peribronchial type has been well described by Hubschman, Glaus and Fritzsche (47), and MacCallum (92). Lobular pneumonia has been noted by all observers. The type of consolidation in this series has been tabulated in relation to the inflammatory reaction.
11. No particular search was made for such lesions until the epidemic was nearly half over. At that time word was received from Camp Devens that hemorrhagic lesions in the rectus muscle were being found. Thereafter, the recti were examined with care. 12. Abscesses supervening upon the rectus hemorrhages are reported by Beals, Blanton and Eisendrath (7), and by Glaus and Fritzsche (47). Generalized abscesses are reported by the latter and by Dietrich (34). Abrahams, Hallows and French (2) report subcutaneous abscesses; Beals, Blanton and Eisendrath, abscesses of the kidneys. 13. The sinuses of the head and middle ears were examined in a number of cases with negative findings. Suppuration of these areas is, however, reported by others. Stone and Swift (138) found pus in the sphenoidal sinus in 68 per cent of their cases with pneumococci, streptococci and B. influenzÆ present. Wolbach (162) found twenty cases of infection of the sphenoid sinus from twelve of which B. influenzÆ alone or combined with pneumococci or streptococci were isolated. Lacy (74) reports four cases of influenzal sinusitis. 14. Acute nephritis has been reported by many observers, but the histological descriptions have been so meager that judgment regarding it must be suspended. 15. This condition has been met with more frequently in other localities. Stone and Swift (138) report it in a high percentage of their cases. Lamb and Brannin (77) encountered it seven times, and Blanton and Irons (12) report two cases. Borst (15) and JaffÉ (66) also have found this complication. 16. Cheesman and Meltzer (24) demonstrated as early as 1898 the importance of primary injury for the localization and development of secondary infecting bacteria. |
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