│ │B.inf. ++ Emp. S.hem. ────┼─────────────────────────────────┼──────────────────────────────── 99│Bronchopneumonia. Purulent │H.B. S.hem. │bronchitis │Br. B.inf. +++ Lun. S.hem. +++ │ │S.hem. ++ B. inf. + ────┼─────────────────────────────────┼──────────────────────────────── 102│Lobular pneumonia with │H.B. S.hem. │interstitial suppuration. Pur. │Br. B.inf. +++ │bronchitis. Empyema │S.hem. +++ │ │R.L. S.hem. +++ ────┼─────────────────────────────────┼──────────────────────────────── 104│Nodular bronchopneumonia with │H.B. S.hem. │interstitial suppuration. Pur. │R.L. S.hem. ++++ │bronchitis and bronchiectasis. │Emp S.hem. │Empyema. │ │ │ ────┴─────────────────────────────────┴──────────────────────────────── The cases cited in the preceding paragraph are illustrative examples from a series of over 250 necropsies which are described in another section of this report. They serve to indicate clearly the extent to which mixed and superimposed infections of the lungs may occur in pneumonia following influenza and leave little doubt that a considerable proportion of the deaths from influenzal pneumonia are due to this circumstance. Hemolytic Streptococcus Pneumonia Following Influenza But 4 cases of hemolytic streptococcus pneumonia directly following influenza without an intervening pneumococcus infection of the lungs occurred in the group of cases studied clinically. Superimposed infection with S. hemolyticus, however, occurred not infrequently during the course of pneumococcus pneumonia following influenza, as has been stated above. This occurred 3 times in lobar pneumonia and 10 times in bronchopneumonia, with fatal outcome in all but 1 case. =Bacteriology.=—Bacteriologic examination of the sputum in the 4 cases of streptococcus pneumonia directly following influenza showed S. hemolyticus present in abundance. B. influenzæ was also present in large numbers in 3 cases, but was not found in the fourth. In 1 case a Gram-negative micrococcus resembling M. catarrhalis was also present in large numbers in the sputum. Pneumococci were not found either by direct culture on blood agar plates or by inoculation of the sputum intraperitoneally in white mice.