In view of the considerations discussed above, it is believed that the clear and most fundamental indication for the management of epidemic respiratory diseases in the army is to scatter patients as widely as possible instead of following the time-honored custom of concentrating them. In brief, abandon open ward treatment and adopt effective individual isolation of every case, maintaining as strict a quarantine as is demanded in other highly contagious and infectious diseases. The adoption of a strict aseptic technic in the handling of these patients is an evident corollary. Only by this means can the serious and highly fatal secondary hospital infections, which occur in influenza and pneumonia when these diseases are present in epidemic form, be prevented. The prevention of secondary infection, prior to admission to the hospital, is another and more difficult problem. That opportunity for secondary contact infection in cases of influenza before patients reach the hospital is great seems unquestionable, since many cases have already developed these infections at time of admission. During the epidemic patients were crowded in regimental infirmaries, in ambulances, and in the receiving office of the hospital with every opportunity for droplet infection present. No study has been made of this question, but it seems reasonable that the same methods of prevention should apply, namely, effective separation of patients. It is not within the scope of this paper to discuss details of method, but anything that is possible becomes feasible as soon as sufficient evidence can be brought to bear that it is a necessity. In the present instance it would seem that any means that can be used to reduce materially the terrific toll taken by respiratory diseases is an absolute necessity. Summary 1. Secondary contact infection with pneumococci not infrequently occurs in patients with pneumonia following influenza when they are treated in hospital wards. 2. Secondary contact infection with S. hemolyticus readily occurs in patients with pneumonia and may spread rapidly throughout an entire ward with highly fatal results. 3. Secondary contact infection may be responsible for the development of pneumonia in patients with influenza. 4. Ward treatment of these diseases is fraught with serious danger which is greatly increased by overcrowding, by imperfect separation of patients by cubicles, and by imperfect aseptic technic of medical officers, nurses, and attendants. 5. It is probable that secondary contact infection can be effectively prevented only by individual isolation and strict quarantine of every patient. CHAPTER IV THE PATHOLOGY AND BACTERIOLOGY OF PNEUMONIA FOLLOWING INFLUENZA E. L. OPIE, M.D.; F. G. BLAKE, M.D.; AND T.M. RIVERS, M.D.