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sons who live in over-heated and ill-ventilated apartments are also especially subject to attack. The contagious nature of the disease is shown by the fact that an initial case in a household, a school, a factory, or a prison commonly leads to a local epidemic which may include all of those exposed to infection.

The prevention of the disease under existing conditions seems impracticable, as isolation of the sick, and especially of mild cases and of convalescents who are still capable of communicating the disease, is a measure which is not likely to be considered with favour by the public and has not been seriously proposed by health authorities. Those who are in delicate health, and especially elderly persons, should endeavour to avoid contact with persons suffering from influenza. And those suffering from the disease should make it a matter of conscience not to communicate it to their friends by untimely visits, by kissing, etc. For one who recognises the contagious nature of the malady and who has had some previous personal experience as to the discomfort attending an attack, it is not pleasant to have a friend call and announce the fact that he, or she, is “just recovering from an attack of influenza,” or is “really too sick to be out, but could not resist the temptation of running over to see you and to inquire about the children ”—and perhaps bestows a kiss upon the

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"little dears." Those who are confined to the house by an attack should by all means spit in a metal or porcelain receptacle containing a disinfecting solution, and other members of the household should, as far as is practicable, be kept from their room. Those who are able to go about should have an ample provision of pocket-handkerchiefs and these should be immersed in a disinfecting solution upon their return to the house.

Fortunately the influenza bacillus is soon killed by desiccation and by exposure to sunlight. An effectual way of disinfecting woollen clothing, stuffed furniture, etc., will therefore be to expose it in the open air. The bacilli in dried sputum do not survive more than twenty-four hours and a majority of them are killed in seven or eight hours. Diffuse daylight also hastens their death. It is therefore unnecessary to resort to the rigid measures of disinfection recommended in diphtheria and tuberculosis, in which diseases the specific germs resist desiccation for a long time. Free ventilation for two or three days and exposure of infected articles in the open air will ensure the disinfection of the room and its contents. The disease is no doubt largely spread by the minute droplets ejected by the sick in coughing or sneezing, each one of which contains thousands of influenza bacilli.

CHAPTER XI

PNEUMONIA

I OBAR or “croupous” pneumonia is due to a

micrococcus discovered by the present writer in 1880 and since demonstrated to be the cause of this infectious disease. The micrococcus of pneumonia is found in great numbers in the exudate which fills the air cells of the portion of the lung involved (one or more lobes) and in the sticky sputum coughed up by the patient. This is "rusty” in appearance on account of the presence of red blood-corpuscles. In fatal cases of pneumonia the micrococcus is not infrequently found, also, in the blood of the infected individual, but as a rule the disease may be regarded as a localised infection. The symptoms are due in part to a deficient supply of oxygen from the occlusion of the air cells in one or more lobes and in part to the absorption of the toxin produced by the micrococcus. The fatality of the disease depends largely upon the extent of lung tissue involved and also upon the age and vital resisting power of the individual attacked. Depressing influences of all kinds predispose to an attack, and especially alcoholism, malnutrition, and insanitary surroundings. Pneumonia also frequently occurs as a complication of other infectious diseasesmeasles, influenza, typhoid fever.

It is most prevalent during the spring months. In

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Fig. 9. Micrococcus of pneumonia; magnified 1000 diameters. A, with “capsule," as seen in the blood of an infected animal; B, as seen in a culture fluid.

the United States the area of greatest prevalence is the Middle Atlantic Coast region. The Gulf Coast region and the South Atlantic Coast region have the smallest proportion of deaths from this disease. The North Atlantic Coast region, the Interior Plateau, the Central Appalachian region and the region of the Great Northern Lakes have all about the same rate (103 to 106

per 1000 deaths from all causes). The greatest mortality occurs in children under five years of age (388.6 out of 1000 deaths from this disease).

The total number of deaths reported as due to pneumonia during the census year 1900 was 105,971, the proportion in 1000 .deaths from all causes being 106.I. This is an increase over the ratio shown by the preceding census (90.6).

The State of New York gave the highest rate (228.4) and Michigan the lowest (109.3). The rate was considerably higher in cities than in the rural districts, and the census of 1900 shows an increase in the cities and a diminished rate in the country over the rates of 1890. The death-rate among the coloured population (349 per 1000 deaths) was considerably greater than among whites (184.8). It was also larger for foreign-born whites than for native whites. The death-rate from pneumonia per 100,000 of the population was 190 in 1900 and 186.9 in 1890. These figures show that pneumonia ranks with tuberculosis as a cause of mortality in the United States and that while the number of deaths from the lastmentioned disease is diminishing there has been a decided increase in the number of deaths from pneumonia during the past ten years.

The recent statistics of the city of Chicago show a notable increase in the number of deaths from this

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