Synonyms.—Epidemic Catarrhal Fever; La Grippe.

Definition.—An acute infectious disease, the contagiousness of which is questionable, protean in character, but affecting more constantly the respiratory apparatus and nervous system, attended by great prostration and occurring epidemically and pandemically. Following a general epidemic it occurs sporadically for one, two, or three years.

History.—While it is very likely that the disease has existed for ages, and that the epidemic which raged among the Greek soldiers at the siege of, Syracuse, 395 B. C., was influenza, and that the epidemics of 827, 888. 896, 927, and 996 were of the same character, the authentic historical accounts date, according to Hirsh, to an epidemic which prevailed in Italy, Germany, and England during the month of December, 1173. Even this and the epidemics of 1293, 1323, and 1387 are considered unreliable by most medical writers, who date the first reliable account to the epidemic or rather pandemic of 1510, which visited Spain, Italy, Hungary, Germany, France, and England.

Since this historic date, the disease, at intervals of a few years has swept over countries with a rapidity unknown to any other affection.

Since 1655, repeated epidemics have occurred in our own country, the last (1889-90) being the greatest pandemic that ever swept the earth. Beginning in Bokhara, in Southern Russia, it crossed the great Russian Empire, spread over Germany, invaded England and France, and in less than six months had made the circuit of the globe.

Its force is irresistible, and it spares neither age, sex, nor condition. The millionaire and the pauper stand helpless before this Nemesis. Fortunately, unless severe complications arise or the treatment be too heroic, the mortality is small.

Etiology.—To what extent meteorological conditions figure as a causal agent, we are unable to state, and while damp, cold, foggy weather may present conditions that are favorable to the generation and the propagation of the poison, it is not likely that it produces the primary toxin.

In 1892, Pfeiffer, at the Hygienic Institute of Berlin, discovered in the sputum of influenza patients a bacillus which was characteristic, and which he separated and cultivated, a culture of which injected into rabbits gave rise to influenza. Kitasate and others confirm the discovery, and claim that this specific germ is not found in any other disease, and those who believe in the microbic theory consider the bacillus of Pfeiffer the causal agent.

The method of entrance into the system is most likely by way of the respiratory apparatus, and the rapidity with which it travels and the great number attacked, irrespective of contact with each other, warrants this position.

The scourge usually lasts from four to seven weeks. One attack does not render a person immune, and a second or third attack is common. The exhaustion that attends the disease renders the system susceptible to the influence of any and every toxin, and the sequelae of grip are legion.

Pathology.—There are no characteristic anatomical lesions in a case of uncomplicated influenza. Where the disease has continued for some time, the mucous membrane of the air-passages as the disease progresses this becomes more profuse, is removed with less effort, the cough is easier, and the paroxysms occur at longer intervals. With the increased secretion of the mucus, the fever subsides, all the symptoms are mitigated, and the patient enters the convalescent stage from the fifth to the eighth day.

In more severe cases a severe catarrhal bronchitis develops, with the usual attendant symptoms.

One of the most frequent and severe complications of this type is pneumonia. The cough is short and hacking, the respiration labored and oppressed, and the patient presents an anxious appearance. If the pleura be also involved, a sharp lancinating pain accompanies the cough. The sputum assumes the characteristic rusty form, the crepitant and subcrepitant rales develop, there is dullness on percussion, and the dusky hue of the face speaks of imperfect aeration of the blood, and the patient has to be propped up in bed to assist the inspiratory muscles in filling the lungs. The symptoms are so pronounced that the case can not be mistaken.

Heart-failure may occur in this type, though very rare, unless depressants, like the coal-tar products, have been used.

Gastro-Intestinal.—In some the stomach and bowels appear to receive the force of the infection, there being nausea and vomiting, together with diarrhea. This type was noticed quite frequently in 1891. The diarrhea was dysenteric in character, there being a great deal of tenesmus and pain. With this type the catarrhal symptoms were slight, and might be overlooked. Children were more affected with this form than adults.

Nervous.—This type is especially severe in persons of nervous and excitable temperaments. The headache is intense, the patient is restless and irritable, the eyes are bright, the pupils contracted, and delirium is often present. The fever is acute, the temperature being 104° or 105°. In the severer forms a meningitis develops, with the usual attendant symptoms. In all these forms the fever is remittent in character.

Sequelae.—There are few, if any, diseases that leave so large a train of chronic lesions in their path, the most prominent being chronic bronchitis. Asthma, laryngitis, and phthisis have more rarely followed. An enfeebled action of the heart persists for a long time, and angina pectoris occasionally follows.

Chronic catarrhal diarrhea is one of the results, while nephritis and cystitis occur sufficiently often to render the victim most miserable.

The most. painful sequelae, however, are of the nervous system,—migraine of a severe and intractable character; neuralgia of various parts; insomnia, that renders the patient's life a burden, and makes him grow thin and cross and irritable; melancholy, that dread affection that robs life of its pleasures, yet makes its owner dread to lay it down; and, lastly, mania, which is worse than death,—these are a few of the results which follow influenza.

Diagnosis.—The diagnosis is easily made. The sudden invasion, the catarrhal symptoms, the hard, dry cough, intense pain in head and back, and general aching of the body, the marked prostration, are characteristic, and can hardly be mistaken.

Prognosis.—The prognosis is usually favorable, though severe complications, like pneumonia, pericarditis, or nephritis, would make the prognosis problematical, as it would in delicate children and among the very aged.

Treatment.—Our school has been successful to a remarkable degree owing to the fact that the treatment has not been routine, but each phase of the disease has been met with remedies directed to control certain conditions, rather than in treating it as a whole. Specific remedies for specific conditions have certainly been successful.

If we keep in mind the important fact that grip is depressing and rapidly exhausts vitality, it will save us from serious mistakes. First, we insist most emphatically that the patient take his bed early, and remain there until the fever has disappeared. Secondly, we avoid depressants as we would a pestilence. A depressing treatment added to depressing disease has been responsible for many deaths that have been attributed to some grave complications. With the exception of a single dose of phenacetin or antikamnia in the beginning, we discard the use of all coal-tar products.

In most cases the patient aches all over, or, as he expresses it. every bone in his body aches, and the myalgia is so great that the patient is crying for relief. In these cases, where the heart action is good, one five-grain antikamnia powder or a three-grain phenacetin powder, followed by the appropriate remedy, will relieve the headache and the backache, and render the patient fairly comfortable within an hour. This is the extent of my use of the coal-tar products. One powder at the beginning of the disease, followed by the judicious use of the specific, will prevent a return of the severe pain. If the heart action is weak, however, it must not be used, though severe pain is nearly always accompanied by a full, bounding pulse.

Aconite.—If the pulse be small, give aconite five drops to water four ounces. - Teaspoonful every hour.

Veratrum.—In the adult the pulse is usually full, strong, and bounding, with flushed face, bright eyes, and contracted pupils. Such cases need veratrum fifteen to thirty drops, and gelsemium ten to twenty drops, to water four ounces. Teaspoonful every hour, until the pulse responds to the sedative and the irritation of the nervous system subsides, when we give it every two or three hours. If the patient is restless or unable to sleep, a five-grain diaphoretic powder may be given.

Bryonia.—For the cough, which early develops, and is attended by chest-pains, bryonia five to ten drops, with the appropriate sedative, will give the best results.

Macrotys.—If there is muscular soreness, rheumatic in character, or if it be about the menstrual period, macrotys will be the better remedy.

Ipecac.—Where there is intestinal irritation, give ipecac ten drops to four ounces water, a teaspoonful every hour.

Bismuth Subgallate.—Where there is but little fever, with persistent diarrhea, subgallate of bismuth five to ten grains, and one-eighth of a grain of opium, every four, five, or six hours, will be found efficient. Should complications arise, they will be treated according to the special condition present.

The heart should be carefully watched, and cactus, crataegus, digitalis, or strophanthus employed as they may be needed. These agents, however, will seldom be needed if the coal-tar products be withheld.

The diet should be light, milk in some form being preferable. The patient should not be allowed to return to his work too soon.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.