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Influenza.

Problems:

Synonyms:—La Grippe; epidemic catarrh; epidemic catarrhal fever.

Definition:—An acute disease, highly infectious, epidemic, endemic and pandemic, characterized by febrile paroxysms, intense aching, muscular pains and often a bursting, almost unbearable frontal headache, involving the orbits, and the upper nasal region with catarrh of the respiratory passages and of the digestive tract, and exhaustion of the nervous system. It is further characterized by the occurrence of erratic and unanticipated manifestations, and by grave complications and intractable sequelae. The bacillus of Pfeiffer is found present in all true epidemic cases.

Etiology:—There is much uncertainty as to the cause of the sudden appearance of prevailing epidemics of this disease in different parts of the world almost simultaneously. There is no known influence that could convey an infectious micro-organism from individual to individual, and from one locality to another, widely distant, in the time these epidemics burst upon different parts of the world. While the bacillus of Pfeiffer is found universally present in these epidemics there is an argument in favor of the belief that it is an accompaniment of the disease, a product of the disease processes, rather than that it is the cause. That the disease occurs at other times in an endemic or pseudoepidemic form with all the severity, with all the intractable phenomena and fatal complications and sequelae of the pandemic cases, when the bacillus of Pfeiffer is not found, is undeniable.

There are certain atmospheric influences present that induce individual susceptibility. In 1890, when the epidemic burst upon the United States in the months of January and February, there was what is known as an open winter. There was no ice nor snow. There was prevailing chill, rain, damp and fog. It has been observed that at other times there were but few, if any, cases, as long as frost and steady clear cold weather prevailed, but upon the appearance of thaw, rain and persistent damp, chilly, cloudy weather a widespread epidemic has suddenly appeared. Atmospheric, climatic or obscure telluric conditions have certainly an influence in epidemic outbreaks.

At the time an epidemic of influenza prevails there is an almost complete absence of other infectious and epidemic disorders, but individual cases of this disease will occur as complications or as the sequelae of other infectious diseases, as secondary infection. Age has but little influence in the spread of the disease. Infants and those advanced in years, with those also of middle life, are attacked, but those feeble and previously indisposed are more susceptible, especially the aged. Attacks of the disease bestow no immunity from future attacks, and certain individuals appear to become susceptible to its influence and suffer from it repeatedly.

Symptomatology:—The symptoms of the disease vary greatly with the general character of the epidemic, the atmospheric conditions and the susceptibility of the patient. The onset usually is sudden and without warning. There is a chill, a quickly rising temperature and simultaneously a bursting headache or extreme muscular aching, amounting in many cases to pain, especially in the deep muscles of the back and across the loins. Congestion and engorgement of the mucous membranes of the nasal passages, with a sensation of fulness, pressure and distress or pain across the face and through the orbits at the root of the nose is quite common and it is frequently accompanied by a profuse watery discharge, with lachrymation. The fever usually reaches a high point—104° F.—quickly, and remains there for two or three days with but little variation, but in an occasional case the temperature does not rise above 101.5° or 102° F., where it may remain persistently for many days.

The patient is quickly prostrated, and presents all the evidences of severe illness. If the physician was not aware that the disease is self-limiting, and if uncomplicated, is usually harmless in its results, he would anticipate the approach of some fatal malady, so violent are the initial manifestations. There is restlessness, insomnia, depression of spirits or mental hebetude, dullness, and in some cases delirium. If there are no complications, no further involvement of organs or viscera for two or three days, the symptoms will abate as abruptly as they appeared, and within a few days more the patient, with the exception of extreme and apparently unwarrantable weakness, will have regained his health. But it is rare indeed that other organs do not become involved.

The respiratory organs are most frequently affected, and bronchial or pulmonary congestion, with bronchitis or pneumonitis, are apt to develop. Any disorder whatever developing as a complication of influenza is apt to be greatly intensified in all its phenomena—more severe and intractable than if it appeared alone. And any inflammatory disease that is complicated by the appearance of the phenomena of influenza is greatly aggravated thereby.

Acute catarrhal manifestations in the stomach and in the intestinal tract are not uncommon, becoming severe and only managed with great care and difficulty. Mucus diarrhea and vomiting may be severe, accompanied with severe erratic pain. Jaundice is present from the same cause. Inanition may follow from suspended or imperfect functional action of these organs. This becomes serious, as nervous exhaustion is also induced.

The nervous system is quickly influenced by influenza. It is estimated that 45 per cent of all the cases affect the nervous system, and immediate nervous prostration is common. Mental disorder occurs in many cases, especially of those past middle life. Neuritis, neuralgias and painful conditions of certain nerves or nerve groups are common. Paralyses and locomotor ataxia may be induced. The heart is directly influenced. There may be inflammation in any of its several forms, resulting in dilatation and consequent valvular lesions, or through impairment of the nervous centers there may be tachycardia or bradycardia, or other erratic action of an obscure character. Feeble heart action is common, and this must receive persistent attention from the first.

Kidney complications, as renal congestion, with albuminuria, acute nephritis and pyelo-nephritis frequently occur, and cystitis is not an uncommon complication.

Diagnosis:—Acute coryza is very commonly declared to be la grippe. A distinction must always be made between these cases and those typical in character, as the latter demand more care and widely different treatment. The presence of an epidemic will usually determine in favor of the malady, but endemic cases must not be overlooked. The sudden attack, the extreme headache and nasal symptoms, the violent backache and muscular pains, with sudden and rapidly increasing weakness, and finally the abrupt termination and quick restoration are all pathognomonic of influenza.

Treatment:—A common error of the laity to which the profession gives too little attention is the belief that one must not give up to this disease, but must continue about his employment actively and must fight it off by physical exercise. This is productive, in many cases, of the most dire results. It is the author's observation of many hundreds of cases that those who have the disease mildly—with a quick termination—those who recover with the least exhaustion, those who avoid complications and sequelae are those who, at once, recognizing the possible seriousness of this malady, give themselves up entirely to the treatment and cure of the disorder by the most approved and active measures, anticipating and antagonizing every indication most promptly.

The patient should immediately go to bed and remain in bed until all active symptoms have abated. He should at the very onset take a hot mustard foot bath or a Turkish bath and induce free perspiration. Hot teas with a full dose of asclepias or jaborandi will be of great service. He should cover up warmly in bed and continue a mild transpiration for some hours. While I am opposed to the use of the synthetics in general, in sthenic cases at the first appearance and recognition of the characteristic headache a dose of from five to eight grains of acetanilid, repeated perhaps once, will be of great service. The other indicated remedies must not be neglected for this. Another remedy which has been specific in many cases with me for the orbital or supra orbital pain with that characteristic distressing feeling of fulness, tightness and engorgement across the face at the root of the nose is sodium salicylate. To an adult I at once prescribe three fifteen-grain doses two hours apart. This produces a marked amelioration of the symptoms and facilitates the influence of other directly indicated remedies. In doses of perhaps five grains every two or three hours, the remedy may be continued if the severe muscular pain, soreness and aching persist. Gelsemium is a remedy of much service for the phenomena of engorgement above described if given in full physiological doses. From three to five minims of the specific medicine every hour is essential with which to control the high temperature. It reduces the irritation, both of the nerve centers and of the peripheries, and permits a relaxation—a dilatation of the capillaries—and thus at once abates the engorgement and equalizes the circulation. Another remedy for the above phenomena in many cases is salicin in from five to ten grain doses every two or three hours during the first day, and perhaps every four hours the second day. Its influence is general and its tonic properties prevent depression. It also relieves the severe muscular aching. For the fever aconite should be given in small frequently repeated doses, continued with either of the above remedies. The indications for bryonia are conspicuous in many cases. Macrotys is indicated for the muscular aching that persists after the abatement of the immediately severe symptoms. When the fever continues aconite and macrotys should be given together in small doses every hour. The complications which arise must be met promptly by the administration of the remedy that the specific indications will suggest.

Cactus is indicated for the depressed heart. Phytolacca will meet the glandular complications, which are often so stubborn and intractable. Echinacea has a wide and general influence and may be given when the patient continues very ill, with symptoms of infection of any character, or where typhoid symptoms appear. Ammonium chlorid is of great value where bronchial irritation, with deficient secretion, persists. From two to five grains may be given every two hours. The indications for euphrasia are those of acute coryza, persistent in many of the cases. This will be especially efficient in la grippe of infancy and early childhood. When this condition persists with bronchial irritation the air of the room must be kept moist. A vapor impregnated with the oil of eucalyptus, or this oil and turpentine, equal parts, is of great value. The monobromate of camphor in certain forms of nervous irritation is also of service in this disease. When the symptoms abate, the temperature falling and the skin and tongue moist, quinin should be given, two grains every three hours, on the second or third day of convalescence. Hydrastin may be combined with it, and nux vomica if feebleness is pronounced, and especially if atonicity of the stomach and anorexia persist. The strychnin arsenate, 1/67 of a grain every three hours, will be found an excellent tonic and restorative when convalescence is delayed or prolonged.

The patient must be kept in the house and in an equable temperature, with no physical exercise or exertion, until convalescence is thoroughly established. This is as imperative as the necessity for putting the patient in bed at the onset. The temperature, at first high, becomes subnormal in most cases in early convalescence, and exposure at this time would result only in relapse.


The Eclectic Practice of Medicine with especial reference to the Treatment of Disease, 1910, was written by Finley Ellingwood, M.D.



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